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water supply during showering, dishwashing, laundering, and other activities does not indicate significant exposure by this route. To evaluate this exposure route, levels of gasoline constituents in the household drinking water should be measured and more information about the storage-tank leak should be obtained.

The potential for gasoline or hydrocarbon-based solvent exposure through the patient’s hobby should be explored carefully. Detailed information should be obtained regarding the patient’s use of gasoline as a solvent to clean his hands or automobile parts. What is the frequency and duration of exposure? Is gasoline stored in open containers in the garage? Is the garage ventilated while he is working? If there is any indication of recreational gasoline abuse, his symptoms could be related to overexposure.

  1. Several of the hydrocarbons in gasoline can produce CNS toxicity. The most likely components, based on their percentage volume, would be toluene and xylene. n-Hexane can also cause CNS, as well as peripheral nerve, toxicity; however, the low concentration of n-hexane in gasoline makes it an unlikely candidate.

  2. Nonspecific symptoms can be very difficult to evaluate. If there is no objective evidence of disease and no laboratory or physical abnormalities, the clinician should consider other contributory factors. Are the readjustment stresses to the new community? Are there financial or marital difficulties or other external considerations?

  3. If a careful history indicates that the patient has had recent onset of frequent headaches, as well as other neurobehavioral symptoms, a thorough neurologic examination should be performed. If deficits are demonstrated, further neurologic workup, such as scans, EEG, and neurobehavioral testing, is indicated. If gasoline toxicity is a consideration, liver and kidney function should be evaluated, although abnormalities are unlikely unless there has been severe acute overexposure.

  4. No, the measured results are well within normal limits and do not indicate a toxic exposure. Given the potential variability of water analyses, it would be appropriate to confirm these insignificant levels by performing two or three analyses.

  5. Occasional misuse of liquid gasoline to clean hands or machinery parts is unlikely to cause significant toxicity, although the practice may present a serious fire or explosion hazard. Repeated skin contact can lead to defatting of the skin and dermatitis. The dermatitis on the patient’s hands in this case study could indeed be from dermal contact with liquid gasoline.

    Prolonged and repeated misuse of gasoline as a solvent or cleaning agent can, however, cause significant toxicity. If the patient has frequent extensive skin contact with liquid gasoline or is frequently exposed to high concentrations of gasoline vapors via open containers of gasoline in a confined space, his headaches, confusion, and forgetfulness could be from gasoline overexposure.

  6. The single most important intervention in this case would be to counsel the patient on the hazards of gasoline and to eliminate further misuse. Removal of exposure would most likely lead to a complete resolution of symptoms without further sequelae. In a few cases, some residual deficits might persist.

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