Abstract
A 32-year-old male had been inhaling thinner for over 5 days and was transmitted to our institution due to loss of consciousness. He was in shock and showed an increase in anion gap, severe metabolic acidosis, renal dysfunction, and a high level of serum hippuric acid (177ml·dl-1) on admission. Thinner mainly consists of toluene that metabolizes to hippuric acid. We performed continuous hemodiafiltration on the patient to eliminate hippuric acid, a metabolite of toluene as his serum level of hippuric acid increased gradually up to 210ml·dl-1. It was reduced to 2ml·dl-1 following continuous hemodiafiltration. There is no special treatment for toluene poisoning that will show improvement only through fluid infusion in patients with normal renal function. However, in patients with poor renal function, an accumulation of hippuric acid may not only further metabolic acidosis, but also further damage renal function.
The case presented suggests that the induction of continuous hemodiafiltration for patients who present with acute thinner poisoning complicated by acute renal dysfunction is effective in the removal of accumulated hippuric acid, lowering extended metabolic acidosis and in ultimate recovery from deteriorated renal function.
