ACMT%Board%Review%
Miscellaneous%Toxicants%
Brandon'Wills,'DO,'FACEP,'FACMT'Fellowship%Director,%Medical%Toxicology%Department%of%Emergency%Medicine%
VCU%Medical%Center%Virginia%Poison%Center% VCU TOX
2.2.10 Miscellaneous Toxicants 2.2.10.1 Acrolein 2.2.10.2 Acrylamides 2.2.10.3 Acrylates 2.2.10.4 Amines 2.2.10.5 Aniline Compounds 2.2.10.6 Azides 2.2.10.7 Bromide Compounds 2.2.10.8 Butadienes 2.2.10.9 Carbon Disulfide 2.2.10.10 Chlorates 2.2.10.11 Coal Tar Products 2.2.10.12 Diamines 2.2.10.13 Dibromochloropropane (DBCP) 2.2.10.14 Dimethylacetamide (DMAC) 2.2.10.15 Dimethylformamide (DMF) 2.2.10.16 Dinitrobenzene 2.2.10.17 Dinitrotoluene (DNT) 2.2.10.18 Epichlorohydrin 2.2.10.19 Ethylene Dibromide (EDB) 2.2.10.20 Ethylenediamine (EDA) 2.2.10.21 Fluoride Compounds 2.2.10.22 Fuels 2.2.10.23 Hexachloro-1,3-Butadiene (HCBD) 2.2.10.24 Isocyanates (eg, toluene diisocyante) 2.2.10.25 Maleic Anhydride 2.2.10.26 Mercaptans 2.2.10.27 Methylene Diamine (MDA) 2.2.10.28 Nitriles 2.2.10.29 O-Phenylenediamine (OPD) 2.2.10.30 Phosphorus/phosphides 2.2.10.31 Phthalates 2.2.10.32 Polymers 2.2.10.33 Resins 2.2.10.34 Styrene 2.2.10.35 Trimellitic Anhydride 2.2.10.36 Triorthocresylphosphate (TOCP) 2.2.10.37 Xylidine
Our%Gameplan%
Organize%your%memory%
Using%study%aids%(quick%look%at%flashcards)%
60%min:%brief%reviewP%focus%on%test%rather%than%content%%
20%min:%Miscellaneous+Toxicants+Jeopardy%overview%
Sources% Dr.%Sean%Bryant%
Dr.%Mike%Greenburg%
Sullivan,%2nd%Ed%
Greenburg,%2nd%Ed%
My%board%review%notes%
http://pubchem.ncbi.nlm.nih.gov/%(structures)%
Acrolein%
Acrolein%=%Acrid%=%IRRITATING%
I:%Contact%herbicide%
I:%%WWI%Lacrimator%
Acrylaldehyde, propenal, allyl aldehyde Ethylene aldehyde, aqualin, (CH2=CHCHO)
TP%Water%soluble%irritant%
TP%Cellular%toxin%via%oxygen%free'radicals'
MP%Metabolite%of%cyclophosphamide'
Acrylamides%Heating%Starches%
UP%Polymer%production%(SDSPPAGE),%flocculator%%
Propenamide, acrylic amide, akrylamid
TP%Axonopathy%
TP%Dermatitis%(peeling,%red/blue,%hyperhidrosis)%
TP%IARC%2A%(poss%gyn%CA)%
MP%Polymer%=%nonPtoxic,%Monomer=%toxic%
Acrylates%
UP%CrossPlinking%properties%(plexiglass)%
Acrylates, methylacryates, Cyanoacrylates Ethyl, methyl, 2-ethyl hexyl, butyl…
TP%Irritant%(skin,%MM,%and%pulmonary)%
TP%Contact%dermatitis%
MP%Penetrates%latex/%rubber%easily%%
Amines% Benzidine
Dimethylamine
Dimethylamine Trichlorotriethylamine Benzidine β-naphthylamine
-Vulcanization
AZO Dyes
Aniline%Compounds%
UP%Precursor%for%polyurethane,%indigo=%blue%jean%die%
IP%Smells%like%rotten%fish%
Aniline
Aniline 4-chloroaniline 4-aminophenol Nitrobenzene 4,4’-Methylene dianiline
