Fatal accidental inhalation of brake cleaner aerosols.

Brake cleaner liquid is commonly used for cleaning of engines and motor parts. The commercially available products usually contain mainly volatile organic compounds. As a consequence brake cleaner evaporates fast and almost completely from the cleaned surface. This case report presents a fatal accidental inhalation of brake cleaner liquid aerosols due to the attempted cleaning of a boat engine. A 16year old boy was found lifeless in the engine compartment of a boat engine. In close proximity to the body, the police found cleanings wipes soaked with brake cleaner as well as a pump spray bottle filled with brake cleaner. Essentially the autopsy revealed a cerebral oedema with encephalomalacia, no coagulated blood as well as increased blood and tissue fluid content of the lung. Toxicological analysis revealed brake cleaner fluid in the lung, gastric content and heart blood.

Rhabdomyolysis with acute tubular necrosis following occupational inhalation of thinners.

Thinners are mixtures of organic solvents commonly containing toluene, xylene, acetone, hexane, benzene and methyl isobutyl ketone. This report describes a case of rhabdomyolysis with acute tubular necrosis and renal failure, most likely attributable to toluene, following occupational exposure to thinners while cleaning a steel water tank. These adverse health effects have previously been reported following acute poisoning or intentional inhalation by drug abusers, but rarely in the occupational setting. Poor working conditions, lack of health and safety training and delayed treatment contributed to the onset and severity of the patient's complications. This case emphasizes the need for strict control measures, including adequate ventilation, training on working in confined spaces, appropriate personal protective equipment and emergency rescue procedures in such settings. In addition, rhabdomyolysis, acute tubular necrosis and renal failure should be added to safety data material as possible complications of excessive inhalation of thinners.

Fatal acute poisonings in Australian children (2003-13).

BACKGROUND AND AIMS: Fatal poisonings in children comprise a small proportion of cases investigated by an Australian coroner; however, they present a major opportunity for death prevention. This study aimed to examine fatal child poisonings in Australia to (1) estimate the rate of acute poisoning deaths in children; (2) describe the key characteristics of the cohort; and (3) describe the outcomes of coronial recommendations made as a death prevention measure. DESIGN: Retrospective case series. SETTING: The National Coronial Information System (NCIS), a database of cases reported to an Australian coroner. PARTICIPANTS: Ninety poisoning deaths reported to an Australian coroner between January 2003 and December 2013 involving children (≤ 16 years of age). MEASURES: Logistic regression, Pearson's correlation coefficient and descriptive statistics were used to examine the significance of associations. The primary outcome measures were poisoning type and cause of death. Covariates included age and mental illness. FINDINGS: There were marginally more males (52.2%) [confidence interval (CI) = 44.4-45.6] in the cohort and most occurred in the 13-16-year age group (58.9%) (CI = 7.5-12.5). Deaths were typically unintentional (61.1%) (CI = 17.9-27.1) and occurred in the home (68.9%) (CI = 6.8-15.7). The most common form of poisoning was due to opioids (24.4%), followed by carbon monoxide (20%) and volatile substances (18.9%) (CI = 18.5-19.6). Males had slightly higher odds of dying from prescription opioids compared with females [odds ratio (OR) = 1.9, CI = 0.7-5.1], but this was not statistically significant. A recommendation was made by a coroner in 12 cases, 10 of which related to poisons (including drugs). Of these, eight recommendations were implemented. CONCLUSIONS: In Australia between 2003 and 2013 there were on average eight acute poisoning deaths in children each year, most commonly involving prescription opioids and adolescents. There has been a downward trend in mortality since 2003. These cases generated more than twice as many recommendations for public safety compared with other Australian coroners' cases.

Scintigraphic evaluation of renal functional damage in volatile substance abusers.

OBJECTIVE: Volatile organic compounds can be maintained easily and can cause dependency. Volatile substance abuse may cause damage by affecting several systems. The aim of our study was to evaluate renal functional damage in volatile substance abusers by diuretic renogram. METHODS: Twenty nine volatile substance abusers and 30 young healthy voluntary young men were included in our study. Technetium-99m mertiatide diuretic renogram was used to evaluate renal functions and collective system urodynamics to investigate the progress of renal functional damage. Images were evaluated visually and quantitatively. Split renal function of each kidney, time to peak activity (Tmax), and half-time for radiopharmaceutical clearance from pelvicalyceal system (T1/2), ratio of cortical and whole-kidney counts at 20-3 min, and maximum counts (T20/3 and T20/max) were compared in the two groups. RESULTS: In the study group, time to reach peak activity was statistically prolonged compared with the healthy volunteers. In the volatile substance abuser group, the average Tmax values, average T1/2 values, cortical and whole-kidney T20/3, and T20/max values were found to be prolonged compared with the control group in the diuretic renogram. There was no significant difference in the split renal function ratios between the two groups. CONCLUSION: In this study, possible renal functional damage was evaluated in volatile substance abusers by diuretic renogram. In conclusion, diuretic renogram can be useful in the evaluation of renal functional damage before blood renal function tests are affected and it could be used in the follow-up of the disease in volatile substance abusers. The results of this pilot study from our country, of course, should be supported by further clinical studies.

