CURRICULUM FOR THE HEALTH SCIENCES IN SOUTH EASTERN EUROPE
Number (unit, topic): U4-T4
Review – Status: D
ECTS (suggested):
Title
Occupational Poisoning with Organic Solvents
Author(s), degree,
institution(s)
Asst. Prof. Bela Prokes, MD, PhD
specialist in occupational medicine
Department of Occupational Medicine,
Medical Faculty Novi Sad
Asst. Prof. Bela Prokes, MD, PhD
Address for
correspondence
Keywords
Learning objectives
Department of Occupational Medicine,
Medical Faculty Novi Sad
Futoska 121
Novi Sad
Tel +381 21 614-277, 613-998, fax 624-128
E-mail zzzrns@eunet.yu
Poisoning, Organic solvents, Benzene, Chlorinated
Hydrocarbons, Tetrachlorethane, Aliphatic Hydrocarbons,
Benzine, Petroleum, Carbon Disulphide, Nitro derivates,
Nitrobenzene, Trinitrotholuene, Amino derivates, Aniline.
It is expected that students and future public health
professionals become familiar with environmental health
risk assessment. This include competence in health risk
characterization and evaluation as a member of a team as
well as a competence in a risk managment.
Synopsis (Abstract)
This topic covers:
Teaching methods
Transparency presentation, Orall lecture, Distribution of the
literature to small group of students, Diskusion about target
themas, Presentation of clinical entitys
Specific
recommendations
for teacher
Assessment of students
Practical work on intoxication diagnosis and work capabillity
evaluation; Orall exam
Occupational Poisoning with Organic Solvents
Bela Prokeš, MD, PhD, specialist in occupational medicine
Department of Occupational Medicine, Medical Faculty Novi Sad
ORGANIC SOLVENTS – Main charactheristics
Classification according to Simonen:
1. Aromatic hydrocarbons
2. Hydrocarbon halogen derivatives
3. Aliphafle hydrocarbons
4. Alcohols
5. Ethers
6. Esters
7. Aldehydes
8. Ketones
9. Carbon disulphide
10.Policyclic hydrocarbons
CHARACTERISTICS:
-
Easy evaporation
Fat solvents
Unchangeable in reaction with water, alkalis
Must NOT have chemical reaction with matters they dissolve
APPLICATION:
-
Manufacture of varnishes
Colours
Anticorosive mixtures
Rubber, artificial leather, industrial viscose products, textile md.
Paper, wood industry
Oil, fat extraction
Fat-removal from metal parts
Dry-cleaning of textiles
Chemical and pharmaceutical industry
PENETRATION
Main path's
1. Inhalatory
2. Gastrointestinal
3. Skin and mucous membrane
ELIMINATION
Main path's
1. Lungs – mainly unchanged
2. Gastrointestinal – feces – fat soluble unchanged chemicals and
methabolites
3. Kidney's – urine – water soluble unchanged chemicals and methabolites
4. Lacrimes, Sweat, Milk
CLASSIFICATION ACCORDING TO TOXIC EFFECT:
1.
2.
3.
4.
Narcotic effect (benzine, ethers, acetone)
Neurotoxic effect (CS 2 , methyl alcohol, THE)
Effect to hematopoiesis (bensol, toluol, TNT)
Effect to liver, kidneys (halog. derivatives glycols)
FIRE AND EXPLOSION DANGER
PREVENTION (MEASURES OF PROTECTION)
AROMATIC HYDROCARBONS
BENZENE
BENZENE HOMOLOGUES
BENZENE CONDENSES
DERIVATIVES OF BENZENE, HOMOLOGUES AND
CONDENSES
BENZENE (C 6 H 6 ):
CHARACTERISTICS: colourless liquid with characteristic odour.
APPLICATION:
-Chemical reagent (for organic synthesis, manufacture of
styrene, detergents, pesticides, perfumes, explosives,
fertilisers, pharmac. products).
-Fuel (Since 1950 antidetonator was added to fuel in USA)
-Solvent (Industry of plastic and artif. fibbers, colours,
varnishes, rubber, caoutchouc, for oil and fat extraction,
in manufacture of photographs, minors, in medicine).
WAY OF ENTRANCE:
Main path's
1. Inhalatory
2. Gastrointestinal
3. Skin and mucous membrane
ELIMINATION
-Unchanged
-Oxidation in blood as well as oxidative product through kidneys
-Storage (CNS, liver, endok.syst., bone marrow)
-In liver - phenol, triphenol, catehol, hydrochinol, in conjugation
with H 2 SO 4 and glucuronic acid are developed organic sulphates
and glucuronates.