TP%Acute:%MetHb,%irritant%
TP%Chronic:%%Bladder%CA%
%%%%%Methylenedianiline:% %%Hepatitis'(Epping'jaundice)'
'''''' ' ' ''Due to contaminated bread
T- Aniline (Spain) Toxic oil syndrome Due to contaminated rapeseed oil (interstitial pulm dz)%
Azides%%
UP%Airbag%accelerant;%pesticde,%explosives%
IP%Labs%and%manufacturing%plants%
TP%Cellular%asphyxiant,%resp%failure/%pulm%edema%
TP%Eye%irritant%%
Bromide%Compounds%%
UP%Photographic,%hot%tub%chemicals,%fumigants...%
TP%Crosses%membrane%faster%than%Cl,%replacing%Cl%%
%%%%%%causing%sedation/%neuropsych%(KBrP%19th%century)%
T%(chronic)P%neuropsych,%acne%(30%%facial),%axonopathy%
MP%Low%anion%gap%(false%high%Cl)%
Butadienes%
UP%Monomer%for%plastics%(ABS%plastic*),%tobacco%smoke%
*ABS:%AcrylonitrilePbutadienePstyrene%
Butadiene
1,3-butadiene Hexachloro-1,3- butadiene Many others
TP%Irritant%(skin%and%mucous%membranes)%
TP%IARC%2A%(lymphohematopoetic,%testicular,%thyroid,%mammary)%
Carbon%Disulfide%UP%Volatile%organic%solvent%
IP%%Rayon,%fumigation%
TP%Acute:%Irritant%(defatting),%disulfiram%rxn%
TP%Chronic:%%
%%%%%1.%%Distal%axonopathy'
%%%%%%%%%%%%%%%%%%%2.%%Optic%nerve%(resembles%optic%neuritis)%
%%%%%%%%%%%%%%%%%%%3.%%CV%(HTN,%CAD)%
%%%%%%%%%%%%%%%%%%%4.%%Repro%(SAB,%prematurity,%decreased%libido)%%
Chlorates%
UP%Oxidizer,%pesticide,%explosives,%bleaching%paper%
UP%Prior%uses:%%pryotechnics,%mouthwash%
Potassium chlorate Calcium chlorate Sodium perchlorate, etc
TP%Oxidizer=%MetHb,%hemolysis,%renal%failure%
MP%FYIP%Perchlorates=%%Also%oxidizers%but%more%stable%
Coal%Tar%Products%Sources:% %wood%creosote=%beach%wood%
%%%%%%%%%%%%% % %(phenol,%cresols,%guaiacols,%xylenols)%
%%%%%%%%%%% % %coal%tar%creosote=%byPproduct%of%coal%tar%
%%%%%%%%%%% % %(85%%polycyclic%aromatic%hydrocarbons%(PAH))%
UP%Wood:%%wood%protectant%
%%%%%%Coal%tar:%wood%preservative%(railroad%ties),%Rx%psoriasis%
TP%Dermal%irritant,%pulmonary=%restrictive/%obstructive%
%%%%Cancer%d/t%PAH%(lung,%oral,%stomach,%bladder,%scrotal,%skin)%
Diamines%
UP%Hydrazine=%Rocket%fuel%(reducer),%insecticides,%plastics%
UP%PPphenylenediamine=%%henna'&'all'hair'dyes...%
Hydrazine TDI
Diamine (Hydrazine) Hexamethylene diamine Toluene-2,4-diamine (TDI) 2-methyl-1,4- benzenediamene
TP%Irritant/%sensitizer%(dermal%&%pulmonary),%lupusHlike%
TP%Hydrazine=INH%(seizures,%hepatitis,%MetHb,%skin%sensitizer)%
Dibromochloropropane%(DBCP)%
UP%Nematicide%(D/C’d%in%1979)P>%replaced%by%dibromoethane%
TP%Dermal%/%ocular%irritant%
TP%Testicular%(aspermia,%oligospermia)%
%%%%De+Balls+Can’t+Produce+(DBCP)%%
Dimethylacetamide%(DMAC)%
UP%Paint%remover,%solvent%for%plastics%(dissolves%PVC)%
