Aim and background: Commonly found in glues, paints, varnishes and industrial solvents, toluene is a widely abused drug due to its acute neurologic effects including euphoria and subsequent depression. However, its abuse is also associated with dangerous electrolyte and metabolic abnormalities, rhabdomyolysis, acute kidney injury (AKI) and cardiac abnormalities. Case description: A young lady, chronic inhalational abuser of toluene, presented to our hospital with acute intoxication secondary to ingestion of whitener solution in an unconscious state. She was found to have severe acidemia and hypokalemia, progressing to acute kidney injury (AKI). The patient was admitted in ICU for mechanical ventilation, and correction of electrolyte and metabolic abnormalities. Thereafter, she made a complete recovery and was successfully discharged. Conclusion: The hallmark of toluene intoxication is a normal anion gap hyperchloremic metabolic acidosis with severe hypokalemia or distal renal tubular acidosis (RTA) type 1. Patients may also develop AKI, rhabdomyolysis and cardiac abnormalities (arrhythmias and ST-T segment changes due to severe hypokalemia), but rarely respiratory depression. Management involves adequate resuscitation, intensive care admission and aggressive correction of acid base and electrolyte abnormalities, as there is no specific antidote. Clinical significance: Early recognition and management of clinical features and complications like AKI and arrythmias is of utmost importance in patients with toluene intoxication.