Hydrocarbon toxicity: A review

Characteristic three-layered intestinal contents in a case of gasoline ingestion

INTRODUCTION

Ingestion of gasoline can cause severe pulmonary and gastrointestinal complications. Computed tomography may reveal characteristic findings.

CASE SUMMARY

A 61-year-old man had gastrointestinal symptoms, and subsequently developed respiratory distress and altered mental status after ingesting approximately 150 mL of gasoline.

IMAGES

Abdominal computed tomography revealed a characteristic three-layered appearance of intestinal contents, likely representing intestinal fluid, ingested gasoline, and gas. Chest computed tomography showed bilateral pulmonary infiltrates consistent with pneumonitis.

CONCLUSION

Recognition of the characteristic three-layered appearance of the intestinal contents on abdominal computed tomography might aid in the diagnosis of gasoline ingestion.

Brucella pituitosa strain BU72, a new hydrocarbonoclastic bacterium through exopolysaccharide-based surfactant production

Hydrocarbon and heavy metal pollution are amongst the most severe and prevalent environmental problems due to their toxicity and persistence. Bioremediation using microorganisms is considered one of the most effective ways to treat polluted sites. In the present study, we unveil the bioremediation potential of Brucella pituitosa strain BU72. Besides its ability to grow on multiple hydrocarbons as the sole carbon source and highly tolerant to several heavy metals, BU72 produces different exopolysaccharide-based surfactants (EBS) when grown with glucose or with crude oil as sole carbon source. These EBS demonstrated particular and specific functional groups as determined by Fourier transform infrared (FTIR) spectral analysis that showed a strong absorption peak at 3250 cm-1 generated by the -OH group for both EBS. The FTIR spectra of the produced EBS revealed major differences in functional groups and protein content. To better understand the EBS production coupled with the degradation of hydrocarbons and heavy metal resistance, the genome of strain BU72 was sequenced. Annotation of the genome revealed multiple genes putatively involved in EBS production pathways coupled with resistance to heavy metals genes such as arsenic tolerance and cobalt-zinc-cadmium resistance. The genome sequence analysis showed the potential of BU72 to synthesise secondary metabolites and the presence of genes involved in plant growth promotion. Here, we describe the physiological, metabolic, and genomic characteristics of Brucella pituitosa strain BU72, indicating its potential as a bioremediation agent.

Is ethyl chloride the new nitrous oxide? A case report

BACKGROUND

Over the last decade, there has been an emerging trend of recreational misuse of several drugs and inhaled solvent including ethyl chloride. This case report follows CARE guidelines and highlights, with supporting video, the neurological features of ethyl chloride intoxication.

CASE PRESENTATION

A 48-year-old man was seen for the sudden occurrence of an unsteady gait with dizziness. His only medical history was a chronic and treated HIV infection without any complications. Clinical examination revealed a cerebellar syndrome associated with impairment of short-term memory. Biological and radiological workups were normal. After several days, the patient recalled ethyl chloride inhalation. He fully recovered after being discharged from hospital.

CONCLUSION

Clinicians should recognise the clinical features and neurological manifestations of ethyl chloride intoxication due to the potential fatal cardiovascular complications of this intoxication.

Cellulose Acetate-Ionic Liquid Blends as Potential Polymers for Efficient CO2 Separation Membranes

CO2 capture, applied in CO2 separation from natural gas or in CO2/N2 separation from power plant flue gas streams, is of great importance for technical, economic, and environmental reasons. The latter seems important because CO2, as a greenhouse gas, is considered the main contributor to global warming. Using polymeric membranes for CO2 separation presents several advantages, such as low energy demand, small equipment volume, and the absence of liquid waste. In this study, two ionic liquids (ILs) were used for the preparation of cellulose acetate (CA)-IL blend membranes for potential CO2 capture applications, namely, 1-butyl-3-methylimidazolium hydrogen sulfate ([Bmim+][HSO4-]) and choline glycine ([Ch+]Gly-), as they present adequate CO2 dissolution ability. The first IL is commercially available, whereas the latter was synthesized by a novel route. Several composite membranes were prepared through the solvent casting technique and characterized by a variety of methods, including thermogravimetry, calorimetry, FTIR spectroscopy, and X-ray diffraction. The CO2 sorption in the composite membranes was experimentally measured using the mass loss analysis (MLA) technique. The results showed that the ILs strongly interacted with the C=O groups of CA, which exhibited high affinity with CO2. In the case of [Bmim+][HSO4-], a reduction in the available sites that allow strong intermolecular interactions with CO2 resulted in a decrease in CO2 sorption compared to that of pure CA. In the case of [Ch+]Gly-, the reduction was balanced out by the presence of specific groups in the IL, which presented high affinity with CO2. Thus, the CA-[Ch+]Gly- blend membranes exhibited increased CO2 sorption capability, in addition to other advantages such as non-toxicity and low cost.

Physiologic Effects of Substance Use

Physiologic and psychological effects of substance use are common occurrences. They may be the proximate purpose of the exposure or related to an unintended complication. Acute short-term exposure effects may not be the same as long-term effects. These effects are mediated by different receptors they act on and the homeostatic changes that occur due to repeat exposure. We review in this article the physiologic and psychological effects from exposure to commonly encountered drugs, ethanol, sedative hypnotics, cocaine, amphetamines, marijuana, opioids, nicotine, hydrocarbons (halogenated and non-halogenated), and nitrous oxide.

Exposure to volatile hydrocarbons and neurologic function among oil spill workers up to 6 years after the Deepwater Horizon disaster

BACKGROUND

During the 2010 Deepwater Horizon (DWH) disaster, oil spill response and cleanup (OSRC) workers were exposed to toxic volatile components of crude oil. Few studies have examined exposure to individual volatile hydrocarbon chemicals below occupational exposure limits in relation to neurologic function among OSRC workers.

OBJECTIVES

To investigate the association of several spill-related chemicals (benzene, toluene, ethylbenzene, xylene, n-hexane, i.e., BTEX-H) and total petroleum hydrocarbons (THC) with neurologic function among DWH spill workers enrolled in the Gulf Long-term Follow-up Study.

METHODS

Cumulative exposure to THC and BTEX-H across the oil spill cleanup period were estimated using a job-exposure matrix that linked air measurement data to detailed self-reported DWH OSRC work histories. We ascertained quantitative neurologic function data via a comprehensive test battery at a clinical examination that occurred 4-6 years after the DWH disaster. We used multivariable linear regression and modified Poisson regression to evaluate relationships of exposures (quartiles (Q)) with 4 neurologic function measures. We examined modification of the associations by age at enrollment (<50 vs. ≥50 years).

