Document Negb8qG8LoGmrv33D625DkJ3V

LETTER (lin ii.il Vixicnlogv. Wi.' i. I?1* I sc : ,'itn| , P-1 706 Pneumonitis Following Inhalation of a Commercially Available Water Repellent Ta the Edita t . Water repel lew products used lu protect upparel. tool wear, and accessories contain solvents and prtifKjIladl.s. Several reports have demonstrated pulmonary eompho.iitons following the inhalation unite solvent l . l . l triehlu roethane (I -4i. Follow ne prohibition ol this suivent in Jamiarv l `/V4. newer solvents m used multiple episodes ot severe pulmonary toxicity (5 Sr Alter an apparent -arhsilienee ot such repiets. vve repiut a case ol fHiltnnriniv toxicity alter exposure to lire l m e s ol an incompletely tdertidieil walee repellent produel. t rise rtrp o rt \ 5 5 -veut-slid wlmo mart with a historv ol hyporlipidemtu. childhood asthma, .u>d resrless h-g svridronte p re sented to the emergency department iL i); with level. chills, dyspnea, tangue. anil dizziness. His past surgical history included an appendeetomy and leg surgery after Trauma several years ago. His social history was signifi cant tor pipe-smoking, occasional ethanol use. and travel to A l i n a in .April - May rd !044 j fe ro.-cived titalana pro phy taxis with irtet)oi|iune hclore and after this visu. The patient hail no known drug alletaies hut liai! an egg and egg pn-ducl allergy. 1he only medication prior to admis sion .-..s aiorvaMatm One day prior to admission 1(0 / I L-Wi. the patient used a a utci-rcpcllent spray on sonic laineoais in his garage \ short lime alter the administra(lon .4 die .lerosidiosl -w.uer repellent, the patient had episodes (HMipii'diielise cough and tell fevciislt with chills l.aler dial night die paliem fell nauseated upon awakening .uul had a syncopal episode -with briel loss ot consciousness in his hufhrnom. the next day he suit lelt lev crush with chills, and lutl dyspnea, fatigue, and dizzi ness at which tu ne his wile brought him to die HO. Iri die HO. his p O . was 40* f m,| a chesi \ ray showed btlat eral ditluse airspace disease. S>hiu afterwards, while .sleeping. his 0 . saturation dropped to a nadir o f 4 2 'i . His O . saluraiion unproved to <)(>'-; with the u s e ol a 100', nonrelv'eather mask I h-. temperature was 3 7 . and re spnatoiy iate 3S lucaths/miu. His lungs were icrunrknhlc foi ihoiichi in die mid lung / o n e I ahorniory values were tiolahk-for a iihite blood cell cornu ul IX .> t o / m m . Ihc patient was treated with niethylpieihiisolom- 12s ntg intravenously IVi m tits' HI) ,m.l was admitted to tits' intensive care uni! `or ovy ccnation nioim.irine Oiue llteiapy m the intensive cate unit included mclhvlpicdiitsolonc 4(1 nig IV every b hours and azithromycin MKI mg IV/-.I I he patient iei|iiired I II), lo r a days at 40 <X(i'-< Hi Flow to keep lus oxygen salutation above MO'-. On day 2 of'hospitalization, repeal elicsi \ ray showed m:pmvenntnt ot airspace disease and tile patient lelt -aih|cc lively better. An echocardiogram showed preserved left ventricular function and no pericardial s lfusion An elec trocardiogram showed normal sinus rhvlhm and m- iscii emic changes. The patient was wcaue.il oil (Ik- -ixvkcii on dav 3 and tiai! an uneventful recovery to ilischar-..v from the hospital on day i DISCI SSION t h e neio-olt/i'd -Ante: icpellcul. lectio n d m j.. d is tributed by Blue Mag-e Frod-uns. Im . ot Stockton C A Thei*anisier m'ltes dial it di-gs not ci-nrain l . l . l uichior.