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)% Legend%for%this%talk% U=%Uses% I=%Industry% T=%Toxicity% M=%Miscellaneous%factoids% Acrylaldehyde, propenal, allyl aldehyde Acrolein% Ethylene aldehyde, aqualin, (CH2=CHCHO) Acrolein%=%Acrid%=%IRRITATING% I:%Contact%herbicide% I:%%WWI%Lacrimator% TP%Water%soluble%irritant% TP%Cellular%toxin%via%oxygen%free'radicals' MP%Metabolite%of%cyclophosphamide' Propenamide, acrylic amide, Acrylamides% akrylamid Heating%Starches% UP%Polymer%production%(SDSPPAGE),%flocculator%% TP%Axonopathy% TP%Dermatitis%(peeling,%red/blue,%hyperhidrosis)% TP%IARC%2A%(poss%gyn%CA)% MP%Polymer%=%nonPtoxic,%Monomer=%toxic% Acrylates, methylacryates, Cyanoacrylates Acrylates% Ethyl, methyl, 2-ethyl hexyl, butyl… UP%CrossPlinking%properties%(plexiglass)% TP%Irritant%(skin,%MM,%and%pulmonary)% TP%Contact%dermatitis% MP%Penetrates%latex/%rubber%easily%% Dimethylamine Trichlorotriethylamine Benzidine Benzidine Amines% β-naphthylamine Dimethylamine AZO Dyes -Vulcanization Aniline 4-chloroaniline Aniline%Compounds% 4-aminophenol Nitrobenzene 4,4’-Methylene dianiline Aniline UP%Precursor%for%polyurethane,%indigo=%blue%jean%die% IP%Smells%like%rotten%fish% 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)% 1,3-butadiene Hexachloro-1,3- butadiene Butadienes% Many others Butadiene UP%Monomer%for%plastics%(ABS%plastic*),%tobacco%smoke% TP%Irritant%(skin%and%mucous%membranes)% TP%IARC%2A%(lymphohematopoetic,%testicular,%thyroid,%mammary)% *ABS:%AcrylonitrilePbutadienePstyrene% 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)%% Potassium chlorate Calcium chlorate Chlorates% Sodium perchlorate, etc UP%Oxidizer,%pesticide,%explosives,%bleaching%paper% UP%Prior%uses:%%pryotechnics,%mouthwash% 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)% Diamine (Hydrazine) Hexamethylene diamine Toluene-2,4-diamine (TDI) 2-methyl-1,4- benzenediamene Diamines% TDI Hydrazine UP%Hydrazine=%Rocket%fuel%(reducer),%insecticides,%plastics% UP%PPphenylenediamine=%%henna'&'all'hair'dyes...% 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%% Methylisocyanate (MIC) Toluene diisocyanate (TDI) Isocyanates% MIC UP%Producing%polyurethane%polymers%% %%%%(don’t%confuse%with%aniline%also%a%polyurethane%precursor)% UP%Methylisocyanate%(MIC)P%production%of%carbamates% TP%MIC:%Major%irritant%(pulm,%derm,%ocular)% TP%TDI:%#1'Occupational'asthma'(HP)% 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% Mercaptomethane Chemicals%with%a%–SH%group%(noxious≈%cabbage)% UP%Odorant%(natural%gas=%tPbutylmercaptan)% UP%Intermediate%in%synthesis%of%fuels,%pesticides…% TP%Irritant%(derm,%MM,%respiratory)% TP%MetHb%&%hemolysis%(worse%in%G6PD)%% acetonitrile propane nitrile Nitriles% butanenitrile Acetonitrile Chemicals%with%a%–CN% UP%Solvents%(eg.%artificial%nail%remover),%reagents% 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”*% PPD UP%OPD:%dyes,%fungicides,%vet%antihelminthic% UP%PPD:%hair'dyes'and'henna'tattoos%% TP%OPD=severe%urticaria/dermatitis%(eye%blindness)% TP%PPD=%bladder%cancer%% Phosphorus% Red Phosphides% Zn Phosphide Phosphorus UP%Making%phosphates,%detergents,%fertilizer,%match%tips%(red)% UP%Zn%&%Al%phosphide:%Insecticides,%rodenticides% 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% diethylhexyl phthalate UP%Plasticizing%for%vinyl,%softens%PVC% TP%Controversial%whether%phthalates%have%health%%