Document VJxL9766J07j7K2aZK3EOb8QN

FILE NAME Talc TALC DATE 1966 June DOC TALC220 DOCUMENT DESCRIPTION Journal Article - Massive Talc Aspiration 653 @ Massive Talc Aspiration Successful Treatment With Dexamethasone WALTER T. HUGHES MD AND THOMAS KALMER MD LOUISVILLE FATALITIES HAVE been reported fol- lowing the aspiration of talcum powder in infants The incidence of nonfatal illness from the inhalation of this dusting powder is unknown Because of the ready availability of this substance and since the clinical mani- festations from aspiration mimic those of acute infectious bronchiolitis it is likely this etiology may sometimes be overlooked in milder cases Tale is hydrous magnesium silicate and commercially the mineral tale is usually mixed with other silicates such as serpentine tremolite anthophyllite and other ingredients predominantly carbonates Talc is insoluble chemically inert and in a fine state of subdivision it is used topically as a mechanical protective acts mainly by preventing friction and by absorbing moisture but otherwise has no therapeutic ef- fect Inhalation of tale dust may result in acute or chronic lung disease Sudden massive inhalation produces acute respiratory distress of the bronchiolitis fibrosa obliterans type4 which is often fatal Sustained inhalation of significant amounts of tale can produce pneumoconiosis talcosis The case herein presented is of the former type in which an infant accidently inhaled a large amount of tale dusting powder and suffered acute re- spiratory distress The course of this in- fant's illness similar to the reported fatal cases seemed to be favorably influenced by treatment with dexamethasone Decadron - Report of a Case vt playing A healthy month white male infant was playing with can of talcum powder on Sept 24 1965 At AM the mother was attracted to the infant because of coughing and gasping The face was covered by and the mouth was caked with the powder He vomited a small amount and by 10 AM appeared to be in slight respiratory distress After receiving an emetic in community hospital he was returned home By afternoon the infant was having more difficulty in breathing and was taken to the family physician who administered an antibiotic to prevent infection The dyspnea dif not abate and the patient was admitted to Louise ville General Hospital at midnight On examination the infant was in moderate re- spiratory distress very restless and irritable The rectal temperature was 101 F 38.3 pulse 160 min blood pressure 120 systolic by palpation method and the rate of respiration was min The month and pharynx were normal There was moderate intercostal and subcostal retraction Air exchange was fairly good but expiration was pres longed No rales were detected The abdomen was not distended and the liver and spleen were not enlarged There was no cyanosis but the baby coughed frequently A roentgenogram of the chest at the time of admission revealed no abnormalities other than signs of moderate hyperinflation The hemoglobin was 8.6 100 cc and the white blood cell count was 17,000 mm with 51 neutrophils 37 lymphocytes and % monocytes The red blood cells were hypochromic and the hematocrit was 20 and reticulocyte count 1.4 Dietary history substantiated the impression of deficiency anemia Upon admission the patient was placed in a tent with oxygen mist There was no evident re- sponse to 0.15 m aqueous epinepherine injected subcutaneously A dose of 300,000 units of procaine penicillin G were administered twice daily _ Isoproterenol Isuprel 2.5 mg was given orally every six hours Twenty hours after the aspiration the infant was in severe respiratory distress with marked retractions of the chest He was slightly cyanotic dilation and reducing inflainniation 2.0 mg of dexamethasone was administered intramuscularly and continued every 12 hours for seven doses Within 6 to 12 hours after initiation of steroid therapy improvement was definite and the respiratory rate was between 40 and 60 per minute Continued improvement came rapidly and dexamethasone was discontinued on Sept 29 1965. On this date and afterward the infant was asympto- matic and without respiratory distress Examina- tion on October 7 revealed no symptoms nor physical abnormalities the chest roentgenogram was normal and the hemoglobin had increased to 12.0 100_ce 100_ce with oral iron therapy Comment 5 Received for publication Jan 5. 