Anesthesia & Clinical Research
Open Access

Abstract

An Unusual Case of Intoxication: High Blood Alcohol Levels without Alcohol Ingestion

Filippo Sanfilippo, Ajay Raithatha, Mimmo Scollo and Renato Bernardini

We describe an unusual case of intentional intoxication through inhalational abuse of hairspray. On the scene,
paramedics found a haemodynamically stable but unconscious female surrounded by more than 100 cans of
hairspray. On arrival to the emergency department the patient had recovered consciousness, and was only mildly
confused. Blood samples showed severe metabolic acidosis with an increased anion gap and, deranged Urea,
Creatinine and Creatine phosphoKinase (CpK). The patient was then admitted to the high-dependency unit, while
simultaneously receiving intravenous hydration. The metabolic features improved over the next few hours, and renal
replacement therapy was not initiated. However the patient remained confused for a 24-hours period, in a
“hangover-like” state, despite the metabolic parameters returning to normal. Interestingly the toxicology screen on
admission subsequently showed high alcohol levels (206 mg/dl), despite no history of oral alcohol intake. The lady
was known to chronically abuse and inhale hairspray. The patient was discharged 4 days later with full recovery.
We explain the prolonged confusional state by the presence of relatively high alcohol levels, induced by the
inhaled hairspray. Polyanions (such as the acrylates contained in the hairspray) are well known to increase tissue
permeability, and are used as drug-carriers. In this case polyanion activity on airways mucosa favoured the
absorption of denatured alcohol, the main compound in the hairspray. Initially, the metabolism of polyanions
produces acids causing bicarbonate consumption and increased anion gap. However the short half-life of these
anions is typically associated with a fast recovery, with normal bicarbonate levels at 24-hours post-admission.