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Health Hazards of Solvents Case Study #3

Health Hazards of Solvents Case Study #3. James E. Cone MD, MPH and Karen Packard, RDH, MS This presentation is made possible by a grant from the Association of Occupational and Environmental Clinics and the National Institute for Occupational Safety & Health. Case 3.

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Health Hazards of Solvents Case Study #3

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  1. Health Hazards of SolventsCase Study #3 James E. Cone MD, MPH and Karen Packard, RDH, MS This presentation is made possible by a grant fromthe Association of Occupational and Environmental Clinics and the National Institute for Occupational Safety & Health.

  2. Case 3 • Mr. Z works in a chemical barn for a chemical company. • He was working next to a 2000 gallon chemical storage tank containing lasso-atrazine (triazine herbicide), which was recirculating and a high pressure hose broke and sprayed chemical into his face.

  3. Case 3 • First aid and eye wash was provided • Complaints initially: eye irritation and visual difficulties, headaches. Eye exam by ophthalmologist: corneal stain + on L eye. Acuity 20/70 L eye, 20/70 R eye. • Chief complaint in follow-up: Severe headaches every time he goes to work at the same job.

  4. Case 3 - MSDS • Lasso-Atrazine: • Contains alachlor (2-chloro 2, 6 diethyl N methoxy methyl). Mild skin irritant. Hepatotoxic, kidney toxicity. Eye irritation. Skin sensitizer. Possible carcinogen. • Contains atrazine (2 chloro 4 ethyl amino 6 isopropyl amino S-triazine). Herbicide. Slight skin irritation. Renal effects. Carcinogen in animals. • Mixed with solvent: benzene chloride. Strong narcotic effects, with CNS intoxication.

  5. Case 3 • Headaches start predictably after he begins work at the plant in the same area, resolve on weekends, several hours after going home from work. • One type of headache was bitemporal, constant and mild in character (3/10). The second type was much more intense (9/10), pulsating, associated with nausea and vomiting, and required him to stop whatever he was doing at the time and rest.

  6. Case 3 • He was evaluated at the University Clinic, and treated with amitriptyline and trilafon. • No prior history of headaches. No family history of headaches / migraine. • He reports sleep disturbance: early awakening. Intrusive thoughts. • ETOH: occasional wine with dinner. • Multiple prior mild acute intoxication episodes with dizziness.

  7. Case 3 • Neuropsychological evaluation: Difficulty with verbal memory, complex visual memory especially memory storage of new information. Full scale IQ 78. Premorbid estimate 106. Mild loss of cognitive integrative functions. Personality: severe depression. • After six months, a CT Scan of Brain is performed and is normal. • Eye acuity gradually returned to 20/20 in both eyes.

  8. Case 3 • What are your diagnoses? • What features of the headaches may be helpful in making the diagnosis? • Which chemical(s) are most likely responsible for ongoing symptoms? What other chemicals are common causes of these types of headaches? • What is his prognosis? • What additional treatment recommendations?

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