Document V3GQ7zMe3Eo8aN5Xj1renBE2q
ETHYL CORPORATION
INTER-OFFICE
CORRESPONDENCE
TO C. B. Hunt
ADDRESS
Houston Plant
FROM
J. P. Gibbs, M. D.
ADDRESS
Houston Plant
SUBJECT Surveillance for liver disease in Houston Plant Employees
DATE
August lA, 198A
As part of our physical examination program we routinely check several factors (on blood test) that indirectly provide information regarding the status of the liver.
These tests include: *
Total Protein Album!n GlobuIin Total Bilirubin Direct Bilirubin Alkaline Phosphatase G-Glutamyl Transpeptidase
SGOT SGPT LGH
Each of these tests is done annually and the results compared against normal ranges established for healthy populations. In addition, the average values for our employees are computed and compared with averages experienced in a much larger population tested by our commercial laboratory (MetPath). In this way, hopefully, we would be able to detect any minor abnormalities that might affect a large number of employees.
The two most sensitive of these tests, which frequently become abnormal when the other tests remain normal are the SGPT and SGOT (enzyme tests). These enzymes are easily measured and when elevated imply some
damage to liver cells, however, other testing is required to determine the cause of the damage. The attached figures 1 and 3 show a month by month comparison of our mean values for SGPT and SGOT respectively over a 12 month period. Figures 2 and A show a frequency distribution plot for all of our values in the first quarter of 198A for SGPT and SGOT respect ively. The several values above 2 standard deviations represent multiple
rechecks on 3 or A employees with high enzyme levels.
By far the most common cause of high SGOT and SGPT levels is excessive alcohol consumption. The employee is counselled regarding the effects of alcohol and the risks of cirrhosis and if it is evident that alcohol could be a factor the employee is asked to stop drinking and the tests repeated
at 2 or 3 week intervals until they return to normal.
FC ?978
C. B. Hunt
-2- August Ik, 138k
One employee was recently found to have persistently elevated liver enzyme levels that could not be attributed directly to alcohol or to any medications. Since he worked as an outside machinist it was assumed that he could potentially have been exposed to any of the chemicals that we have here on the Plant, although no particular exposure incidents could be recalled. He was referred to a gastroenterologist for further evaluation which included nuclear scans of the liver, special blood tests and a liver biopsy. The scans and blood tests were normal and the biopsy revealed mild to moderate fatty infiltrate (steatosis). Figure 5 taken from Zimmerman's textbook of Hepatoxicity lists several possible findings on a liver biopsy and agents associated with each finding. Figure 6 also taken from Zimmerman's text lists agents known to produce Steatosis. Unfortunately, there is no way to determine if this employee's steatosis (fatty liver) is due to a toxic exposure or to some other condition (such as obesity). If it is presumed to be due to a toxic exposure, there Is no laboratory test available to determine what the responsible agent is nor is there any way to test for the presence of any suspected agents in the blood or liver cells.
In order to determine if other employees with similar possible chemical exposure histories had an increased incidence of abnormal liver enzyme tests, I reviewed the medical records of all other employees who have been working as shift Machinists for at least a year at the Houston Plant.
In figure 7 I have compared their SGPT and SGOT enzyme levels with those
of the remainder of the employees at the Houston Plant and with MetPath's average values. I do not think that there is any statistically significant difference between the group of outside machinists and the total Houston Plant population or between the Houston Plant population and the much larger pop ulation that MetPath serves. I would therefore conclude that there is not any significant exposure to liver toxins occurring routinely at the Houston Plant.
It is well known that a number of agents can produce an hepatic injury that appears to be an expression of special individual susceptibility instead of intrinsic toxicity of the offending agent. This could possibly be the case with the employee with steatosis. In such cases, I recommend that the employee be restricted from any likely exposure to any suspected liver toxins unless a definite cause of his liver disease (such as alcohol) is found.
JPG: iz cc: G. B. Meyers, M. D.
JV P. Gibbs, M. D.
EC ?979
HETPATH BATA
0.60
II.It
21.11
SI.II
41.11
IKX*XXXXXXIXXNXXXXXXIXX*XXXX*XIXMXXXXXXXIXX*
MAR 84 I
X
MEAN I 28.53
X
S.O. I 64.15
X
G.T.