An autopsy case of fatal repellent air freshener poisoning.

We describe a first fatal case of repellent air freshener ingestion. A 79-year-old Japanese man with Alzheimer-type senile dementia orally ingested repellent air freshener containing three surfactants: polyoxyethylene 9-lauryl ether, polyoxyethylene (40) hydrogenated castor oil, and lauric acid amidopropyl amine oxide (weight ratio of 1.3%). About 1h after the collapse, he was in cardiopulmonary arrest and subsequently died 10h after his arrival. The forensic autopsy performed 5.5h after death revealed the 380ml of stomach contents with a strong mint perfume identical to that of the repellent air freshener and the findings of acute death. Toxicologically, 9.1µg/ml and 558.2µg/ml of polyoxyethylene 9-lauryl ether were detected from the serum and stomach contents taken at autopsy. Generally, ingestion of anionic or non-ionic surfactants have been considered as safe. However, because the patient suffered from cardiac insufficiency with a low dose of repellent air freshener ingestion, medical staff members must evaluate the elderly patient for cardiac and circulatory problems regardless of the ingested dose. Not only medical and nursing staff members, but also families who are obliged to care for elderly persons must be vigilant to prevent accidental ingestion of toxic substances generally used in the household.

Volatile substance misuse deaths in Washington State, 2003-2012.

BACKGROUND: Volatile substance misuse (VSM - also known as huffing or sniffing) causes some deaths, but because there are no specific cause-of-death codes for VSM, these deaths are rarely tabulated. OBJECTIVES: Count and describe VSM deaths occurring in Washington State during 2003-2012. METHODS: We used the textual cause-of-death information on death certificates to count VSM-associated deaths that occurred in Washington State during 2003-2012. We extracted records that contained words suggesting either a method of inhalation or a substance commonly used for VSM, and reviewed those records to identify deaths on which the inhalation of a volatile substance was mentioned. We conducted a descriptive analysis of those deaths. RESULTS: Fifty-six deaths involving VSM occurred in Washington State during 2003-2012. VSM deaths occurred primarily among adults age 20 and over (91%), males (88%), and whites (93%). Twelve different chemicals were associated with deaths, but 1 of them, difluoroethane, was named on 30 death certificates (54%), and its involvement increased during the study period. Gas duster products were named as the source of difluoroethane for 12 deaths; no source was named for the other 18 difluoroethane deaths. CONCLUSIONS: Most VSM deaths occurred among white male adults, and gas duster products containing difluoroethane were the primary source of inhalants. Approaches to deter VSM, such as the addition of bitterants to gas dusters, should be explored.

A longitudinal study of aldehydes and volatile organic compounds associated with subjective symptoms related to sick building syndrome in new dwellings in Japan.

To determine whether indoor chemicals act as possible environmental risk factors responsible for sick building syndrome (SBS)-related symptoms in new houses (<6 years old) in Japan, we studied 871 people living in 260 single-family houses in 2004 and 2005. We measured the indoor concentrations of aldehydes and volatile organic compounds and longitudinal changes in the living rooms over two consecutive years. Participants answered standardized questionnaires on SBS symptoms and lifestyle habits. Approximately 14% and 12% of subjects were identified as having SBS in the first and second year, respectively. According to analysis adjusted for sex, age, smoking, and allergic diseases, increases in aldehydes and aliphatic hydrocarbons contributed to the occurrence of SBS. Elevated levels of indoor aldehydes and aliphatic hydrocarbons increased the possible risk of SBS in residents living in new houses, indicating that source controls against indoor chemicals are needed to counter SBS.

Two serious and challenging medical complications associated with volatile substance misuse: sudden sniffing death and fetal solvent syndrome.

Volatile substance misuse is a prevalent and often overlooked behavior among adolescents, including reported use among young pregnant women. Several medical repercussions can arise from the improper use of volatile substances, yet they are often underappreciated among scientists and health professionals. This brief review reports on the recent advances made in the preclinical and clinical data about two serious medical complications surrounding volatile substance misuse: sudden sniffing death and fetal solvent syndrome. Suggestions for treatment interventions are discussed. The paper's limitations are noted.