1966 From the Department of Pediatrics University of Louisville School of Medicine Louisville Rot requests to 226 E Chestnut St. Louisville r Hughes The case presented here followed a course similar to all the reported cases of fatal tale aspiration up to the time when therapy with dexamethasone was initiated Improvement Amer J Dis Child 111 June 1966 JNJTALC000438719 TALC ASPIRATION & KALMER 654 3 appeared to follow administration of this drug The most recently reported case by Jenkins in 1963 was that of a monthold infant who had coughing and some respiratory distress immediately after aspira- tion of talcum powder and was hospitalized five hours later with grunting respiration with a rate of min and intercostal retraction Respiration became increasingly more labored and finally ceased ten hours after the aspiration Molnar and coauthors case was a month Negro boy whose respiratory rate reached min seven hours after admission and death occurred 20 hours after aspiration of the talcum powder Cless and Anger's case followed an identical course Antibiotics oxygen mist digitalis morphine and epinepherine had no demon- 2. Adrenocortical steroids produce con- siderable temporary improvement in berylliosis similar in some respects to talcosis 3. An inflammatory reaction occurs in bronchi and bronchioles which might be re- duced by dexamethasone If the favorable response to treatment was due to use of the steroid it was probably due to the inflammatory effect of the drug Failure of response to epinepherine used bronchodilation prior to dexamethasone would suggest simple was not responsible for the improvement In conclusion it is strongly urged that talcum powder be removed from the en- vironment of children and the traditional as- sociation of talcum powder and babies be abandoned It has no medicinal value demonstrated - strable effect on these cases Pathologically lesions of bronchitis and acute bronchiolitis have been in the fatal cases with pulmonary edema focal atelectasis and compensatory emphy- sema The bronchial and bronchiolar lumens wherever placed it serves as a foreign body. and at least three deaths and an unknown morbidity have resulted from this silicate powder Summary and alveoli may be filled with a homogenous basophilic matrix embedded with leukocytes epithelial fragments and refractile particles Complete desquamation of the epithelium in bronchi is seen with various grada- many tions of edema hyperplasia and squamous metaplasia The submucosa is swollen and polymorphonuclear often infiltrated with leukocytes and refractile particles of talc.2 The pathological changes seen in talc pneu- moconiosis have been described as both A case is presented of a month infant who aspirated talcum powder became severely dyspneic and was successfully treated with dexamethasone The clinical course is compared to the three fatal cases reported in the literature There is no justification for the use of talcum powder in in- fant care Generic and Trade Names of Drugs cellular and fibrotic reactions affecting primarily the alveoli smaller bronchioles and arterioles.5 Umbilical granuloma has been described secondary to the free use of talcum powder over the trunk and diaper areas of newborn Dexamethasone Deronil Dexameth Gammacorten Hexadrol Isoproterenol Aludrine Isuprel Procaine penicillin Penicillin Lentopen Wycillin REFERENCES infants Surgeons are familiar with granu- 1. Cless D. and Anger .: Erstickungstod Duren from Aayh lomatous reactions in the peritoneum Aspiration von Kinderpuder Kinderaerztl Prax 22 talc Also skin granulomas may result 506-508 March 1954 glove in an incision site 2. Molnar J.J Nathenson G and Edberg .: from talc deposited Fatal Aspiration of Talcum Powder By a Child New Reasoning that led to the use of dexa- Eng J Med 36-37 Jan ) 1962 methasone in this case was as follows 3. Jenkins M.Q Dusting Powder Inhalation St resulting from Carolina Med Assoc 59:62 Feb 1963 pneumoconiosis 1. Talc 4. La Due J.S Bronchiolitis Fibrosa Obliterans chronic exposure to talc in industry requires Arch Intern Med 663-673 Oct 1941 + fibrosis ae at least ten years before pulmonary 5. Kleinfeld M. et al Talc Pneumonconiosis Arch It would of clinical significance appears Environ Health 101-115 July 1963 seen that if in an acute aspiration the in- 6. Creery R.D.G McClure D.M and Rutherford R.J Talc Granuloma of the Umbilicus Lancet 667- r fant could survive two or three days the re- 668 March 30 1957 spiratory tract would clear itself of most of 7. Kennedy B.J. et al Effect of Adrenocortico- the foreign material and further damage tropic Hormone ACTH on Beryllium Granulomatosis Silicosis Amer J Med 134-155 Feb 1951 would be unlikely Amer I Dis Child 111 June 1966 JNJTALC000438720 :