RESULTS

We did not find evidence of adverse neurologic effects from crude oil exposures among the overall study population. However, among workers ≥50 years of age, several individual chemical exposures were associated with poorer vibrotactile acuity of the great toe, with statistically significant effects observed in Q3 or Q4 of exposures (range of log mean difference in Q4 across exposures: 0.13-0.26 μm). We also observed suggestive adverse associations among those ≥ age 50 years for tests of postural stability and single-leg stance, although most effect estimates did not reach thresholds of statistical significance (p < 0.05).

CONCLUSIONS

Higher exposures to volatile components of crude oil were associated with modest deficits in neurologic function among OSRC workers who were age 50 years or older at study enrollment.

Assessing volatile organic compounds exposure and chronic obstructive pulmonary diseases in US adults

Background

Volatile organic compounds (VOCs) are a large group of chemicals widely used in People's Daily life. There is increasing evidence of the cumulative toxicity of VOCs. However, the association between VOCs and the risk of COPD has not been reported.

Objective

We comprehensively evaluated the association between VOCs and COPD.

Methods

Our study included a total of 1,477 subjects from the National Health and Nutrition Examination Survey, including VOCs, COPD, and other variables in the average US population. Multiple regression models and smooth-curve fitting (penalty splines) were constructed to examine potential associations, and stratified analyses were used to identify high-risk groups.

Results

We found a positive association between blood benzene and blood o-xylene concentrations and COPD risk and identified a concentration relationship between the two. That is, when the blood benzene and O-xylene concentrations reached 0.28 ng/mL and 0.08 ng/mL, respectively, the risk of COPD was the highest. In addition, we found that gender, age, and MET influence the relationship, especially in women, young people, and people with low MET.

Significance

This study revealed that blood benzene and blood o-xylene were independently and positively correlated with COPD risk, suggesting that long-term exposure to benzene and O-xylene may cause pulmonary diseases, and providing a new standard of related blood VOCs concentration for the prevention of COPD.

Spontaneous Pneumomediastinum in a 15-Year-Old Adolescent After Unintended Overexposure to Paint Diluent (Thinner) Fumes: First Reported Case

Spontaneous pneumomediastinum (SPM) is the presence of air in the mediastinal interstices in the absence of any surgical or medical procedure, chest trauma, or mechanical ventilation. SPM can occur during vigorous Valsalva maneuvers, such as weight lifting, coughing fits, hyperemesis gravidarum, and so on, or during inhalation of illicit substances or toxic agents, as a result of an abrupt increase in pressure in the tracheal tree. Preexisting underlying lung disease may be a contributing factor. In the present case, we report for the first time an SPM due to accidental overexposure to paint thinner in a 15-year-old male from a low-income rural family. He was offered a job painting the inside of a house, which he accepted to earn some money for the family household. However, due to his inexperience, he overdosed on a can of paint with thinner. About 2 h after starting work, he began to feel increasingly severe chest pain and had to be rushed to the local level one basic hospital by his parents. Physical examination revealed subcutaneous emphysema over the supraclavicular area and crackles in the precordial area. Chest radiographs showed a pneumomediastinum. In retrospect, the patient denied coughing or sneezing attacks after exposure. He was transferred to a regional tertiary hospital for further diagnostic evaluation to rule out airway/esophageal perforation. Chest computed tomography confirmed underlying SPM and subcutaneous emphysema. The oesophagogram and bronchoscopy were unremarkable. SPM, possibly secondary to overexposure to thinner vapors, a hydrocarbon-based compound, was the final diagnosis. The patient was discharged asymptomatic on day 5.

Development of a biofilm-forming bacterial consortium and quorum sensing molecules for the degradation of lignin-containing organic pollutants

The presence of lignin along with other pollutants makes effluent more complex when it is discharged from Pulp and paper mills. The present study investigates the use of biofilm-forming bacteria isolated from pulp paper mill effluent contaminated sites (PPMECSs) for lignin degradation. Isolated biofilm-forming and lignin-degrading bacteria were identified as Bacillus subtilis, Enterobacter cancerogenus, and Bacillus licheniformis by 16S rRNA gene sequencing. Thin liquid chromatography (TLC) analysis showed that the consortium of bacteria produced acyl-homoserine lactone (AHL) as quorum sensing molecules and extracellular polymeric substances (EPS) that protect the bacterial consortium under unfavorable conditions. The potential consortium was able to reduce lignin (900 ppm) by 73% after 8 days of incubation in a minimal salt medium containing kraft lignin and glucose at pH 7.0 and 37 °C as compared to individual strains. The degradation by-products were identified as amides, alcohols, and acids. The major organic pollutants in the effluent were reduced after treatment of the constructed consortium, thus confirming active biotransformation and biodegradation of the lignin. Microscopic examination also indicated the presence of lignin induced biofilm formation. Hence, the constructed biofilm-forming bacterial consortia based on quorum sensing offered a sustainable and effective solution to treat lignin-containing complex pollutants.

ERAS Protocol Options for Perioperative Pain Management of Substance Use Disorder in the Ambulatory Surgical Setting

Even prior to the COVID-19 pandemic, rates of ambulatory surgeries and ambulatory patients presenting with substance use disorder were increasing, and the end of lockdown has further catalyzed the increasing rates of ambulatory patients presenting for surgery with substance use disorder (SUD). Certain subspecialty groups of ambulatory procedures have already established protocols to optimize early recovery after surgery (ERAS), and these groups have subsequently enjoyed improved efficiency and reduced adverse outcomes as a result. In this present investigation, we review the literature as it relates to substance use disorder patients, with a particular focus on pharmacokinetic and pharmacodynamic profiles, and their resulting impact on the acute- or chronic user ambulatory patient. The systematic literature review findings are organized and summarized. We conclude by identifying areas of opportunity for further study, specifically with the aim of developing a dedicated ERAS protocol for substance use disorder patients in the ambulatory surgery setting. - Healthcare in the USA has seen an increase in rates of both substance use disorder patients and separately in ambulatory surgery cases. - Specific perioperative protocols to optimize outcomes for patients who suffer from substance use disorder have been described in recent years. - Agents of interest like opioids, cannabis, and amphetamines are the top three most abused substances in North America. - A protocol and recommend further work should be done to integrate with concrete clinical data, in which strategies should be employed to confer benefits to patient outcomes and hospital quality metrics like those enjoyed by ERAS protocol in other settings.