-Pathophysiological mechanism of effect:
-Hipoxia (without O 2 )
-Decreased ascorbic acid synthesis, C hypo-vitaminosis
-Disturbance of oxidoreductive processes
-Radiomimethic effects (DNA, RNA inhibition),
cytostatic effect.
-Chromosomal aberrations
-Leukemogenic effect
POISONING
ACUTE
CHRONIC
-Neurotrophism
-Prenarcotic
-Cater syndrome
-Chemopathiae
-Hyperplasia (leucosis)
-Hypoplasia
-Skin
-General symptoms
Narcosis (Epil.spasms
spasm. paralysis)
Coma (tox. encephal.
acute, psychosis)
COMPLICATIONS:
RBC + WBC + PLT
Benzene leucosis
= PANMYELOPHTISIS
ESTIMATION OF WORK ABILITY
Depending on poisoning severity
THERAPY - SYMPTOMATIC
CHLORINATED HYDROCARBONS:
are developed in all three physical conditions
-CL and F are less toxic than Br and J.
-Unsaturated are less toxic than saturated
-If H atom is replaced within aromatic hydrocarbon, less toxic
compound is developed and with aliphatic is inversely.
APPLICATION:
solvents, fire-exthiguishing appliances, cooling, fat-extraction, drycleaning, pesticides, chemical and pharmaceutics industry, medicine anaesthetics, colour and varnish industry
WAY OF ENTRANCE:
as before mentioned
EFFECT:
SPECIFIC
-Neurotoxic
-Hepatotoxic
-Nephrotoxic
NON-SPECIFIC
-Irritable
-Narcotic
VINYLCHLORIDE (CH 2 =CHCl):
CHARACTERISTIC: Colourless gass with sligtly sweet odour
APPLICATION: plastic mass
WAY OF ENTRANCE:
as before mentioned
ELIMINATION:
-Unchanged
-Metabolites: Carboxymethyl cistein, Thiodiglycol acid
TOXICITY:
Astnovegetative symptoms
Acroosteolysis
Changes on lungs
Changes in blood
Liver angiosarcom
Cancer - other localities
TETHRACHLORETANE:
CHARACTERISTIC: Non-inflammable liquid, THE MOST TOXIC
APPLICATION: Tetrachloride ethylene, trichlorine ethylene, fat and oil
solvent, in manufacture of organic matters, bitumen, tar
WAY OF ENTRANCE:
as before mentioned
- TOXICITY:
Acute: Narcotic effect, General sympthoms of CNS, liver, heart,
kidneys
Chronic: Effect to CNS (tox. encephalopathy), gastrointestinal, liver
ALIPHATIC HYDROCARBONS
BENZINE:
- Structure – hydrocarbon mixture
- Application: fuel, solvent, in rubber industty, in colour and
varnish industiy, oil extraction from seed
WAY OF ENTRANCE:
as before mentioned
TOXICITY: Narcotic (CNS)
POISONING:
ACUTE
1. Slight : headache, irritation of eyes and respiratory system,
irritability (hypotonia, bradicardia, hypothermia)
2. Hard: tremor, enlarged liver, proteinuria, comatose, hallucination,
amnesia.
CHRONIC
General symptoms, depression, tremor, irritation of eyes, respiratory
system and skin.
FIRST AID:
-O 2
-Artificial respiration
-Sedatives
-Cardiotonie
-Vitaminotherapy
ESTIMATION OF WORK ABILITY:
Depending on poisoning severity
PREVENTION
PETROLEUM
Toxicology:
Acute poisoning:
The same as H 2 S poisoning - if there is Sulphur in petroleum, and
benzine poisoning
Chronic:
Astenovegetative syndrome, irritation of eyes, skin and respiratoiy
system.
CARBON DISULPHIDE (CS 2 )
CHARACTERISTIC: colourless liquid, with ether-like odour
APPLICATION: Manufacture of viscose fibbers, cellophane, optical glass,
glue, in chemical industry, solvent, pesticide etc.
WAY OF ENTRANCE:
Main path is inhalatory way
ELIMINATION:
- Unchanged - through lungs
- Through urine
- Through excrement - non-organic sulphates through milk
POISONING:
ACUTE
Slight: intoxication, headache, dizziness, exhaustion, paresthesies.
Medium: narcotic effect, euphoria, irrational laughter, dizziness,
headache, ataxia, hallucination, delirium
Hard: loss of consciousness, tox. coma
COMPLICATIONS: Ecephalom.and mental disorder
CHRONIC
Neurasthenia, weakness, fatigue, loss of appetite, vegetative lability,
perspiration, dermographia, palm hyperhidr., weakened sensibility.