I loom
X
IXXXMMXXKKIXXKKXMXXKIKKKXXKRKX
FEB 84 I BEAK I 27.71
X X
S.D. I 68.14
X
G.T. i loom
X
IXKXKKKXXXIRXNKXXKXXIKKXKXXXKX
JAN 84 I MEAN I 29.16
X X
S.D. I 69.16
X
G.T. I 100080
X
IXXXKKXXKXIXKKKKKXKKIKKXKMXXXKI
DEC 83 I
-
X
MEAN I 29.61
X
S.D. I 74.21
X
G.T. I 100006
X
IXXXXKKXKKIXXKXKKKKXIKXKXXKXXXI
HOV 83 I MEAN I 28.75 S.D. 1 80.07 G.T. I 100000
X K X X
IKXXXKKKXMIXXXKXXXKKlXKXKKKKXXl
OCT 83 1 MEAN 1 29.77
X X
S.D. I 72.86
X
G.T. I 100000
X
JXXXXXXXXXIXXXXXXXXXIXXXXXXXXXIX
SEP 83 I
VX
MEAN I 30.77
X
S.D. G.T.
I 71.14 I 100000
X X
IXXXKKXKXKlKXXXXXXXXlXXKXKXKKXlX
AUG 83 I
X
MEAN S.D.
I 29.95 I 74.98
X X
G.T. I 100000
X
JUL 83 MEAN S.D. G.T,
JUN 83 MEAN S.D. G.T.
MAY 83 MEAN S.D. G.T.
XX
X 30.01
X
I 78.45
X
I 100006
X
IXKKXXXKXXINKKKKKKKKlXXXKKKXKKIKK
IX
I 31.87
X
: 91.30
X
I 110000
X
IKKXKKXXKKIXXXNKXKXXIXXXXKKXXXIXXX
IX
X 32.73
X
I 86.83 I 101000
X X
APR 83 I
MEAN X 31.54 S.D. I 71.01
X X
MN(tO> ' DATE^/31/84
METPATH OCCUPATIONAL EPIDEMIOLOGICAL 5URVEI
ESI RESULT LT GROUPINGS
o.o - 2.50 2-SD I
2.51- 5.00
I
5.01- 7.50
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7.51- 10.00 ' IKXX
0.01- 12.50
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2.51- 15.00
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5.01- 17.50
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7.51- 20.00
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0.01- 22.50
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12.51- 25.00
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0.01- 32.50 MEAN IKXXXXXKXXXXK
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9 31- 65.00
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5.41- 67.50
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7.31- 70.00
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2.31- 75.00
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5.01- 77.50
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7.51- 80.00
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0.01- 82.50
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7.31- 90.00
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*XXX FREQUENCY DISTRIBUTION XXXX
PROGRAM
PAGE
SPECIMEN X
ETHYL CORP
COUNT
--------
X
X
STATISTICAL SUMMARY FROM 1/ 1/84 TO 3/31/84
0 ACCOUNT 20692
2 TEST 1750 TRANSAMINASE, SGP
3
2 REFERENCE RANGE 10 UNADJUSTED FOR AGE AND SEX
14 1-70 UHITS/L
17
5
27
12
If
12
11 LOU 7.00 If. HIGH 212.00
3
f
7 RAU STATISTICS
3 SAMPLE SIZE - 189
4 MEAN
* 33.497
1
STD. DEV.
- 26.782
2 CO. OF VAR. = 79.954
1
1
I REFINEO STATISTICS 0 (VALUES BEYOND 3 S.O. OMITTED)
1 SAMPLE SIZE = 186
1 MEAN
* 30.710
1
STD. DEV.
