Toluene toxicity as a cause of elevated anion gap metabolic acidosis.

Dyspnea and elevated anion gap metabolic acidosis are common presenting problems in critically ill patients. In certain cases, however, the standard workup for these problems does not reveal an etiology, and other diagnoses must be considered. We describe a woman who presented with dyspnea and severe acidemia due to a profound metabolic acidosis, who was subsequently found to have toluene toxicity secondary to inhalant abuse. This case demonstrates that when the initial workup for an elevated serum anion gap acidosis is unrevealing, alternative etiologies such as inhalant abuse should be suspected and evaluated.