Meeting professionals' needs in the United Kingdom for effective VSM intervention.

An exploratory study examined what professionals needed to support their responses to volatile substance misuse (VSM). Many respondents saw VSM as a problem of unknown dimensions and were uncertain about how to tackle it. Resources for treatment and prevention were seen as outdated. Workers were concerned that VSM was becoming more common among adults, supporting an indication found in a study of VSM-related deaths. Evidence-informed treatment protocols, information on working with clients, assessments of local needs, and the evaluation of existing approaches to VSM would improve the response. A further phase of the research will be reported in 2012.

Quantitative assessments of indoor air pollution and respiratory health in a population-based sample of French dwellings.

BACKGROUND: Various volatile organic compounds (VOCs) have been related to respiratory health effects, but have generally been assessed individually without taking into account the fact that such pollutants are highly correlated to one other. AIMS: We investigated the effects of exposure to various VOC, and considered their combined effect on adult asthma and rhinitis. METHOD: A national cross-sectional representative survey conducted by the Indoor Air Quality Observatory objectively assessed 20 VOCs in 490 main dwellings in France. A standardized questionnaire determined the prevalence of asthma and rhinitis among 1012 inhabitants of the dwellings (≥ 15 years). Marginal models for binary outcome were used to relate VOCs exposure to asthma and rhinitis, controlling for potential confounders. A global score representing the number of VOCs in each dwelling with an elevated concentration (using the 3(rd) quartile value of the distribution as a threshold value) was then derived as a measure of the combined effect of VOCs. Specific scores were built using a similar approach, grouping VOCs by family. RESULTS: Asthma (8.6%) was significantly associated with N-undecane and 1,2,4-trimethylbenzene and rhinitis (38.3%) with ethylbenzene, trichloroethylene, m/p- and o-xylene. The global VOC score was associated with a significant risk of asthma and rhinitis (odds ratio (OR) of 1.40 and 1.22, respectively, for 5 additional VOCs with high exposure level). Both specific scores for aromatic hydrocarbons and aliphatic hydrocarbons were associated with a significantly risk of asthma (OR=1.12; 95% confidence interval (CI): 1.01-1.24 and OR=1.41; 95% CI=1.03-1.93, respectively). The specific VOC score for halogenated hydrocarbons was associated with a significant risk of rhinitis (OR=1.28; 95% CI: 1.07-1.54). CONCLUSION: We have shown that high concentrations of VOCs in homes were associated with an increasing prevalence of asthma and rhinitis in adults.

Quantitative assessment of airborne exposures generated during common cleaning tasks: a pilot study.

BACKGROUND: A growing body of epidemiologic evidence suggests an association between exposure to cleaning products with asthma and other respiratory disorders. Thus far, these studies have conducted only limited quantitative exposure assessments. Exposures from cleaning products are difficult to measure because they are complex mixtures of chemicals with a range of physicochemical properties, thus requiring multiple measurement techniques. We conducted a pilot exposure assessment study to identify methods for assessing short term, task-based airborne exposures and to quantitatively evaluate airborne exposures associated with cleaning tasks simulated under controlled work environment conditions. METHODS: Sink, mirror, and toilet bowl cleaning tasks were simulated in a large ventilated bathroom and a small unventilated bathroom using a general purpose, a glass, and a bathroom cleaner. All tasks were performed for 10 minutes. Airborne total volatile organic compounds (TVOC) generated during the tasks were measured using a direct reading instrument (DRI) with a photo ionization detector. Volatile organic ingredients of the cleaning mixtures were assessed utilizing an integrated sampling and analytic method, EPA TO-17. Ammonia air concentrations were also measured with an electrochemical sensor embedded in the DRI. RESULTS: Average TVOC concentrations calculated for 10 minute tasks ranged 0.02 - 6.49 ppm and the highest peak concentrations observed ranged 0.14-11 ppm. TVOC time concentration profiles indicated that exposures above background level remained present for about 20 minutes after cessation of the tasks. Among several targeted VOC compounds from cleaning mixtures, only 2-BE was detectable with the EPA method. The ten minute average 2- BE concentrations ranged 0.30 -21 ppm between tasks. The DRI underestimated 2-BE exposures compared to the results from the integrated method. The highest concentration of ammonia of 2.8 ppm occurred during mirror cleaning. CONCLUSIONS: Our results indicate that airborne exposures from short-term cleaning tasks can remain in the air even after tasks' cessation, suggesting potential exposures to anyone entering the room shortly after cleaning. Additionally, 2-BE concentrations from cleaning could approach occupational exposure limits and warrant further investigation. Measurement methods applied in this study can be useful for workplace assessment of airborne exposures during cleaning, if the limitations identified here are addressed.