%%%%%Smells%like%fish/%ammonia%
TP%Potent%hepatotoxin:%↑%LFT,%jaundice,%hepatomegaly,%liver%necrosis%
TP%Irritant:%esophagitis,%conjunctivitis,%dermal%burn%
Dimethylformamide%(DMF)%
'“Universal'Solvent”'
UP%Penetrates%most%plastics%(makes%them%swell)%
IP%%%Acrylic%fiber%production,%paint%strippers%
%%%%%Vehicle%for%transdermal%drug%delivery%
TP%Potent%hepatotoxin%(CLN,%steatosis)%
TP%Disulfiram%rxn%%
TP%Pulm%irritant%
Dinitrobenzene%
UP%EXPLOSIVES,%spandex,%dyes%
TP%Retrobulbar%neuritis%&%optic%neuropathy%
TP%MetHb%(potent)%
TP%Subacute%hepatic%necrosis,%aplastic%anemia%
TP%May%have%bitter%almond%odor,%hair/skin/%eye%yellowing%%
Dinitrotoluene%(DNT)%
UP%EXPLOSIVES,%diisocyanate%production,%dyes%
TP%Uncouples%oxidative%phosphorylation%
TP%MetHb%
TP%Hemolytic'anemia%
TP%Retrobulbar%&%optic%neuropathy%%
MP%Turns%skin%yellow'
Epichlorhydrin%
UP%Highly%reactive%plastics%production%
IP%Production%of%dye,%lubricants,%adhesives,%drugs%
TP%Strong%Irritant'(sensitizer):%respiratory,%dermal,%ocular%
TP%Nephrotoxicity,%CNS%depression,%hypotension%
MP%Penetrates%rubber%
MP%Sweet,%chloroform%odor%has%poor%warning%property%%
Ethylene%Dibromide%(EDB)%(AKA%Dibromoethane)%
UP%Replaced%dibromochloropropane%as%nematicide%
UP%Fumigant%(grainP%banned%1948),%fire%extinguishers,%%lead%scavenger%in%gasoline%
TP%Hepatotoxicity%(GSSH%depletion)%
TP%Strong%irritant%(dermal,%pulmonary)%
Ethylenediamine%(EDA)%
UP%Dyes,%solvent,%emulsifier%(skin%creams/%latex)%
UP%Drug%production:%%
%%%%%(EDTA,%imidazolines,%aminophylline,%antihistamines)%
TP%Sensitizer%(contact%dermatitis,%occ%asthma)%
TP%MetHb%%
Fluoride%Compounds%
UP%NaF:%electroplating,%toothpaste/%water%additive%
%%%%%%HF:%cleaning%brick/%rust,%glass%etching%
TP%Chelates%divalent%cations%(Ca++,%Mg++),%results%%in%↓%Mg/%Ca,%%
%%%%%↑%K%=%ventricular%fibrillation%
TP%Chronic=%fluorosis:%�%%bone%density,%calcification%of%ligaments,%%
hyperostosis,%whitePbrown%dental%spots%%%
(axial%osteosclerosis/%nerve%compression)%
Fuels%
UP%EnergyPproducing%hydrocarbons%
TP%PULMONARY%(pneumonitis)%
MP%Jet%fuels%(kerosene,%benzene,%xylene,%toluene)%
%%%%%JPP7%&%JPP8%∼%pure%kerosene%%
HexachloroP1,3PButadiene%(HCBD)%
UP%Heat%transfer%liquid%(transformers/%hydraulic%fluid)%
UP%Fumigant%in%vineyards%(don’t%confuse%with%Bordeaux=%copper%sulfate)%
TP%Irritant%(Pulmonary'hemorrhage)%
TP%Hepatic%fatty%degeneration%
TP%Renal%tubular%necrosis,%tubular%adenomas%%
Isocyanates%
UP%Producing%polyurethane%polymers%%
%%%%(don’t%confuse%with%aniline%also%a%polyurethane%precursor)%
UP%Methylisocyanate%(MIC)P%production%of%carbamates%
MIC
TP%MIC:%Major%irritant%(pulm,%derm,%ocular)%