* 15.376
1 CO. OF VAR. = 50.070
t MEDIAN = 27.51- 30.00 0 MODE s 22.51- 25.00 1
1
2 PREVIOUS MONTH
0
MEAN
- 34.510
2 STD. DEV. = 28.57'
0
0
0 ACTUAL COUNTS BASED ON
e:
0 DEPENDENT REFERENCE RA..
I COUNT PCT,
TOTAL
189 lor
0 INSIDE REF. RANGE 1M 93 0 OUTSIDE REF. RANGE 14 7
I
3 SCALE* 1 SYMBOL - 1 OCCURRENCE
S^grr
ETHYL COKE
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10.00
20.0
30.00
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50.00
MAR *4
MEAN S.D. COUNT
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23.94 10.32
47
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JAN 84 X
X
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S.D. I 10.37
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COUNT I
67
X
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DEC 83 I MEAN I 22.58
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S.D. I 7.76
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26
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S.D. I 8.41
X
COUNT I
57
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COUNT I
55
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AUO 83 I
X
MEAN I 27.12
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S.D. I 16.69
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50
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JUl 83 I
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MEAN I 25.77
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S.D. I 9.25
X
COUNT I
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MEAN X 27.09
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APR 83 I
X
MEAN I 27.18
X
S.D. I 10.55
X
^
HETPATH DATA
0.00
10.00
MAR 84 I MEAN I 29.18 S.D. I 42.84 G. T. 1 100000
20.00
I30MI
XfXXX
X
X
X
X
FEB B4 I
MEAN 1 28.68 S.D. I 47.14 G.T. I 100000
X X X X
JAN 84 I MEAN I 29.34 S.D. I 50.72 G.T. I 100000
X
X
X
X
DEC 83 1 MEAN I 29.76 S.D. I 54.11 G.T. I 100000
NOV 83 I MEAN 1 29.11 S.D. I 54.84 G.T. I 100000
*
H
X
OCT 83 I MEAN I 28.90 S.D. X 47.16
X
V
G.T.
1 100000
X
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SEP 83 I
V
MEAN 1 29.15
*
S.D. G.T.
1 49.11
N
I 100000
*
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AUG 83 I MEAN I 29.37 S.D. I 52.24 G.T. I 100000
X X
X X
INKKXNXMXNIXXXMMMXKXZXXMXXXXXX
JUL 83 I
X
MEAN I 28.84
X
S.D. X 54.04
X
G.T. I 100006
X
IKXXKXXKKXIKXXXXXXKKIKKXKKKKKK
JUN 83 I
X
MEAN I 29.43
X
S.D. I 64.59
X
G.T. I 100600
X
IKXKXKKXXKIXWXXXKXXXIKXKXKKXKXI
HAY 83 I
MEAN 1 29.92
S.D. G.T.
X 59.20 X 100000 IKKXXXXXXKIKKKKKKXKKXXNKKKKKKKI
APR 83 I Mr E*A4N X 28.50
X
X
40
I
N907 XX DATE 3/31/84
v\O>
CD CO
METPATH OCCUPATIONAL EPIDEMIOLOGICAL SURVEILLANCE PROGRAM
PAGE 9
SPECIMEN x COUNT X --------- X
ETHYL CORP STATISTICAL SUMMARY FROM 1/ 1/84 TO 3/31/84
ACCOUNT 20(92
TEST 1740 TRANSAMINASE, S60
REFERENCE RANGE UNADJUSTED FOR AGE AND SEX
1-70 I.U./L IS 13 18
22
23 18 24 LOU 12.00 15 HIGH 95.00
1
RAU STATISTICS
2 SAMPLE SIZE a 189
MEAN
= 25.772
STD. DEV.
= 11.723
CO. OF VAR. = 45.485
REFINED STATISTICS
(VALUES BEYOND 3 5.D. OMITTED)
SAMPLE SIZE -
184
MEAN
* 24.272
STD. DEV. =
7.190
CO. OF VAR. a 29.(23
MEDIAN a 22.01- 24.0
MODE a 26.01- 28.f
PREVIOUS MONTH
MEAN
a
STD. DEV, a
29.(Ou 13.990
0 ACTUAL COUNTS BASED ON AGE-SEX 1 DEPENDENT REFERENCE RANGES
1 COUNT PCI.
2 TOTAL
189; 180
INSIDE REF. RANGE
183 97
OUTSIDE REF. RANGE
(3
MXKX FREQUENCY DISTRIBUTION XKKX
SCALED 1 SYMBOL a 1 OCCURRENCE