Low-level hydrogen sulfide and central nervous system dysfunction.

Forty-nine adults living in Lovington, Tatum, and Artesia, the sour gas/oil sector of Southeastern New Mexico, were tested for neurobehavioral impairment. Contributing hydrogen sulfide were (1) an anaerobic sewage plant; (2) two oil refineries; (3) natural gas/oil wells and (4) a cheese-manufacturing plant and its waste lagoons. Comparisons were to unexposed Wickenburg, Arizona, adults. Neurobehavioral functions were measured in 26 Lovington adults including 23 people from Tatum and Artesia, New Mexico, and 42 unexposed Arizona people. Participants completed questionnaires including chemical exposures, symptom frequencies and the Profile of Mood States. Measurements included balance, reaction time, color discrimination, blink reflex, visual fields, grip strength, hearing, vibration, problem solving, verbal recall, long-term memory, peg placement, trail making and fingertip number writing errors (FTNWE). Average numbers of abnormalities and test scores were adjusted for age, gender, educational level, height and weight, expressed as percent predicted (% pred) and compared by analysis of variance (ANOVA). Ages and educational attainment of the three groups were not statistically significantly different (ssd). Mean values of Lovington residents were ssd from the unexposed Arizona people for simple and choice reaction times, balance with eyes open and closed, visual field score, hearing and grip strength. Culture Fair, digit symbol substitution, vocabulary, verbal recall, peg placement, trail making A and B, FTNWE, information, picture completion and similarities were also ssd. The Lovington adults who averaged 11.8 abnormalities were ssd from, Tatum-Artesia adults who had 3.6 and from unexposed subjects with 2.0. Multiple source community hydrogen sulfide exposures impaired neurobehavioral functions.

GC/MS based identification of skunk spray maliciously deployed as "biological weapon" to harm civilians.

Our laboratory has been asked to elucidate the origin of a strong "toxic smell" present in a prominent politician's office, private house and motorcar. This stinky and pungent atmosphere has caused serious nausea and vomiting to several individuals. Urine samples were collected from the persons presenting symptoms of nausea for toxicological analysis. Drops, paper and cotton swabs of an oily liquid found at the implicated places were submitted by police to our laboratory for investigation. Methanol extracts of the drops were acetylated for gas chromatography/mass spectrometry (GC/MS) analysis in the electron impact mode; the cotton and paper swabs were analysed using headspace-gas chromatography/mass spectrometry (HS-GC/MS). The GC/MS analysis of the acetylated methanol extracts revealed that the major peaks of the chromatogram could be attributed to 2-methylquinoline, to 2-quinolinemethanethiol, to S-2-quinolinemethyl thioacetate, to 2-phenylethanethiol, to bis(E)-2-butenyl disulphide and to bis(3-methylbutyl) disulphide. Several volatile sulphur-containing compounds have been identified with the HS-GC/MS system. Detailed examination of the spectra as well as GC/MS analysis of commercially available skunk secret allowed us to relate the identified compounds to those present in the defence spray of skunks. No health sequels were observed for any of the persons implicated in this case.

Effects on perceived air quality and symptoms of exposure to microbially produced metabolites and compounds emitted from damp building materials.

UNLABELLED: This work investigated perceived air quality and health effects from exposure to low to high levels of volatile organic compounds (VOCs) emitted from damp building materials and a mixture of molds growing on the materials. A mixture of Wallemia sebi, Fusarium culmorum, Penicillium chrysogenum, Ulocladium botrytis, and Aspergillus versicolor was inoculated on pine wood and particle board. In Study 1, each of 27 participants took part in two exposure conditions, one with air from molds growing on building materials (low levels of emissions from the building materials and the mold mixture) and one with blank air, both conditions during 60 min. In Study 2, each of 24 participants was exposed (10 min) four times in a 2 x 2 design randomly to air from moldy building materials (high levels) and blank, with and without nose-clip. The participants rated air quality and symptoms before, during, and after each exposure. Self-reported tear-film break-up time and attention and processing speed (Study 1) was also measured. Exposure to high VOC levels increased the reports of perceived poor air quality, and in the condition without nose-clip enhanced skin symptoms were also noted. No such outcome was observed when exposing the participants to low VOC levels. PRACTICAL IMPLICATIONS: Emissions from building materials caused by dampness and microbial growth may be involved in indoor air health problems. This study showed that exposure to high levels of VOC emitted from damp building materials and a mixture of mold may cause perceived poor air quality. It also indicated that stimulation of chemical warning systems (the nasal chemosensory part of the trigeminal system and the olfactory system) may enhance skin symptoms.