Acute benzyl alcohol intoxication: An autopsy case report

INTRODUCTION

The main mechanism of death and the pathological appearance of cases of benzyl alcohol intoxication has not been fully investigated. Autopsy reports of cases of benzyl alcohol intoxication have not been published.

CASE PRESENTATION

A 24-year-old man was found in the state of cardiopulmonary arrest at a construction site. He had been performing paint stripping. He was immediately transferred to the hospital, but he did not recover. An autopsy showed focal coloring of the skin without any major caustic injury. A histopathological investigation showed vacuolar degeneration in the epidermis and dermo-epidermal junction, and severe erosion of the tracheal and bronchial mucosa. No pathological changes in the kidney were evident. A neuropathological investigation showed central chromatolysis of neuronal cells in pontine nuclei and grumose degeneration in the cerebellar dentate nucleus. The blood content of benzyl alcohol was 780.0 μg/mL.

LESSONS

Present case suggest that multiple pathways of exposure may be associated with more rapid progression in acute benzyl alcohol intoxication, and that early and/or severe involvement of the central nervous system rather than renal dysfunction may be associated with an early death.

Poisonings from hydrocarbon inhalant misuse in Australia

BACKGROUND AND AIMS

Inhalational misuse of volatile substances has been a significant public health concern because of the risk of sudden death and associated chronic complications such as encephalopathy. The Australian Government released a Consensus-based clinical practice guideline in 2011 on the management of volatile substance use in Australia, which noted a lack of available data particularly on harms. This study aimed to measure (1) the number of calls received by the New South Wales Poisons Information Centre (NSWPIC) regarding inhalational hydrocarbon exposures or poisonings and (2) the number of unintentional deaths reported to the National Coronial Information System (NCIS) in Australia.

DESIGN, SETTING, CASES, MEASUREMENTS

We performed a retrospective review of all recreational inhalational hydrocarbon exposure calls to the NSWPIC between 1 January 2010 and 31 December 2020. A search was made of the NCIS database in all states and territories over the same period to determine the number of non-intentional inhalational hydrocarbon-related deaths in Australia.

FINDINGS

Between January 2010 and December 2020, there were 752 primary calls made to the NSWPIC regarding hydrocarbon use or exposure. Age or age bracket was recorded in 748 cases, with 508 (67%) calls involving children or adolescents. Over the same time, there were 58 unintentional deaths involving the recreational use of inhalational hydrocarbons. The median age at death was 23 years (interquartile range = 15-30 years), and 72% (42 cases) were male. Cause of death was predominately acute suffocation/asphyxia, encephalopathy related to chronic use, cardiac arrest likely from sudden sniffing syndrome or thermal injuries secondary to unintentional fires sparked by the volatile agents.

CONCLUSION

Although death and cardiac arrest are uncommon among people in Australia who misuse hydrocarbons for recreational use, the deaths and cardiac arrests tend to occur in adolescents.

Assessment of contaminants in sand production from petroleum wells offshore Sabah

Sand production remains a huge obstacle in many oil and gas fields around the world, but the hazards of contaminants riding on the produced sand are often not emphasised. Improper disposal of the sand could see the toxic leaching into the environment including the food chain, endangering all living organisms. The impending sand production from an oilfield offshore Sabah also suffers from the lack of hazards identification; hence, this study was conducted to assess the contaminant on the produced sand. Sand samples were collected from multiple wells in the area, with the contaminants extracted using n-hexane and subjected to chemical and thermal analyses. FTIR and GC-MS detected traces of harmful pollutants like naphthalene, amine substances, cyclohexanol, and short-chain alkanes. It was discovered that the volatile fraction of the contaminants was able to evaporate at 33 °C, while high energy was needed to remove 100% of the contaminants from the sand. Overall, the produced sand from the oilfield was unsafe and required treatment before it could be dumped or used.

Mycobacterium infection secondary to exogenous lipoid pneumonia caused by nasal drops: a case report and literature review

BACKGROUND

Exogenous lipoid pneumonia (ELP) is a rare disease and its diagnosis is often mistaken or delayed. Secondary infection with rapidly growing non-tuberculous mycobacteria is a rare complication of lipoid pneumonia.

CASE PRESENTATION

A 38-year-old man presented with fever, cough, sputum, chest tightness, and shortness of breath. He had a 2-year history of allergic rhinitis and used liquid paraffin-containing menthol nasal drops daily. A chest CT scan showed multiple patchy ground glass opacities with blurred borders in both lungs, which were located in the inner pulmonary field and distributed along the bronchi. His ambient air PO₂ was 63 mmHg. The patient was diagnosed with ELP by CT-guided lung biopsy. The nasal drops were discontinued, and systemic glucocorticoids were administered. During treatment, the pulmonary lesions deteriorated, and bronchoalveolar lavage was performed during bronchoscopy. Additionally, Mycobacterium abscessus was detected in the lavage fluid. Upon detection of a secondary M. abscessus infection, glucocorticoids were gradually discontinued, and anti-M. abscessus treatment was implemented. The patient's symptoms rapidly ameliorated. After 11 months of anti-M. abscessus treatment, a repeat CT scan showed clear regression of the lung lesions.

CONCLUSION

Routine microbiological examination of samples, including sputum or alveolar lavage fluid, is necessary for patients with diagnosed or suspected ELP.

1,1-Difluoroethane Hydrocarbon Cardiomyopathy

1,1-Difluoroethane (DFE) cardiomyopathy results from the direct inhalation of toxic halogenated hydrocarbons. We present a case series of acute DFE cardiomyopathy illustrating the typical presentation of severe DFE cardiomyopathy along with a detailed description of its mechanism of injury. (Level of Difficulty: Advanced.).

Waxing activity as a potential source of exposure to per- and polyfluoroalkyl substances (PFAS) and other environmental contaminants among the US ski and snowboard community

BACKGROUND

Skiers and snowboarders apply waxes and solvents to their equipment to enhance glide across the snow. Waxing results in exposures to per- and polyfluoroalkyl substances (PFAS) and particulate matter, which have been associated with adverse health effects among professional wax technicians in Scandinavia. However, little is known about exposure among people who participate at other levels of sport, including recreationally, in other regions.

