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Health Hazards of Solvents
James E. Cone MD, MPH
and Karen Packard, RDH, MSThis presentation is made possible by a grant from the Association
of Occupational and Environmental Clinics and the National Institute
for Occupational Safety & Health.
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Module Goals
To provide an overview of occupationalsolvent exposure
To review potential health outcomes andpublic health prevention options.
To provide step by step approach todiagnostic testing and treatment of solvent-
related diseases To provide background information on
specific solvents
To illustrate the diverse effects of solvents
through cases involving solvent toxicity
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What is a solvent?
Classes of Common Organic Solvents:
aliphatic hydrocarbons amines
cyclic hydrocarbons esters
aromatic hydrocarbons alcohols halogenated hydrocarbons ketones
aldehydes ethers
A solvent is a
liquid at roomtemperatureused to dissolveother substances
Permission to use photo requested from AIHA Lab Safety Committee
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Scope of the Problem
Over 49 milliontons of solventchemicals are
produced andused each year inthe US alone.
Often exposureinvolves a mixtureof solvents.
Permission requested from US Navy
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Occupational Disease due to Solvents?
390,000 new cases of all types ofoccupational disease appear annuallyin the US.
It is unknown how many of these casesmay be related to solvent exposure.
Similar to other occupational diseases,
95% of all occupational solvent-relateddisease cases are never reported,most are never recognized as beingoccupationally-related.
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OccupationalEnvironmental
Workplace solvents may also result inexposures to neighborhoodresidents if
discharged fromworkplaces withoutadequate controls.
Other hazards:
Fire or explosion Improper storage or disposal
Used with Permission of
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OccupationalEnvironmental
Residualperchloroethylenesolvent may be present
in freshly dry cleanedclothes
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Properties of Solvents
Solubility
Non-flammability/
Flammability/
Explosivity
Volatility
Metabolism
Complex mixtures
Used with permission of Advanced Chemistry Development Co. Graphic
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Routes of Solvent Exposure
Inhalation
Absorption
-skin
-mucous
membranes
Ingestion
InjectionJane Norling Graphic
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Organ System Effects
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BiologicalMonitoring
For Example:
Urine testing for:
Benzene Phenol
Toluene Hippuric Acid, o-Cresol
Xylene Methyl Hippuric Acid
n-Hexane 2,5 hexanedione*
-References:
ACGIH Biological Exposure Indices
* Not commercially available at this timeCorel Graphic
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Occupations Exposed to Solvents Painters
Construction workers Semiconductor workers
Machinists / auto mechanics
Manufacturing workers Glue, Paint, Chemical, Plastics
Rotogravure Printers, Metal Degreasers
Graffiti removers
Refinery workers Manicurists
Drycleaners
Many others
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Solvent Related Diseases
Acute Intoxication Chemical Headache
Chemical Hepatitis
Chronic Toxic
Encephalopathy
Hematological
Effects
Renal Effects Reproductive Health
Effects
Toxic Peripheral
Neuropathy
Bill Bowerman developed
n-Hexane related peripheral
neuropathy from glues used forrunning shoes
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Dx of Solvent-Related Disease
10 Step Process
Certain conditions shouldtrigger the thought that it
might be solvent-related:
Chemical hepatitis, peripheralneuropathy, chronic headache,
chronic cognitive impairment,
miscarriage, and asthma.
Corel Graphic
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Dx: Step 1 - Medical & Exposure
Records Prior medical records
Industrial Hygiene data Labels, Material Safety
Data Sheets (MSDS),
Chemical Inventory Lists
OSHA reports
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Dx: Step 2 - Exposure History
Symptoms &
Exposure History
Complete History &
PhysicalExamination
Specific job duties,
solvent exposures
Exposure monitoring
Frequency of acute
solvent intoxication
episodes
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Acute Solvent Intoxication -Stages
Narcosisimpaired psychomotor
function as measured by
reaction time, manual
dexterity, coordination, or
body balance
Anesthesia
Central nervoussystem depression
Respiratory arrest
Unconsciousness
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Dx: Step 3 - Medical History
Asthma
History of Blood
Dyscrasias
Hearing loss
History of PsychologicalProblems Prior to exposure
After exposure
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Dx: Step 4 - Physical Examination
Focus on:
Skin
Eyes
Gastro -
intestinal
Neurologic
system
Mental Status
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Dx: Step 5 - Laboratory Tests
Screening
Biological Indices
Pathologic
Indices
NIOSH Database of Medical Tests for OSHA
Regulated Substances:
http://www.cdc.gov/niosh/nmed/medstart.html
Corel Graphic
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Dx: Step 6 - Other Testing Nerve Conduction
Studies
Color Vision
Hearing
Pontogram (blinkreflex facial and
trigeminal nerveevaluation)
Peak flow
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Dx: Step 7 - Site Visit
Walk Through of Patients Workplace
Assess workplace
and potential exposures
Personal or area
industrial hygiene
sampling
Ventilation of worksite
Potential skin exposure
Obtain prior environmental test results, ifavailable
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Dx: Step 8 - Relationship?
Decide whether the the
patients diagnosis is
more likely than not
work-related.
Is the latency period
adequate?
Exposure data
consistent?
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Dx: Step 9 - Make the Diagnosis
Was the dose of the solvent exposure
adequate, in your opinion, to cause the
problem? (e.g., is there a history of
acute intoxication episodes?)
OR Is patient particularly sensitive to
the effects of solvents (e.g. increasedindividual susceptibility or acquired
intolerance)?
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Dx: Step 9 - Diagnosis
Rule out other diseases with similar
outcomes:
e.g., Alcoholic Hepatitis/ Hepatitis B
Decide if a pre-existing condition exists
that has been exacerbated.
File Clinicians First Report, if required
by State Law.
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Dx: Step 10 - Disposition
Return to work
Modified duty / preclusions
Factors of disability Objective/ Subjective
Vocational rehabilitation
Apportionment
Future medical care
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Prevention of Solvent Exposures
Elimination Substitution
Engineering
Controls
Administrative
Controls
Isolation
Personal ProtectiveEquipment
Education
Used with permission from
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Personal Protective Equipment
Protective Clothing-Impermeable aprons
Gloves Breakthrough
time depends on type of
glove, solvent exposureand activity.
Chemically resistant gloves: natural rubber,
butyl rubber, chloroprene, nitrile, andfluorocarbon; or various plastics: polyvinylchloride, polyvinyl alcohol, polyethylene
Permission requested from
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Personal Protective Equipment-
RespiratorsRespirator Program must
include:
Training
Cleaning
Fit testing
Medical Clearance
Change of filters scheduledepends on exposure type andamount
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Environmental pressures are
often the primary cause ofsolvent substitution.
Montreal Protocol
Clean Air Act
Pollution Prevention (P2)
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Additional Resources
Handouts
Bibliography
Web Sites
Jonathan S Rutchik, MD, MPH Organic Solventshttp://www.emedicine.com/neuro/topic285.htm
Acknowledgements:
Photos by Janet Delaney Elizabeth Katz, MPH, CIH
Rosemarie Bowler, PhD
Public Health Institute, AOEC and NIOSH staff