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Environmental Medicine: Integrating a Missing Element into Medical Education (1995)
Institute of Medicine (IOM)

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. "Case Study 25: Paint Remover Hazard." Environmental Medicine: Integrating a Missing Element into Medical Education. Washington, DC: The National Academies Press, 1995.

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Environmental Medicine: Integrating a Missing Element into Medical Education

Short exposures to methylene chloride result in formation of carboxyhemoglobin (COHb) that continues to increase after exposure before slowly returning to normal levels. The presence of methanol further prolongs period of COHb elevation and cardiovascular stress.

with the air pollution in his section of Milwaukee. This nonsmoker was discovered to have a COHb saturation of 6%, and of 8% on each of the two mornings following a two-hour exposure the previous evening to paint-and-varnish-remover vapors. After a fruitless search to discover the exogenous source of CO, the cardiologist was exposed for one hour to a low concentration of methylene chloride vapor in a controlled-environment chamber.2 The subject’s COHb level rose from a preexposure level of 0.4% to 2.4%. Because there was no evidence of a hemolytic process, it was presumed that the CO was a metabolite of CH2Cl2. To confirm this isolated observation, a series of experiments were conducted in which 21 male and nine female volunteers were exposed to CH2Cl2 vapor concentrations of 50, 100, 250, 500, and 1,000 ppm for varying periods of time. A prompt elevation of COHb was observed in each subject exposed to CH2Cl2.2,7

EXPERIMENTAL PROCEDURE

Paint Remover Exposure.—To investigate the potential of paint and varnish removers that contain CH2Cl2 to elevate COHb to toxic levels, four three-hour paint stripping operations were carried out in a controlled-environment chamber where the ventilation rate could be regulated, the CH2Cl2 vapor concentration accurately monitored, and careful medical surveillance of the four volunteer participants was possible. Two individuals participated in each experiment. One actively applied the paint remover and did the stripping while the second subject remained sedentary, making it possible to assess the effect of alveolar ventilation on absorption. Three room-ventilation rates were studied. The first simulated the air turnover commonly encountered in home basements, while the other two simulated the higher rates of air turnover that could be encountered in industrial settings. In each three-hour experiment, one quart of a liquid gel paint remover was applied to a baby crib with a paint brush and later, scraped off. The volatile components of the paint remover were 80% CH2Cl2 and 20% methanol by weight.

Subjects.—Four healthy men ranging in age from 19 to 47 years volunteered for the study after the purpose, procedure, and risks of the investigation had been fully explained. None of the subjects used drugs or consumed alcohol during the 24-hour periods preceding and following each experiment. One subject, who was a smoker, abstained for 12 hours prior to the experiment and was not permitted to smoke until a final COHb determination had been made.

Exposure Chamber.—The four experiments were conducted in an 817-cu m (2,680-cu ft) controlled-environment chamber.2,7 Air flow was adjusted so that the half-life of the CH2Cl2 vapor would range from 33 to 11 minutes. Air temperature was 22.3 to 23.3 C and the relative humidity was 55%.

Analysis of Exposure Chamber Atmosphere.—The CH2Cl2 vapor concentration in the breathing zone of the subjects was continuously recorded by an infrared spectrometer equipped with a 10-meter path-length gas cell. This gas cell was continuously supplied with air drawn from the subject’s breathing zone through a polyethylene tubing that measured 0.635 cm in diameter.2,7 The absorbance of 13.3µ