OBJECTIVE

We sought to characterize wax-related exposures among US skiers and snowboarders who participate across numerous levels of sport to expand scientific understanding of environmental health risks among this population.

METHODS

We used an anonymous electronic survey to evaluate wax-related exposures among US cross-country and downhill skiers and snowboarders. Specifically, we assessed (Fang et al., 2020): duration of time involved with each sport in any role (Freberg et al., 2013), intensity of wax-related exposures based on time spent in waxing areas, wax use, and wax type (Rogowski et al., 2007), frequency of fluorinated wax application, and (Freberg et al., 2010) use of exposure interventions.

RESULTS

Participants tended to be long-term winter sports enthusiasts (e.g., median downhill skiing duration: 31 years). Nearly all (92%) participants personally applied some wax to their skis/snowboards and most applied waxes containing PFAS (67%) and solvents (62%). Ski professionals waxed the most pairs of skis with fluorinated waxes annually (median (IQR): 20 (1, 100)), though individuals participating recreationally also applied fluorinated waxes regularly. Exposure interventions were not widely used.

SIGNIFICANCE

Waxing activities may pose significant risk of exposure to PFAS and other environmental contaminants among the US ski and snowboard community. Efforts are needed to reduce these exposures through changes to wax use patterns and broader adoption of exposure reduction strategies.

A case report of recreational use of inhaled Freon leading to acute hypoxemic respiratory failure salvaged by veno-venous extracorporeal membrane oxygenation

BACKGROUND

Freon™ is a halogenated hydrocarbon often used as a refrigerant. When inhaled recreationally, it has the desired effects of euphoria and intoxication. Toxic effects include cardiovascular and neurologic insults such as arrhythmias and seizures, and less well-described toxicities include airway and lung injury. The treatment in general is primarily supportive.

CLINICAL FEATURES

We present the case of a 42-yr-old previously healthy male who developed acute bronchiolitis and pneumonitis following inhalation of Freon leading to severe respiratory failure. He was supported by veno-venous extracorporeal membrane oxygenation and managed with high-dose corticosteroids.

CONCLUSION

To our knowledge, this is the first case report of an inhaled Freon exposure resulting in acute lung injury refractory to conventional therapy that was salvaged by vv-ECMO as a bridge towards a full recovery.

Assessing volatile organic compounds exposure and prostate-specific antigen: National Health and Nutrition Examination Survey, 2001–2010

Background

Volatile organic compounds (VOCs) are a large group of chemicals widely used in people's daily routines. Increasing evidence revealed the VOCs' accumulating toxicity. However, the VOCs toxicity in male prostate has not been reported previously. Thus, we comprehensively evaluated the association between VOCs and prostate-specific antigen (PSA).

Methods

A total of 2016 subjects were included in our study from the National Health and Nutrition Examination Survey with VOCs, PSA, and other variables among U.S. average population. We constructed XGBoost Algorithm Model, Regression Model, and Generalized linear Model (GAM) to analyze the potential association. Stratified analysis was used to identify high-risk populations.

Results

XGBoost Algorithm model identified blood chloroform as the most critical variable in the PSA concentration. Regression analysis suggested that blood chloroform was a positive association with PSA, which showed that environmental chloroform exposure is an independent risk factor that may cause prostate gland changes [β, (95% CI), P = 0.007, (0.003, 0.011), 0.00019]. GAM observed the linear relationship between blood chloroform and PSA concentration. Meanwhile, blood chloroform linear correlated with water chloroform in the lower dose range, indicating that the absorption of water may be the primary origin of chloroform. Stratified associations analysis identified the high-risk group on the chloroform exposures.

Conclusion

This study revealed that blood chloroform was positively and independently associated with total PSA level, suggesting that long-term environmental chloroform exposure may cause changes in the prostate gland.

Hydrocarbon exposure effect on energetic metabolism and immune response in Crassostrea virginica

Crassostrea virginica was exposed to different light crude oil levels to assess the effect on transcriptomic response and metabolic rate. The exposure time was 21 days, and levels of 100 and 200 μg/L were used, including a control. The most significant difference among treatments was the overexpression of several genes associated with energy production, reactive oxygen species (ROS) regulation, immune system response, and inflammatory response. Also, a hydrocarbon concentration-related pattern was identified in ROS regulation, with a gene expression ratio near 1.8:1 between 200 and 100 μg/L treatments. Statistical analysis showed no interaction effect for metabolic rate; however, significant differences were found for oil concentration and time factors, with a higher oxygen consumption at 200 μg/L. Our findings provide novel information about the metabolic response of C. virginica during hydrocarbons exposure. In addition, our results point out which biological processes should be investigated as targets for searching bioindicators.

Periarticular calcifications containing giant pseudo-crystals of francolite in skeletal fluorosis from 1,1-difluoroethane "huffing"

Inhalant use disorder is a psychiatric condition characterized by repeated deliberate inhalation from among a broad range of household and industrial chemical products with the intention of producing psychoactive effects. In addition to acute intoxication, prolonged inhalation of fluorinated compounds can cause skeletal fluorosis (SF). We report a young woman referred for hypophosphatasemia and carrying a heterozygous ALPL gene variant (c.457T>C, p.Trp153Arg) associated with hypophosphatasia, the heritable metabolic bone disease featuring impaired skeletal mineralization, who instead suffered from SF. Manifestations of her SF included recurrent articular pain, axial osteosclerosis, elevated bone mineral density, maxillary exostoses, and multifocal periarticular calcifications. SF was suspected when a long history was discovered of 'huffing' a computer cleaner containing 1,1-difluoroethane. Investigation revealed markedly elevated serum and urine levels of F^-. Histopathology and imaging techniques including backscattered electron mode scanning electron microscopy, X-ray microtomography, energy dispersive and wavelength dispersive X-ray emission microanalysis, and polarized light microscopy revealed that her periarticular calcifications were dystrophic deposition of giant pseudo-crystals of francolite, a carbonate-rich fluorapatite. Identifying unusual circumstances of F^- exposure is key for diagnosing non-endemic SF. Increased awareness of the disorder can be lifesaving.

