Renal Tubular Acidosis Associated with Toluene Sniffing

A 25-year-old man with a history of toluene sniffing was admitted to the hospital because of tetraparesis. Laboratory examination revealed severe hypopotassemia, hyperchloremia, metabolic acidosis with a normal anion gap, elevation of serum GOT, GPT, CK, and alkaluria, and incresed urinary excretion of hippuric acid. Alkaluria despite metabolic acidosis and severely decreased serum bicarbonate were consistent with distal renal tubular acidosis. Increased urinary excretion of hippuric acid indicated exposure to toluene, and these findings were highly suggestive of toluene-induced renal tubular acidosis. He gradually recovered with abstinense from toluene sniffing and oral supplement with potassium and bicarbonate.