Environmental Medicine Integrating a Missing Element into Medical Education (1995) / Chapter Skim
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Case Study 46: Trichloroethylene Toxicity
Case Study 46: Trichloroethylene Toxicity
Pages 772-792
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From page 772... ...
ED TCE is a CNS depressant arid a suspected hepatotoxin in humans. EN EPA considers TCE an animal carcinogen and a potential cancer hazard to humans.
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From page 773... ...
During the initial consultation, the mother reports that they are living in an area supplied by municipal well water. They have recently received a notice f rom the mun icipal water district stating that their drinking water contains 100 parts per billion (ppb)
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From page 774... ...
Consumer products that contain TCE include typewriter correction fluids, paint removers/strippers, cosmetics, adhesivesfspot removers, and cleaning fluids for rugs. Prior to its ban for certain applications in 1977, TCE was also used as a general (mostly obstetrical)
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From page 775... ...
National Priorities List, with a maximum level of 12,300 ppt TCE in the ambient air at one New Jersey site. TCE in drinking water is a result of its rapid leaching from landfills and its discharge from industrial wastewaters.
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Sudden death has occurred in apparently healthy workers exposed to concentrations exceeding current legal workplace standards and in solvent abusers deliberately sniffing typewriter correction fluid from plastic bags or in enclosed spaces. Some of these deaths were due to asphyxia, whereas others were attributed to either ventricular fibrillation or asystole.
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From page 777... ...
) treatment could reduce the metabolism of TCE and thus increase its CNS depressant effects.
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The time between TCE inhalation and urinary excretion of trichloroethanol is relatively short (biologic half-life approximately 10 hours) compared with the urinary excretion of trichloroacetic acid (biologic half-life approximately 52 hours)
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Hepatotoxicity has been associated primarily with intentional TCE inhalation abuse. Renal failure has been reported in concert with confirmed hepatic damage.
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From page 780... ...
In a study of 50 workers employed from 1 month to 15 years in various industrial cleaning and degreasing operations using TCE, complaints due to chronic exposure included decreased appetite, sleep disturbances, ataxia, vertigo, headache, shortterm memory loss, and fewer word associations. Greater frequency of symptoms were noted in workers exposed to higher (85 ppm)
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, which led to renal failure. Another case involved a worker exposed to 99.5% TCE for 8 hours; he developed allergic interstitial nephritis with secondary tubular necrosis.
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From page 782... ...
O Evidence does not show that TCE adversely affects the human Immune system. TCE produces minimal irritation of the respiratory tract except at concentrations exceeding current workplace standards.
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From page 783... ...
An occupational history should be routinely obtained and should include items such as company name and location, job title, description of chemical processes encountered, known toxic agents used, workplace investigations, and coworker complaints. An environmental history should also be obtained, including location and duration of residence, proximity to industry, diet, daily activities, type of water supply, and use of consumer products that contain TCE.
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From page 784... ...
Since hepatic injury may occur, liver function tests should be performed. Chronic Exposure Reported necrologic effects associated with chronic workplace exposure to TCE have included nonspecific symptoms such as headache, ataxia, decreased appetite, sleep disturbances, fatigue, weakness, dizziness, memory loss, emotional instability, impaired judgment.
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From page 785... ...
Urinary metabolltes are trichloroethanol and trichloroacetic acid. Liver function tests, a serum creatinine test, and continuous cardiac monitoring should be considered for persons acutely exposed to TCE.
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Last year, the child developed additional infections despite the antibiotic regimen, and you referred her to an otolaryngologist, who performed a myringotomy and tympanostomy without incident. The mother estimates the child has had four episodes of coryza or mild influenza last year, with about 7 days of illness that merited staying home from day care.
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From page 787... ...
O Removal from the source and supportive care Is the recommended treatment for acute TCE exposure. O Symptomatic treatment Is recommended for chronic TCE exposure.
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From page 788... ...
Table 1. Standards and regulations for trichloroethylene Agency Focus Level Comments ACGIH Air-Workplace 50ppm Advisory; TWA NIOSH Air -Workplace 25 ppm Advisory; TWA: OSHA Air -Workplace 50 ppm Regulation; PEL§wer Hour workday 200,ppm Regulation; STEL9 EPA Air-Environment N/A Under review Drinking Water 5 ppb Regulation ACGIH = American Conference of Governmental Industrial Hygienists; EPA a Environmental Protection Agency; NIOSH = National Institute for Occupational Safety and Heals; OSHA Occupational Safety and Health Administration t TWA (Time-Weighted Average)
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From page 789... ...
of urine at the end of the work week reflects the upper biologic limit for TCE exposure. Urinary trichloroacetic acid levels can be increased by the same compounds that affect blood trichloroethanol levels.
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From page 790... ...
King GS, Smialek JE, Troutmen WG. Sudden death in adolescents resulting from the inhalation of typewriter correction fluid.
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From page 791... ...
(b) You will need information on TCE toxicity, including reproductive and developmental effects; information on TCE contamination of the families drinking water, including duration of contamination; copies of information provided to the family by the municipal water company; and responses, if any, from local and state health agencies.
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From page 792... ...
consists of testing induction of B lymphocyte differentiation in vitro, stimulated by pokeweed mitogen and histologic and immunofluorescent examination of biopsy specimens; T-cell surface markers; assays of T-cell helper or killer cell functions; and functional assays using appropriate target cells. It is inappropriate to perform these latter tests on environmentally exposed patients except for epidemiologic research.
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