Hydrofluorocarbons pneumonitis as a complication of inhalation injury following air‐conditioning repairs

Hydrofluorocarbon (HFC) pneumonitis is an uncommon cause of inhalation injury. HFCs are a group of chemicals predominantly used for refrigeration and cooling. A 19‐year‐old air‐conditioning technician developed acute onset of dyspnoea and chest tightness while servicing an air conditioner in a confined space. We diagnosed him with HFC pneumonitis based on the history of exposure and the high‐resolution computed tomography (HRCT) thorax findings. He was treated with steroids and supportive oxygen therapy. He recovered fully after 5 days of hospitalization and was discharged. Review at 2 weeks in the outpatient setting showed significant radiological improvement on HRCT thorax.

Toxic benzyl alcohol inhalation: Altered mental status with metabolic acidosis and hyperammonemia

This report presents the case of a patient whose inhalation exposure to benzyl alcohol led to clinical manifestations similar to toluene intoxication, including sudden altered mental status, metabolic acidosis, hypokalemia, hypophosphatemia, and hyperammonemia. Toxicity from benzyl alcohol inhalation is quite rare, and hyperammonemia associated with renal tubular dysfunction in poisoning cases has not been reported in the past.

Acute effects of ambient non-methane hydrocarbons on cardiorespiratory hospitalizations: A multicity time-series study in Taiwan

BACKGROUND

Few environmental epidemiological studies and no large multicity studies have evaluated the acute short-term health effects of ambient non-methane hydrocarbons (NMHC), the essential precursors of ground-level ozone and secondary organic aerosol formation.

OBJECTIVE

We conducted this multicity time-series study in Taiwan to evaluate the association between airborne NMHC exposure and cardiorespiratory hospital admissions.

METHODS

We collected the daily mean concentrations of NMHC, fine particulate matter (PM2.5), ozone (O3), weather conditions, and daily hospital admission count for cardiorespiratory diseases between 2014 and 2017 from eight major cities of Taiwan. We applied an over-dispersed generalized additive Poisson model (GAM) with adjustment for temporal trends, seasonal variations, weather conditions, and calendar effects to compute the effect estimate for each city. Then we conducted a random-effects meta-analysis to pool the eight city-specific effect estimates to obtain the overall associations of NMHC exposure on lag0 day with hospital admissions for respiratory and circulatory diseases, respectively.

RESULTS

On average, a 0.1-ppm increase of lag0 NMHC demonstrated an overall 0.9% (95% CI: 0.4-1.3%) and 0.8% (95% CI: 0.4-1.2%) increment of hospital admissions for respiratory and circulatory diseases, respectively. Further analyses with adjustment for PM2.5 and O3 in the multi-pollutant model or sensitivity analyses with restricting the NMHC monitoring from the general stations only confirmed the robustness of the association between ambient NMHC exposure and cardiorespiratory hospitalizations.

CONCLUSION

Our findings provide robust evidence of higher cardiorespiratory hospitalizations in association with acute exposure to ambient NMHC in eight major cities of Taiwan.

Ethylene dimethacrylate used as an NH3 adsorbent with high adsorption capacity and selectivity

NH₃ molecularly imprinted polymers (NH₃-MIPs) were synthesized that could successfully separate and recover NH₃ during sludge aerobic composting; however, increased toluene usage during the adsorbent preparation incurred a high cost and severe environmental risks. The purpose of this study was to reduce toluene usage by optimizing the reagent composition of NH₃-MIPs, based on maintaining a high NH₃ adsorption capacity and selectivity. Five adsorbent groups, including NH₃-MIPs, and NH₃-Ethylene dimethacrylate adsorbents (NH₃-EGDMA) with 0%, 75%, 90%, and 100% toluene reduction efficiencies, were prepared and tested for their adsorption performance. The results showed that NH₃-EGDMA with 75% toluene reduction not only had a high NH₃ adsorption capacity (104.42 mg g^-1) but also had a high separation factor for NH₃/methyl sulfide (3121) and NH₃/dimethyl disulfide (4597). The adsorption mechanism was identified as a chemical force between NH₃ and NH₃-EGDMA with a 75% toluene reduction using the analysis of the kinetic model. This study significantly reduces NH₃ adsorbent cost as well as harm to the environment during the adsorbent preparation, which was beneficial to the popularization and application of this NH₃ adsorbent.

Management of hydrocarbon burns: Considering mental health and biochemical abnormalities

Volatile substance misuse, particularly the inhalation of hydrocarbons, is a growing issue globally. Consequences of VSM, both acute or chronic, causes cardiovascular, respiratory, renal, metabolic and central nervous system damage. Whilst the effects of hydrocarbon abuse have been reported, the combination of intoxication with hydrocarbon and burns sustained has not yet been presented. A retrospective case series of patients who presented in the last 5 years to the Royal Adelaide Hospital with hydrocarbon-related burns in the context of illicit use was undertaken. Our aims are to present to the wider scientific community the high morbidity and mortality of hydrocarbon burn injuries and why this tertiary Burns Unit feel it most appropriate to medically stabilise these patients prior to definitive surgery for their burn. All patients that presented with acute hydrocarbon intoxication and sustained concomitant burns had significant psychiatric disorder and substance abuse history and three of five had either not eaten in several days resulting in acute malnourishment, refeeding syndrome or had evidence of chronic malnourishment with deranged electrolytes and hypoalbuminaemia. Their definitive burns surgery was delayed where appropriate in order to facilitate medical stabilisation as they were too high risk of cardiac membrane instability, electrolyte derangement and/or respiratory compromise to undergo safe general anaesthetic and burns debridement. We propose a multidisciplinary team approach, utilising not only our Burns Unit care model of physiotherapists, psychologists, social work and burns trained nurses and surgeons but also Intensive Care, Toxicology, Addiction medicine and General Medical physicians in the management of these patients.

Acute exogenous lipoid pneumonia: Unusual presentation as cavitating lung disease with pneumothorax

Acute lipoid pneumonia is quite uncommon and is associated with oily or lipid contents within the alveoli. Exogenous lipoid pneumonia due to kerosene poisoning, manifests with a wide clinical spectrum ranging from subtle chemical pneumonitis to marked severe pulmonary and systemic inflammation. We present an interesting case of an adult male with kerosene poisoning. He manifested with severe cavitating lung disease. In addition, he developed spontaneous pneumothorax. Both cavitating lung disease and pneumothorax are unusual manifestations of acute exogenous lipoid pneumonia and perhaps follow severe lung injury following high volume kerosene exposure.