TP%TDI:%#1'Occupational'asthma'(HP)%
Methylisocyanate (MIC) Toluene diisocyanate (TDI)
Maleic%Anhydride%
UP%Enamels,%bonding,%synthesis%of%malathion%
TP%Allergic%sensitizer%(occupational'asthma)%
%%%%Hypersensitivity%pneumonitis%(HP)=%extrinsic%allergic%alveolitis=%Immunologic%
TP%Irritant%(dermal,%ocular)%'
Mercaptans%Chemicals%with%a%–SH%group%(noxious≈%cabbage)%
UP%Odorant%(natural%gas=%tPbutylmercaptan)%
UP%Intermediate%in%synthesis%of%fuels,%pesticides…%
Mercaptomethane
TP%Irritant%(derm,%MM,%respiratory)%
TP%MetHb%&%hemolysis%(worse%in%G6PD)%%
Nitriles%Chemicals%with%a%–CN%
UP%Solvents%(eg.%artificial%nail%remover),%reagents%
Acetonitrile
acetonitrile propane nitrile butanenitrile
TP%Liberation%of%–CN%%Cellular%asphyxiant%
TP%Irritants%(derm,%MM,%ocular)%
MP%Prolonged%observation%for%delayed%CN%toxicity%
OPPhenylenediamine%(OPD)%PPPhenylenediamine%%(PPD)%
*This'compound'is'also'listed'under'“Diamines”*%
UP%OPD:%dyes,%fungicides,%vet%antihelminthic%
UP%PPD:%hair'dyes'and'henna'tattoos%%
PPD
TP%OPD=severe%urticaria/dermatitis%(eye%blindness)%
TP%PPD=%bladder%cancer%%
Phosphorus%Phosphides%UP%Making%phosphates,%detergents,%fertilizer,%match%tips%(red)%
UP%Zn%&%Al%phosphide:%Insecticides,%rodenticides%
Zn Phosphide Red
Phosphorus
TP%Yellow:%strong%oxidizer,%causes%burns%(Red%is%benign)%
%%%%Ingestion:%%
'''''''1.'“smoking”,'glowing''stool,'smells'of'garlic%
%%%%%%%2.%%Asymptomatic%(hrsPweeks)%
%%%%%%%3.%%Hepatic/%renal%failure%
%%%%Chronic:%%“Phossy'Jaw”H%mandibular%necrosis%
TP%Phospine%gas:%%cellular%asphyxiant%+%pulm%edema%+%#3%above%
Phthalates%
UP%Plasticizing%for%vinyl,%softens%PVC%
diethylhexyl phthalate
TP%Controversial%whether%phthalates%have%health%%
%%%%%effects.%%Some%claim%association%with%asthma,%“sickP%
%%%%%building%syndrome”,%or%endocrine%problems%but%little%%
%%%%%supporting%data%
TP%Diethylhexyl%Phthalate%(DEHP)=%occ%asthma%
Polymers%
*Diverse%group%of%plastics*%
One%class=%Fluoropolymer%plastics:%%
%%%%%%%%%%%%%%%%%%%Polytetrafluoroethylene%(PTFE%=%Teflon)%
tetrafluoroethylene
TP%Polymer%Fume%Fever%(heating%polymers)%
%%%%PPulm%irritant,%fluPlike%syndrome%(similar%to%MFF)%
%%%%PResolves%in%24P48%hrs%%
Resins%
Resins%=%Plastics%
Combustion%can%liberate:%CO,%CN,%phosgene%
Methylenedianiline%– %Toxic%hepatitis%(Epping%Jaundice)%
Anhydrides%–% % %Occupational%pneumonitis%%
methylenedianiline
Styrene%UP%Styrene%=%Styrofoam%
%%Also%ABS,%SBR%plastics%
TP%“Styrene%Sickness”:%HA/fatigue/weakness,%intoxicated%after%exp%to%vapor%
TP%Peripheral%neuropathy%
TP%CNS%(balance,%memory,%color%vision)%
TP%Chronic=%Hearing'loss'
Trimellitic%Anhydride%UP%Plasticizer%for%polymers%(PVC)%
