Medical Management Guidelines for Toluene Diisocyanate
(CH3C6H3[NCO]2)
CAS# 26471-62-5 (mixture), 584-84-9 (2,4-isomer), 584-84-9 (2,4-isomer)
UN# 2078
PDF Versionpdf icon[191 KB]
Synonyms include TDI, diisocyanatotoluene,
and tolylene diisocyanate.
- Persons exposed only to toluene diisocyanate vapor do
not pose secondary contamination risks. Persons whose clothing
or skin is contaminated with liquid toluene diisocyanate
can secondarily contaminate others by direct contact or
off-gassing vapor.
- At room temperature, toluene diisocyanate is a clear,
pale yellow liquid with a sharp, pungent odor. It is combustible
only at high temperatures, but burns to produce toxic gases
(cyanides and nitrogen oxides). It is volatile, producing
toxic concentrations at room temperature. The odor of toluene
diisocyanate does not provide adequate warning of hazardous
concentrations.
- Toluene diisocyanate is absorbed rapidly through the lungs,
but dermal absorption is minimal. No information was located
pertaining to ingestion of toluene diisocyanate. Exposure
by inhalation causes respiratory and systemic effects while
dermal exposure causes inflammation and irritation of the
skin.
General Information
Description
Toluene diisocyanate exists in two isomeric
forms (2,4-toluene diisocyanate and 2,6-toluene diisocyanate)
which have similar properties and effects. Toluene diisocyanate
is produced commercially as an 80:20 (2,4-toluene diisocyanate:2,6-toluene
diisocyanate) mixture of the two isomers. At room temperature,
the mixture is a clear, pale yellow liquid with a sharp, pungent
odor. It should be stored under refrigeration, away from light
and moisture in a tightly closed container under an inert
atmosphere. Toluene diisocyanate is insoluble in water and
miscible with most common organic solvents.
Routes of Exposure
Inhalation
Inhalation is the main route of exposure
to toluene diisocyanate. The vapor is readily absorbed from
the lungs and is irritating to the respiratory tract and lungs
even at low concentrations. Its odor threshold of 2.1 ppm
is 100 times greater than the OSHA permissible exposure limit
(0.02 ppm). Thus, odor does not provide an adequate warning
of potentially hazardous concentrations. Toluene diisocyanate
vapor is heavier than air and may cause asphyxiation in enclosed,
poorly ventilated, or low-lying areas.
Children exposed to the same levels of
toluene diisocyanate vapor as adults may receive a larger
dose because they have greater lung surface area:body weight
ratios and increased minute volumes:weight ratios. In addition,
they may be exposed to higher levels than adults in the same
location because of their short stature and the higher levels
of toluene diisocyanate vapor found nearer to the ground.
Skin/Eye Contact
Direct contact with liquid toluene diisocyanate
can cause severe eye and skin irritation. Exposure to relatively
high vapor concentrations produces inflammation of mucous
membranes. Dermal absorption is slow through intact skin.
Children are more vulnerable to toxicants
absorbed through the skin because of their relatively larger
surface area:body weight ratio.
Ingestion
No information was located pertaining
to ingestion of toluene diisocyanate. Toluene diisocyanate
is very irritating; thus, ingestion would probably produce
chemical burns of the lips, mouth, throat, esophagus, and
stomach. No data were located as to whether ingestion leads
to systemic toxicity.
Sources/Uses
Toluene diisocyanate is made by reacting
toluene diamine with carbonyl chloride (phosgene).
Toluene diisocyanate is commonly used
as a chemical intermediate in the production of polyurethane
foams, elastomers, and coatings; paints; varnishes; wire enamels;
sealants; adhesives; and binders. It is also used as a cross-linking
agent in the manufacture of nylon polymers.
Standards and Guidelines
OSHA PEL (permissible exposure limit)
= 0.02 ppm (ceiling)
NIOSH IDLH (immediately dangerous to
life or health) = 2.5 ppm
Physical Properties - Calcium Hypochlorite
Description: Clear, straw-colored
liquid that becomes cloudy with age
Warning properties: Sharp, pungent
odor at 2.1 ppm; inadequate warning of acute or chronic exposures.
Molecular weight: 174.2 daltons
Boiling point (760 mm Hg): 484 °F
(251 °C) (mixed isomers)
Freezing point: 52-57 °F (11-14 °C)
(mixed isomers)
Vapor pressure: 0.025 mm Hg at
77 °F (25 °C)
Gas density: 6 (air = 1)
Specific gravity: 1.22 (water
= 1)
Water solubility: insoluble
Flammability: 250 °F (121 °C)
(mixed isomers)
Flammable range: 0.9% to 9.5%
(concentration in air)
Incompatibilities
Toluene diisocyanate reacts with strong
oxidizers, water, acids, bases, amines, and alcohols.
Health Effects
- Toluene diisocyanate is severely irritating to tissues,
especially to mucous membranes. Inhalation of toluene diisocyanate
produces euphoria, ataxia, mental aberrations, vomiting,
abdominal pain, respiratory sensitization, bronchitis, emphysema,
and asthma.
- The mechanism by which toluene diisocyanate produces toxic
symptoms is not known, but the compound is highly reactive
and may inactivate tissue biomolecules by covalent binding.