Acute Inhalant-Induced Atrial Fibrillation With Severe Hypocalcemia: A Case Report and Review of the Pathophysiology

The recreational use of inhalants is associated with various detrimental health effects ranging from inebriation to cardiac arrest. It also presents a challenging clinical problem as the diagnosis is made by the presentation and patient’s history, which is often difficult to obtain in an intoxicated or obtunded individual. The incidence of inhalant use is relatively high. National surveys have reported that nearly 21.7 million Americans aged 12 and older have used inhaled substances at least once in their lives. There is no reversal agent or antidote for inhalants and supportive care is generally recommended. We present a case of a young patient presenting with acute inhalant toxicity accompanied by atrial fibrillation with a rapid ventricular response and severe hypocalcemia.

Queering poppers literature: A critical interpretive synthesis of health sciences research on alkyl nitrite use and Canadian policy

BACKGROUND

Poppers (alkyl nitrites) are vasodilators used by many gay, bisexual, and other men who have sex with men (GBMSM) to relieve pain, enhance pleasure, and facilitate penetration during sex. In 2013, the Canadian government cracked down on the sale of poppers products, however prevalence of poppers use among GBMSM in Canada remains high. Poppers have been studied by medical researchers since the 1980s, yet qualitative and community-based research to inform federal policy, remains somewhat less common.

METHODS

We conducted a critical interpretive synthesis (CIS) to better understand poppers health literature using the medical model of health as a point of reference. Analysis was performed using inductive and deductive methods including reflexive note-taking, mind-mapping, and close coding. 153 publications were identified to inform this review of which 5 were chosen for coding based on a purposive sampling framework.

RESULTS

Our findings are unified within a theoretical construct we term responsibility. Responsibility is a construct we use to describe the bias we identified in health sciences literature regarding poppers use that tends to exaggerate the necessity for poppers cessation, and devalue both the benefits of poppers use and the perspectives and experiences of people who use poppers. The emphasis on individual behavior change within the literature appears to be motivated less by objective measures or assessments of health risks and outcomes, and more by harmful stereotypes that position gay men and people who use drugs as inherently irresponsible.

CONCLUSION

We conclude by discussing how these findings have important implications for the review of current policy on poppers sales in Canada which remains influenced by a literature base prejudiced by factors such as homophobia, heteronormativity, and drug stigma, and recommend areas for future work.

Towards a reporting guideline for developmental and reproductive toxicology testing in C. elegans and other nematodes

Implementation of reliable methodologies allowing Reduction, Refinement, and Replacement (3Rs) of animal testing is a process that takes several decades and is still not complete. Reliable methods are essential for regulatory hazard assessment of chemicals where differences in test protocol can influence the test outcomes and thus affect the confidence in the predictive value of the organisms used as an alternative for mammals. Although test guidelines are common for mammalian studies, they are scarce for non-vertebrate organisms that would allow for the 3Rs of animal testing. Here, we present a set of 30 reporting criteria as the basis for such a guideline for Developmental and Reproductive Toxicology (DART) testing in the nematode Caenorhabditis elegans. Small organisms like C. elegans are upcoming in new approach methodologies for hazard assessment; thus, reliable and robust test protocols are urgently needed. A literature assessment of the fulfilment of the reporting criteria demonstrates that although studies describe methodological details, essential information such as compound purity and lot/batch number or type of container is often not reported. The formulated set of reporting criteria for C. elegans testing can be used by (i) researchers to describe essential experimental details (ii) data scientists that aggregate information to assess data quality and include data in aggregated databases (iii) regulators to assess study data for inclusion in regulatory hazard assessment of chemicals.

Chronic exposure to cyclohexane induces stereotypic circling, hyperlocomotion, and anxiety-like behavior associated with atypical c-Fos expression in motor- and anxiety-related brain regions

Recreational abuse of solvents continues, despite cyclohexane (CHX) is used as a safe replacement in gasoline or adhesive formulations. Increasing evidence indicates that CHX inhalation affects brain functioning; however, scanty information is available about its effects on behavior and brain activity upon drug removal. In this study, we used CD1 adult mice to mimic an intoxication period of recreational drugs for 30 days. During the CHX exposure (~30,000 ppm), we analyzed exploratory and biphasic behaviors, stereotypic circling, and locomotion. After CHX removal (24 h or a month later), we assessed anxiety-like behaviors and quantified c-Fos cells in motor- and anxiety-related brain regions. Our findings indicate that the repeated inhalation of CHX produced steady hyperactivity and reduced ataxia, sedation, and seizures as the exposure to CHX progressed. Also, CHX decreased grooming and rearing behaviors. In the first week of CHX inhalation, a stereotypic circling behavior emerged, and locomotion increased gradually. One month after CHX withdrawal, mice showed low activity in the center zone of the open field and more buried marbles. Twenty-four hours after CHX removal, c-Fos expression was low in the dorsal striatum, ventral striatum, motor cortex, dorsomedial prefrontal cortex, basolateral amygdala, lateral hypothalamus, and ventral hippocampus. One month later, c-Fos expression remained low in the ventral striatum and lateral hypothalamus but increased in the dorsomedial prefrontal cortex and primary motor cortex. This study provides a comprehensive behavioral characterization and novel histological evidence of the CHX effects on the brain when is administered in a recreational-like mode.

Inhalants

Toxic inhalants include various xenobiotics. Irritants cause upper and lower respiratory tract injuries. Highly water-soluble agents injure the upper respiratory tract, while low water-soluble inhalants injure the lower track. Asphyxiants are divided into simple asphyxiants and chemical asphyxiants. Simple asphyxiants displace oxygen, causing hypoxia, while chemical asphyxiants also impair the body's ability to use oxygen. Cyanide is a classic chemical asphyxiant. Treatment includes hydroxocobalamin. Electronic cigarette or vaping use-associated lung injury (EVALI) is a relatively new illness. Patients present with respiratory symptoms and gastrointestinal distress. EVALI appears to be associated with vaping cannabinoids. Treatment is supportive and may include steroids.

Huffing and twist: Fatal Torsade de pointes associated with Tetrafluoroethane Inhalation and amphetamine use

Many volatile chemicals inhaled for a recreational high have a chemical structure similar to chloroform and may lead to Ikr blockade and subsequent torsades de pointes. This is one potential mechanism of action for huffing-associated sudden death.

