Intoxication with solvents presents with a picture similar to that of intoxication with alcohol. Behavioural changes together with signs such as nystagmus, incoordination, slurred speech may progress to lethargy, psychomotor retardation and stupor or coma. Death ('sudden sniffing death') may occur from respiratory or cardiovascular depression, acute arrythmias, hypoxia or electrolyte abnormalities. Distinguishing signs include an odour of paint or solvents, conjunctival irritation, 'glue sniffer's rash' around the mouth or nose. Signs of chronic solvent use may be present including jaundice (hepatitis), peripheral and cranial nerve neuropathies, pyramidal tract signs, and signs of chronic renal failure.