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Journal Article 
Danger vapor harmful: spot-remover sniffing 
Litt, IF; Cohen, MI 
New England Journal of Medicine
ISSN: 0028-4793
EISSN: 1533-4406 
HAPAB Carbona, a popular spot-remover whose main components are trichloroethylene and 1,1,1-trichloroethane, is clearly labeled with a warning of its hazard to health but it has become popular among adolescents as a method of getting =high=. The present paper is to alert physicians to the dangers inherent in this habit and reports indications that these compounds in the spot-remover do have the potential for serious hepatic and renal toxicity when sniffed by adolescents. Clinical observations on ten teenagers, 12 to 16 years old, who were found to have sniffed Carbona are reported. Five had abnormal liver function as shown by bilirubin, SGOT, alkaline phosphatase, prothrombin time and thymol turbidity findings. Of these five, four became jaundiced within 1 week of sniffing the spot-remover. All five experienced nausea immediately after inhalation and had been diagnosed as suffering from gastroenteritis. Only one of the patients without heptotoxicity experienced nausea. One patient developed hepatic coma. Of two found with proteinuria, one developed acute renal failure which required hemodialysis. All the patients survived. Their various medical histories included glue sniffing, heroin, peptic ulcer, and a G- 6-PD deficiency with secondary hemolytic crisis. Five of the patients without chemical, renal or hepatic function abnormalities were seen from 2 weeks to 1 year after the sniffing episode and it is possible that minor chemical abnormalities had existed but even the severe documented findings in teh cases were transient. Sniffing of Carbona or similar products must now be considered in the differential diagnosis of gastroenteritis, hepatitis and acute renal failure among the adolescent population. EPIDEMILOGY AND TREATMENT 70/01/00, 20 1969