Distinct genetic regions are associated with differential population susceptibility to chemical exposures

Interactions between environmental factors and genetics underlie the majority of chronic human diseases. Chemical exposures are likely an underestimated contributor, yet gene-environment (GxE) interaction studies rarely assess their modifying effects. Here, we describe a novel method to profile the human genome and identify regions associated with differential population susceptibility to chemical exposures. Single nucleotide polymorphisms (SNPs) implicated in enriched chemical-disease intersections were identified and validated for three chemical classes with expected GxE interaction potential (neuroactive, hepatoactive, and cardioactive compounds). The same approach was then used to characterize consumer product classes with unknown risk for GxE interactions (washing products, cosmetics, and adhesives). Additionally, high-risk variant sets that may confer differential population susceptibility were identified for these consumer product groups through frequent itemset mining and pathway analysis. A dataset of 2454 consumer product chemical-disease linkages, with risk values, SNPs, and pathways for each association was developed, describing the interplay between environmental factors and genetics in human disease progression. We found that genetic hotspots implicated in GxE interactions differ across chemical classes (e.g., washing products had high-risk SNPs implicated in nervous system disease) and illustrate how this approach can discover new associations (e.g., washing product n-butoxyethanol implicated SNPs in the PI3K-Akt signaling pathway for Alzheimer's disease). Hence, our approach can predict high-risk genetic regions for differential population susceptibility to chemical exposures and characterize chemical modifying factors in specific diseases. These methods show promise for describing how chemical exposures can lead to varied health outcomes in a population and for incorporating inter-individual variability into chemical risk assessment.

[Cardiac arrest under special circumstances]

These guidelines of the European Resuscitation Council (ERC) Cardiac Arrest under Special Circumstances are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required for basic and advanced life support for the prevention and treatment of cardiac arrest under special circumstances; in particular, specific causes (hypoxia, trauma, anaphylaxis, sepsis, hypo-/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), specific settings (operating room, cardiac surgery, cardiac catheterization laboratory, dialysis unit, dental clinics, transportation [in-flight, cruise ships], sport, drowning, mass casualty incidents), and specific patient groups (asthma and chronic obstructive pulmonary disease, neurological disease, morbid obesity, pregnancy).

The last two decades on preclinical and clinical research on inhalant effects

This paper reviews the scientific evidence generated in the last two decades on the effects and mechanisms of action of most commonly misused inhalants. In the first section, we define what inhalants are, how they are used, and their prevalence worldwide. The second section presents specific characteristics that define the main groups of inhalants: (a) organic solvents; (b) aerosols, gases, and volatile anesthetics; and (c) alkyl nitrites. We include a table with the molecular formula, structure, synonyms, uses, physicochemical properties and exposure limits of representative compounds within each group. The third and fourth sections review the direct acute and chronic effects of common inhalants on health and behavior with a summary of mechanisms of action, respectively. In the fifth section, we address inhalant intoxication signs and available treatment. The sixth section examines the health effects, intoxication, and treatment of nitrites. The seventh section reviews current intervention strategies. Finally, we propose a research agenda to promote the study of (a) solvents other than toluene; (b) inhalant mixtures; (c) effects in combination with other drugs of abuse; (d) age and (e) sex differences in inhalant effects; (f) the long-lasting behavioral effects of animals exposed in utero to inhalants; (g) abstinence signs and neurochemical changes after interrupting inhalant exposure; (h) brain networks involved in inhalant effects; and finally (i) strategies to promote recovery of inhalant users.

Non-targeted metabolomics of multiple human cells revealing differential toxic effects of perfluorooctanoic acid

Differences in toxic effects of contaminants among human cells are essential for evaluating their health risks to humans. In this study, non-targeted metabolomics of multiple human cell lines (A549 (lung), DLD-1 (intestine) and L-02 (liver) cells) was used to address the differential toxicity of perfluorooctanoic acid (PFOA). The number of differential metabolites (DMs) identified in the PFOA-treated A549 cells (67) was highest, followed by DLD-1 (12) and L-02 cells (10). The categorization of DMs was almost uniquely specific to each of cell lines. PFOA significantly promoted linoleic acid metabolism in L-02 cells whereas this metabolism was inhibited in the PFOA-treated A549 cells. The levels of interleukin (IL)-1β, IL-6, IL-8 and IL-13 were about 1.5 times higher in the PFOA-treated A549 and L-02 cells than in the controls. PFOA stimulated the biosynthesis of arginine and the metabolism of vitamin B6 in A549 cells. Arginine and vitamin B6 supplemented into cell culture effectively decreased the levels of IL-6 and IL-8. The inhibition of purine metabolism by PFOA resulted in the arrestation of DLD-1 cells at the G₀/G₁-phase. Our results suggest that the differential toxicity of PFOA related to exposure pathways could be elucidated by metabolic profiles specific to various human cells.

A multi-taxonomic framework for assessing relative petrochemical vulnerability of marine biodiversity in the Gulf of Mexico

A fundamental understanding of the impact of petrochemicals and other stressors on marine biodiversity is critical for effective management, restoration, recovery, and mitigation initiatives. As species-specific information on levels of petrochemical exposure and toxicological response are lacking for the majority of marine species, a trait-based assessment to rank species vulnerabilities to petrochemical activities in the Gulf of Mexico can provide a more comprehensive and effective means to prioritize species, habitats, and ecosystems for improved management, restoration and recovery. To initiate and standardize this process, we developed a trait-based framework, applicable to a wide range of vertebrate and invertebrate species, that can be used to rank relative population vulnerabilities of species to petrochemical activities in the Gulf of Mexico. Through expert consultation, 18 traits related to likelihood of exposure, individual sensitivity, and population resilience were identified and defined. The resulting multi-taxonomic petrochemical vulnerability framework can be adapted and applied to a wide variety of species groups and geographic regions. Additional recommendations and guidance on the application of the framework to rank species vulnerabilities under specific petrochemical exposure scenarios, management needs or data limitations are also discussed.

European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances

These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy).

Impaired exercise capacity in electrostatic polyester powder paint workers

PURPOSE

Limited number of studies investigated the effects of Electrostatic powder paints (EPP) on human health. We investigated the effects of EPP exposure on lung function, exercise capacity, and quality of life, and the factors determining exercise capacity in EPP workers.