Hard form:
-Damage of nervous system
-Encephalopathy
-Encephaloneuritis
-Damage of peripheral nervous system - Polyneuritis
-Hard sensibility disorder up to anaesthesia,
weakened tendinous reflexes
-Extreme vegetative symptoms
-Damage of endocr. system (adrenal gland,
thyreoidea, testis)
-Vascular disorders - arteriosclerosis, most
frequently on cerebral and renal blood vessels
TREATMENT:
Symptomatic
ESTIMATION OF WORK ABILITY:
PREVENTION
AMINO AND NITRO COMPOUNDS OF AROMATIC COLUMN
APPEAR by replacement of one or more H atoms in benzol’s ring or in
homologue of amino - NH 2 or nitro - NO, group.
APPLICATION: Colour industiy, explosives, pharmac. industry, perfume
industry, rubber, soap, shoe polish, in synthesis of pesticides, plastic mass
etc.
WAY OF ENTRANCE:
1. Inhalatory
2. Skin and mucous membrane
3. Gastrointestinal (rare)
ELIMINATION:
Unchanged through lungs
Through urine in compound with H 2 SO 4 or glucuron acid.
POISONING:
-Irritable effect (skin, mucous membrane, respirat., gastroint. and
urin. system).
-Hematopoiesis damage
-Parenh. organs (liver, kidneys)
-CNS
ETIOLOGY:
-Direct toxic effect of none or metabolites
-Hypoxia (met. and/or sulph. Hb)
MET- Hb
Normally: 1%
Conditioned by enzymatic system of met Hb-reductases which require
DPNH and TPNH as co-enzymes, and non-enzymatic -glutation
SULPH - Hb
Fe loses capacity of connection with O 2 but not CO. Met and Sulph Hb
result in cyanosis. Cyanosis appears when 5 gr. Hb is reduced at 100 ml of
blood. Death appears when 66 % of Hb is transformed in Met Hb.
Within blood are present:
-Heinz’s bodies
-Hemolysis
-Hypoplasia, aplasia (marrow)
-Damage of liver
-Damage of kidneys
-CNS (palidostrial syst. n.opticus)
NITRO DERIVATIVES
NITROBENZENE
CHARACTERISTICS: Yellow liquid with flavour of bitter almond.
APPLICATION: paints, explosives, soap industry.
WAY OF ENTRANCE
ELIMINATION
POISONING
Acute
-Irritable symptoms
-Damage of CNS with paresthesias. epyleptiform. convulsions
---- Coma, death as a result of breath paralysis
-Damage of liver
Chronic
-Irritation (skin, respiratory and digestive system)
-MetHb
-Damage of liver and CNS
TREATMENT:
-Take out poisoned person
-Skin decontamination
-Oxygen therapy
-Treatment of Met Hb with ascorbic acid methylene blue
-Transfusion
-Hepatoprotective therapy
TRINITROTOLUENE (TNT)
CHARACTERISTICS: colourless or slightly yellow powder (crystals)
APPLICATION: explosives
WAY OF ENTRANCE: the most important -
respiratory,
skin,
digestive
ELIMINATION: urine
POISONING:
-Irritable (orange coloured skin, resp.,digest.)
-Met Hb and Sulph. Hb
-Hemolysis
-Hypoplas and aplasia of bone marrow
-Hepatocyte necrosis
-Toxic nephrosis
AMINO DERIVATIVES
ANILINE
CHARACTERISTICS: colourless oily liquid, characteristic smell, water
insoluble
APPLICATION: paint industry, explosive,
industiy, rubber and pesticide industry.
perfume,
pharmaceutical
WAY OF ENTRANCE: respiratory,
skin,
ELIMINATION: In human body it is oxidised in phenyl hydroxilamme and
this in pam aminophenol which is conjugated with H 2 S0 4. glucuronic acid
and is eliminated with urine.
PATHOGENESIS: Effect of noxa itself is minimal it is effect of
metabolism.
CAUSES:
-BPE
-Hemolysis
-MetHb
-Heinz bodies
POISONING:
ACUTE: euphoria, loss of consciousness, dizziness, headache,
weakness, sight disorder, skin and mucous membrane lividity, cyanosis,
dark urine.
CHRONIC: weakness, atonia, anaemia, BPE
REFERENCES:
1. Mikov M, ed Medicina rada. Beograd: Naučna knjiga, 1991 Vidaković
A, ed. Medicina rada. Beograd: Medicinski fakultet, 1996
2. Rosenstock L, Cullen M. ed: Textbook of Clinical Occupational and
Environmental medicine. W.B. Saunders Company, Philadelphia, 1994.
3. Stacey N. ed Occupational Toxicology. Taylor&Francis, London 1995.