TP%Sensitizer/%irritant;%4%syndromes:%
%%%1.%%Asthma/%rhinitis%(IgE)%
%%%2.%%Irritant%syndrome%(dust/%fumes)%
%%%3.%%Late%respiratory%systemic%syndrome%(LRSS)%
%%%%%%%%%%“Trimellitic'Flu”P%Like%MFF,%4P12%hours%after%shift%
%%%4.%%Hypersensitivity%pneumonitis%+%hemolytic%anemia%
%%%%%%%%“Pulmonary%diseaseP%anemia”%(PDA)%
%%%%%%%%%Dyspnea,%cough,%hemoptysis,%anemia%
%%%%%%%%%May%lead%to%restrictive%lung%dz;%pulm%hemosiderosis%
Triorthocresylphosphate%(TOCP)%
UP%Plasticizer%in%lacquer,%hydraulic%fluid%
TP%Weak%AchE%inhibitor%(like%organophosphate)%
%%%% %Inhibits%neuroHtargetHesterase%(NTE)%
TP%Delayed%sensoryHmotor'neuropathy%
''''' '“OPP%ester%induced%delayed%neurotoxicity%(OPIDN)”%
MP'Jamaican%Ginger%(Jake)%adulterated%by%TOCP%
''''' '“Jake%Walk”=%Jake%leg%paralysis%
MP'Morocco:%OPIDN%after%TOCP%adulterated%cooking%oil%
Xylidine%
UP%Making%dyes/%pharmaceuticals,%gas%additive…%
TP%Acute:%%MetHb,%cyanosis,%intoxication%
TP%Chronic:%%Liver/%renal%damage%(animals)%'
Xylidine O-xylidine 2-6-methylaniline
Irritants%P%Acrolein%
P%Acrylates%
P%Epichlorohydrin%
P%Ethylene%Dibromide%(EDB)%
P%Ethylenediamine%
P%Methylisocyanate%(MIC)%
P%Mercaptans%
PMany%more%
PSo%many,%decide%if%this%category%works%for%you...%
Cancer%Causing%PAcrylamides%(2A)%
PAromatic%Amines%(Benzidine,%βPnaphthylamine)%(1):%bladder%
PAniline%(1):%bladder%
%%%%%PPPPhenylenediamine%(PPD):%bladder,%leukemia%
PButadienes%(2A):%lymphohematopoetic%
PCoal%tar:%lung,%oral,%stomach,%bladder,%scrotal,%skin%
PVinyl%Chloride:%Angiosarcoma%of%liver%
PCCl4:%Liver%
Peripheral%Neuropathy%
PAcrylamide%(A)%
PBromide%(Methyl)%(A)%
PCarbon%disulfide%(A)%
PStyrene%(?)%
PTOCP%
PTrichloroethylene%(M)%
Hepatotoxins%
PDimethylacetamide%(DMAC):%Necrosis,%jaundice%
PDimethylformamide%(DMF):%CLN,%steatosis%
PHexachloroP1,3PButadiene%(HCBD):%fatty%degen%
PPhosphorus%(yellow%or%white)%
PXylidine%(in%animals;%also%renal%damage)%
PMethylenedianiline:%Hepatitis%(epping%jaundice)%
MetHb%Inducers%
PChlorates%
PDinitrobenzene%(potent)%
PDinitrotoluene%(DNT)%
PEthylenediamine%
PMercaptans%
PXylidine%
Sensitizers%Pulmonary=%Occupational%Asthma%
P%Anhydrides:%occupational%pneumonitis%(HP)%
P%Maleic%Anhydride:%%Allergic%&%hypersensitivity%pulm%dz%
P%Trimellitic%Anhydride:%%Asthma,%“Trimellitic%Flu”%(HP)%
P%Ethylenediamine%(EDA):%occup%asthma,%contact%dermatitis%
P%Toluene%diisocyante%(TDI)/%isocyanates:%(#1%occ%asthma)%
P%Diethylhexyl%Phthalate%(DEHP):%%occ%asthma%
Hypersensitivity%Pneumonitis%(HP)%Some%overlap%with%previous%slide%
P%%%%Anhydrides/%Maleic%Anhydride%
P Pyrethrum%
P%%%%Trimellitic%Anhydride%
P Isocyanates%(TDI,%MDI)%