* ethane. The Vlateual S.ilety I tala Sheet dos-s list jvu-.-- 17o P-2 Table ! A 1 tf D j 'h M H . i i i J . i ; <! P i i c n ! \ L e a th e r ( M i l l 1. 1! < ' * Svm ptoin P a n e ( Mlill SOB N'iHKt'd W hcc/Jiu* Sute ihtful vvt*r D i/./uissH citJaciic live irruauon R hinoriliea 26 IS IS s S 5 t > i Icuiii distillutes us a ha/urdiHis ingredient Petroleum dis tillates contain mainly unsubstituted aliphatic or straight thatn hydrocarbons in the alkane series t`>). They are hy drocarbons lhai arc rctined from crude oils and include kerosene, gasoline, naphtha (charcoal lighter Mind, lighter lluidi. mineral seal oil i lurniluie pitlislo. arid various sim iliit compounds i'll According to Ash Chaudhrv f.Scplemher 2000iol Mine Magic Products. Inc . other insredi onts include fluorocarbon polymers. The Tectron dwi laltelitlu wains dial die vapor/misl may he harmful, iim-nnonai misuse by inhaling can be faial. and dim n could be harmful or fatal if swallowed, flic niauufitcluier did lot piohihil use in a closed mom nor did if offer iii.slrucnoiis if the product was ingested or inhaled After (he removal of 1.1.1-trichlorocthanc. the te|orimitated walei pi noting products containing fluoro carbons solvents caused several epidemics of pulmonary toxicity. We report this case to alert clinical toxicologists ( the continued market presence uf lUiotopulyiiiei-coulaining waterproofing products ihal have (he potential to ; iiisc life threatening pulmonary injure Michael F. Caron C. Michael While University of Connecticut School of Plianuacv Slorrs. ( onneclicui Drug Inlonnaiiou <'enter. liantord Hospital Haitfnul. Connecticut I CUCI lit the I 'tillin' KKFRRKNCF.S I limi. V , Aki/al.i N . Olikiiicn. M.. Illuse. N . tsliioka. M.: Mariiiiui. I Acme I .une injury A firr hih.tlaiiiui ni Watei Pioulmg Spray Wlule S m. tkmy a C'isaicuc. espi ration IWN, Os s d .l.as - Huiles. H : l.oehsiei!:. K.; |.;u. (...: M e t impali M A. I vm ( asi-, o| t. iilouiiaU'.d Hydioc-aii-'ou Assui.'ialcd M \m .ai d u i Ischemia. Vei Hum 'foxicol l ` 7 . IV. ''VH 101 Wiiiek. ( .1... VVjdil't. XV. w ; H iinioii. H ., Ko/ iii. I.. f atal Infialali.il. o( 1.1 I cii liloi*'i..-'.li.-un; I-o r -iisk S ii fut IW7. C 1,1 Ko. I. \V<hi. ( > ! . . H ealey . K M.. S h cp p au l. H.. f i n is . I l i Inst l>am am i Hypoxi-min irorn fiilialation ol a 'trillilo uiediaiie A er osol (`iolIuli. I. l o v u o l. f l m . lo x icn l PI8.V y.'. T*' A4!. . Hlirkliun. K.K.. U nii. A ; Petrilli. fi .O Domieli S . Don osan. XV. ('ulm ciiaiy l o \ ;c;l\ l-ollowing l'.xpusurc lo a n A ero so ii/ed l Oiilht" i'mlecioi I Toxicol C lin . T m icol i m . W. 21 -2 4 . f>. Sm ilksiem. M b u i t o n . B . . Keene. W. Acule Ffespiralorv llliii'ss f iiikcii lo I s; o Xeo.sol .eutfier ( oiuh uoriei. M M W R 1`J`f.V -i, ')( >- K6 /. 7 Kulis. K . Hieill. .1 . Pliilhps. .y . el al. Seveie Acuti.- Re spiratore lllncss | mki-ii io l se ot Shiu- Spravs MMWR l `J*3. *e. KS5 8 * S lluhhs A I' . ( ...sii.m .o a. X . Xfa. .f.y.t . f-ia/ei. I t t i . Niepel. fM D m a i m . a i ! S : ti r l e A . Si l iu i-elu Meli) D.. Robin so n . V.A.. V.m t y k e . Har gel. M . Xiau:: I : Parker. Acute I u n : .:jlirs fmlused fiy a t, om iucrci.il l.caiher < iiiiiliioii, r f o n e o l Appi l 'lim ili;., el |W7. ' .i. .17 -|(, u - lliirlhm. K M Unii X II li.ilmev II I XVa son S Kulis. K.. Marcus, s Kuukle. I). B H y U n v a r b o n s Micr orn edes. Iin X'ol IOS: l ' p s g(K||i