Environmental Medicine Integrating a Missing Element into Medical Education (1995) / Chapter Skim
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Case Study 42: Toluene Toxicity
Case Study 42: Toluene Toxicity
Pages 727-743
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From page 727... ...
Gasoline contains 5% to 7% toluen e by weight, making toluene a common airbonze contaminant in industrialized countnes. Many organic solvents have great addictive potential; toluene is the most commonly abused hydrocarbon solvent, primarily through "clue sniff no.
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Vital signs include blood pressure 116/80, heart rate 90/minute at rest, respiratory rate 22/minute, and temperature 98.8 F There are no orthostatic changes in pulse or blood pressure.
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Water contamination occurs because toluene is a common chemical in hazardous waste and sludge disposal sites, industrial effluents, and petroleum wastes. Nonetheless, drinking water levels of toluene are usually low relative to those of other volatile organic chemicals.
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In general, solvent abuse tends to decrease with increasing age, but adults of both sexes are known to abuse organic solvents. O Chronic, intentional toluene abuse may lead to serious adverse effects and death.
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She has not been employed in any position entailing chemical exposure since the toluene diisocyanate exposure 2 years ago, but she has noticed mild, transient chest tightness and difficulty breathing when using self-service gasoline filling stations and when exposed to tobacco smoke. (2J Could the patient's current problem be related to the spray paint?
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From page 732... ...
Cha~en,gi (3J Is there any clinical benefit in measuring blood toluene levels or levels of urinary toluene metabolites in this patient?
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Chronically exposed workers have scored lower on some tests of cognitive performance than unexposed controls. Several studies have examined the neuropsychiairic effects of acute exposure to toluene vapors.
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From page 734... ...
Children chronically exposed in utero from high-dose maternal solvent abuse throughout pregnancy have demonstrated microcephaly, CNS dysfunction, attention deficits and hyperactivity, developmental delay, minor craniofacial and limb anomalies, and variable growth deficiency. Severe neonatal acidosis has also been noted, possibly secondary to maternal renal-tubular acidosis.
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From page 735... ...
(5) Should the patient be concerned about future development of cancer from the spray paint exposure?
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From page 736... ...
Because many products containing toluene are mixtures, attempts should be made to ascertain the total composition. Proximity of residence to landfills and industrial facilities and the source of drinking water may provide clues to environmental exposures.
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From page 737... ...
Repeated high-dose exposures associated with solvent abuse may result in progressive memory loss, fatigue, poor concentration, irritability, persistent headaches, and signs and symptoms of cerebellar dysfunction. Although these effects generally are reversible if exposure ceases, some patients remain substantially impaired.
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From page 738... ...
Environmental conditions that may have led to unintentional exposures should be corrected. Chronic Exposure There is no specific clinical treatment for patients who have been chronically exposed to toluene.
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From page 739... ...
Approximately 10 states have drinking water standards or guidelines for toluene ranging from 0.1 to 2 ppm.
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are reference values established by ACGIH that are intended as guidelines for evaluating potential exposure hazards in the workplace. The BEI for the urinary metabolite of toluene (hippuric acid)
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From page 741... ...
White matter dementia in chronic toluene abuse. Neurology 1990,40:5324.
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From page 742... ...
The diagnostic criteria for RADS include the following: · no history of respiratory system complaints · a single, specific exposure in an accident or incident involving high concentrations of an irritant fume, gas, or vapor that was associated with the initial symptoms · symptoms onset occurred within 24 hours of the initial exposure and persisted for at least 3 months · pulmonary function tests usually indicate airflow obstruction challenge testing is positive · other types of pulmonary disease have been ruled out (c) Toluene has caused fetal malformations in chronically exposed experimental animals.
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From page 743... ...
(3) There is little clinical benefit in measuring blood toluene levels or levels of toluene metabolites such as hippuric acid in the urine.
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