Page
513
Front Matter (R1-R12)
Executive Summary (1-4)
1 Introduction (5-13)
2 Curriculum Content (14-21)
3 Implementation Strategies (22-43)
4 Changing Medical Education (44-51)
5 Concluding Remarks (52-53)
References (54-58)
Appendixes (59-60)
A: Taking an Exposure History (61-96)
B: Medical School Courses and Clerkships: Access Points for Integrating Environmental Medicine (97-120)
C: Case Studies in Environmental Medicine (121-138)
Case Study 1: Arsenic Toxicity (139-163)
Case Study 2: Seasonal Arsenic Exposure from Burning Chromium-Copper-Arsenate-Treated Wood (164-167)
Case Study 3: Asbestos Toxicity (168-188)
Case Study 4: Benzene Toxicity (189-207)
Case Study 5: Beryllium Toxicity (208-223)
Case Study 6: Cadmium Toxicity (224-243)
Case Study 7: Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning (244-248)
Case Study 8: Carbon Tetrachloride Toxicity (249-266)
Case Study 9: Chlordane Toxicity (267-288)
Case Study 10: Chronic Reactive Airway Disease Following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient (289-290)
Case Study 11: Chromium Toxicity (291-311)
Case Study 12: Cyanide Toxicity (312-331)
Case Study 13: Dioxin Toxicity (332-348)
Case Study 14: Ethylene/Propylene Glycol Toxicity (349-371)
Case Study 15: Formalin Asthma in Hospital Staff (372-373)
Case Study 16: Gasoline Toxicity (374-394)
Case Study 17: Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease (395-401)
Case Study 18: Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis (402-409)
Case Study 19: Lead Toxicity (410-435)
Case Study 20: Legionaires' Disease: Description of an Epidemic of Pneumonia (436-444)
Case Study 21: Mercury in House Paint as a Cause of Acrodynia: Effect of Therapy with N-Acetyl-D, L-Penixillamine (445-449)
Case Study 22: Mercury Toxicity (450-472)
Case Study 23: Methanol Toxicity (473-492)
Case Study 24: Methylene Chloride Toxicity (493-511)
Case Study 25: Paint Remover Hazard (512-515)
Case Study 26: Fatal Outcome of Methemoglobinemia in an Infant (516-517)
Case Study 27: Nitrate/Nitrite Toxicity (518-537)
Case Study 28: An Outbreak of Nitrogen Dioxide-Induced Respiratory Illness Among Ice Hockey Players (538-541)
Case Study 29: Pentachlorophenol Toxicity (542-557)
Case Study 30: Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy (558-561)
Case Study 31: Cholinesterase-Inhibiting Pesticide Toxicity (562-584)
Case Study 32: Infertility in Male Pesticide Workers (585-587)
Case Study 33: Pesticide Food Poisoning from Contaminated Watermelons in California, 1985 (588-595)
Case Study 34: Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides (596-604)
Case Study 35: Polynuclear Aromatic Hydrocarbon (PAH) Toxicity (605-621)
Case Study 36: Polychlorinated Biphenyl (PCB) Toxicity (622-638)
Case Study 37: Ionizing Radiation (639-673)
Case Study 38: Radon Toxicity (674-694)
Case Study 39: Residential Radon Exposure and Lung Cancer in Sweden (695-700)
Case Study 40: Community Oubreaks of Asthma Associated with Inhalation of Soybean Dust (701-706)
Case Study 41: Tetrachloroethylene Toxicity (707-726)
Case Study 42: Toluene Toxicity (727-743)
Case Study 43: Occupational Asthma Due to Toluene Diisocyanate Among Velcro-like Tape Manufacturers (744-749)
Case Study 44: 1,1,1-Trichloroethane (750-766)
Case Study 45: Trimethyltin Encephalopathy (767-771)
Case Study 46: Trichloroethylene Toxicity (772-792)
Case Study 47: Vinyl Chloride Toxicity (793-811)
Case Study 48: Work-Related Disorders of the Neck and Upper Extremity (812-813)
Case Study 49: Contact Dermatitis in Surgeons from Methylmethacrylate Bone Cement (814-816)
Case Study 50: Skin Lesions and Environmental Exposures: Rash Decisions (817-861)
Case Study 51: Acoustic Trauma Caused by the Telephone: A Report of Two Cases (862-867)
Case Study 52: Behavioral and Audiologic Manifestations of Noise-Induced Hearing Loss (868-871)
Case Study 53: Reproductive and Developmental Hazards (872-892)
Case Study 54: Childhood Asthma and Indoor Enviromental Risk Factors (893-903)
Case Study 55: Populations at Risk From Particulate Air Pollution - United States, 1992 (904-908)
D: Resources: Agencies, Organizations, Services, REferences, and Tables of Environmental Health Hazards (909-970)
E: Committee and Staff Biographies (971-975)