METHODS

Fifty-four male EPP workers and 54 age-matched healthy male individuals (control group) were included. Lung function and respiratory muscle strength were measured. The lower limit of normal (LLN) cut-points for FEV₁ and FEV₁/FVC were calculated. An EPT was used to evaluate bronchial hyperactivity. The handgrip and quadriceps muscle strength were evaluated using a hand-held dynamometer. An ISWT was used to determine exercise capacity. The physical activity level was questioned using the IPAQ. The SGRQ and NHP were used to assessing respiratory specific and general quality of life, respectively.

RESULTS

Duration of work, FEV₁, MIP, handgrip strength, and ISWT distance were significantly lower, and the change in FEV₁ after EPT and %HRmax were significantly higher in the EPP group compared to the control group (p < 0.05). There were no subjects with a < LLN for FEV₁ and FEV₁/FVC in both groups. In the EPP group, ISWT distance was significantly related to age, height, duration of work, FEV₁, change in FEV₁ after EPT, MIP, MEP, handgrip strength, IPAQ, SGRQ, and NHP total scores (p < 0.05). The change in FEV₁ after EPT, MIP, and duration of work explained % 62 of the variance in the ISWT distance (p < 0.001).

CONCLUSIONS

Changes in lung function based on LLN for the FEV₁ and FEV₁/FVC were not clinically relevant in EPP workers. Exercise capacity is impaired in EPP workers. Degree of exercise-induced bronchospasm, inspiratory muscle strength, and duration of work are the determinants of exercise capacity in EPP workers.

Massive Gasoline Ingestion in a 64-Year-Old Female: An Explosive Situation

Hydrocarbons from gasoline are toxins that can affect a multitude of organ systems based on the route of chemical intoxication exposure, with a majority involving oral ingestion or inhalation. Data is still incomplete concerning the systemic complications of gasoline ingestion due in part to variability in the chemical composition of various gasoline products.

A 64-year-old female presented to her local emergency department following the ingestion of gasoline in a suicide attempt with altered mental status, hypotension, shortness of breath, tachypnea, sinus tachycardia, coarse rhonchi bilaterally, and hyperactive bowel sounds. Treatment upon admission included intravenous ampicillin/sulbactam, intubation, an intravenous fluid bolus, and ketamine to address the developing hypotension. The patient developed multiorgan failure and acute toxic encephalopathy despite medical interventions and hemodialysis. After four days, comfort care measures were initiated, and the patient passed away.

Gasoline toxicity can have a profound effect on multiple organs based on the chemical properties and the route of exposure. These sequelae can be monitored through patient symptoms as well as radiologic imaging. Early supportive therapy and decontamination are vital in decreasing the morbidity and mortality associated with gasoline ingestion.

A Case Series of Chemical Dermal Injury Requiring Operative Intervention after Prolonged Dermal Methylene Chloride Exposure

INTRODUCTION

Methylene chloride, also known as dichloromethane, is a volatile hydrocarbon used in paint strippers and removers. Toxicity from methylene chloride may include narcosis and elevated carbon monoxide (CO) levels. Significant injury to the skin can occur after prolonged exposure to methylene chloride and other hydrocarbon-based solvents causing a chemical dermal injury.

CASE REPORT

This case series describes three male patients with prolonged exposure to a methylene chloride-containing paint remover to the bilateral hands with two of the three patients requiring transfer to a tertiary burn center and operative intervention. The clinical significance and impressive resolution of dermal injury from prolonged methylene chloride exposure are highlighted with detailed images and a literature review.

DISCUSSION

Chemical dermal injury secondary to methylene chloride exposure likely results from destruction of lipids within the epidermis and dermis and direct chemical injury. Prolonged exposure to skin can result in clinically important injury that requires management by a burn specialist and may necessitate operative intervention. The severity of the dermal injury can range from severe to mild and should be considered by a clinician after skin exposure to hydrocarbons.

Diesel siphoner's lung: An unusual cause of hydrocarbon pneumonitis

The practice of manual siphoning of diesel from fuel tanks is common among automobile mechanics in Nepal. When an automobile mechanic with a history of diesel siphonage presents with respiratory symptoms, the diesel siphoner's lung diagnosis should be considered. Clinical suspicion confirmed by radiological findings can help in early management and prevention of permanent damage.

[Actions that should not be taken with a paediatric patient who has been exposed to a potentially toxic substance]

OBJECTIVE

To show the preparation process by the Poisoning Working Group of the Spanish Society of Paediatric Emergencies (GTI-SEUP), of the list of things «not to do» for a paediatric patient who has been exposed to a potentially toxic substance.

METHOD

The preparation process of the list was carried out in three phases. First: «Brainstorming» that was open to all members of the GTI-SEUP. Second: Recommendations were selected by following modified-Delphi methodology. All participants were asked to rate the proposals (from 1 = strongly disagree to 9 = strongly agree). Those with an average score greater than 8 were accepted (provided that at least two-thirds of the participants had given them a score ≥ 7), and a second consultation was made for the recommendations with an average score between 6 and 8. Third: Writing and creating a consensus of the final document was done.

RESULT

A total of 11 proposals were initially obtained. Thirty-two of the 57 GTI-SEUP participants completed the scoring questionnaire. In the first consultation, seven «not to do» recommendations were accepted, and four obtained a doubtful average score (between 6 and 8). After the second consultation, the list was made up of eight recommendations. Two refer to general management, four to gastrointestinal decontamination techniques, and two to the administration of antidotes.

CONCLUSION

The list of actions that should not be taken with a child that has been exposed to a possible poison is a consensus tool, within the GTI-SEUP, to promote improvement in the quality of care offered to these patients. This improvement is based on avoiding unnecessary measures, which can sometimes be harmful to the child.

Reversible Nephropathy Associated with Jet Fuel Exposure

Acute kidney injury (AKI) with progression to oliguric or anuric acute renal failure (ARF) is often related to use of well-known nephrotoxic agents including medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme inhibitors (ACEis)/angiotensin II receptor blockers (ARBs), and certain classes of antibiotics. Hyperosmolar IV contrast is also a well-known nephrotoxic agent. Severe sepsis with subsequent hypotension, marked hyperglycemia, and those with difficulty accessing water or with poor oral intake can also present with acute kidney injury related to kidney hypoperfusion, dehydration, and volume depletion. In this case report, we discover and discuss the possible effects of regular and daily occupational exposure of jet fuel (a mixture of hydrocarbons) on renal function. Jet fuel is an underdescribed and not well-known nephrotoxic agent; however, its direct toxicity on kidney function appears to be reversible with removal of exposure and aggressive fluid hydration.