A neonate born to a mother who has abused toluene during pregnancy may develop a distal renal tubular acidosis (RTA).
Features:
(1) metabolic acidosis with low serum bicarbonate concentration
(2) hyperchloremia
(3) hypokalemia
Clues may include:
(1) maternal history of abusing volatile solvents
(2) maternal renal tubular acidosis
(3) teratogenic features in the neonate consistent with toluene effect
(4) premature delivery and/or growth retardation
(5) positive tests for drugs of abuse
(6) toluene in maternal blood or urine if toluene inhalation has been recent
Differential diagnosis: other causes of renal tubular acidosis
The distal RTA due to toluene exposure should clear in a few days.