No information was found as to whether the health effects
of toluene diisocyanate in children are different than in
adults. Exposure to toluene diisocyanate produces severe
respiratory problems and individuals with pre-existing breathing
difficulties may be more susceptible to its effects.
Acute Exposure
The mechanism by which toluene diisocyanate
produces toxic symptoms is not known, but the compound is
highly reactive and may inactivate tissue biomolecules by
covalent binding. Onset of symptoms may be delayed for 4 to
8 hours.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
Respiratory
Toluene diisocyanate produces irritation
of the respiratory-tract. Concentration-dependent effects
occur, often after a delay of 4 to 8 hours and may persist
for 3 to 7 days. High-concentration inhalation can lead to
chest tightness, cough, breathlessness, and inflammation of
the bronchi with sputum production and wheezing. Accumulation
of fluid in the lungs can also occur.
Previously exposed persons may develop
inflammation of the lungs when reexposed to extremely low
levels of toluene diisocyanate. Flu-like symptoms such as
fever, malaise, shortness of breath, and cough can develop
4 to 6 hours after exposure and persist for 12 hours or longer.
Chest x-rays may indicate lung changes.
In sensitized individuals, asthmatic
attacks can occur after exposure to extremely low toluene
diisocyanate air concentrations (0.0001 ppm). Asthmatic reactions
can be immediate, delayed (4 to 8 hours), or both.
Exposure to toluene diisocyanate can
lead to Reactive Airway Dysfunction Syndrome (RADS), a chemically-
or irritant-induced type of asthma.
Children may be more vulnerable because
of relatively increased minute ventilation per kg and failure
to evacuate an area promptly when exposed.
CNS
Acute exposure to high levels of toluene
diisocyanate vapor or toluene diisocyanate-containing smoke
has been associated with lightheadedness, headache, insomnia,
mental aberrations, impaired gait, loss of consciousness,
and coma.
Dermal
Toluene diisocyanate is a skin irritant.
Contact with the liquid may cause second- and third-degree
skin burns. Skin contact may also result in respiratory sensitization,
although this is rare.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
absorbed through the skin.
Ocular
Toluene diisocyanate can cause eye irritation,
inflammation of the eye membrane, inflammation of the cornea,
clouding of the eye surface, and secondary glaucoma.
Gastrointestinal
No cases involving ingestion were located.
Because toluene diisocyanate is a known irritant, it is likely
to cause burns of the lips, mouth, throat, esophagus and stomach.
No data were located as to whether ingestion leads to systemic
toxicity.
Potential Sequelae
After an acute, high-concentration exposure,
persons may develop non-specific bronchial hyperresponsiveness
and toluene diisocyanate hypersensitization.
Sensitization occurs after exposure to
levels greater than 0.02 ppm or after skin exposure. Allergic
tendency is not a strong predisposing factor. Toluene diisocyanate
can also cause lung-function decline in persons not sensitized
to the chemical. Respiratory symptoms related to narrowing
of the bronchi can persist for years.
Neurologic effects, such as difficulty
concentrating, poor memory, and dull headache, have been reported
to persist years after a high-level exposure. It is not known
whether these complications resulted from the neurotoxic effects
of toluene diisocyanate or from lack of oxygen in the blood.
Chronic Exposure
Workers who chronically inhale low levels
of toluene diisocyanate may have minimal or no respiratory
symptoms, then suddenly develop asthma. Chronic workplace
exposure is associated with an increased prevalence of sensitization;
the reported sensitization rate has varied between 2% and
20% of workers and is dependent on the level of exposure.
Sensitized persons are at risk of developing chronic asthma
that may be precipitated by exposures to other chemicals.
Chronic exposure may be more serious
for children because of their potential longer latency period.
Carcinogenicity
The Department of Health and Human Services
has determined that toluene diisocyanate may reasonably be
anticipated to be a carcinogen. The International Agency for
Research on Cancer has determined that toluene diisocyanate
is possibly carcinogenic to humans.
Reproductive and Developmental Effects
No studies were located which address
reproductive effects of toluene diisocyanate in either humans
or experimental animals. No information was found as to whether
toluene diisocyanate crosses the placenta or is excreted in
breast milk. Toluene diisocyanate is not included in Reproductive
and Developmental Toxicants, a 1991 report published by
the U.S. General Accounting Office (GAO) that lists 30 chemicals
of concern because of widely acknowledged reproductive and
developmental consequences.
No known teratogenic effects from acute
exposure are known.
Prehospital Management
- Victims exposed only to toluene diisocyanate vapor do
not pose contamination risks to rescuers. Victims whose
clothing or skin is contaminated with liquid toluene diisocyanate
can secondarily contaminate response personnel by direct
contact or by off-gassing vapor.
- Toluene diisocyanate is a direct irritant to mucous membranes,
skin, eyes, and the respiratory system. Acute inhalation
exposure may lead to euphoria, ataxia, mental aberrations,
vomiting, abdominal pain, bronchospasm, chemical bronchitis,
hypersensitivity pneumonitis, and noncardiogenic pulmonary
edema.
- There is no antidote for toluene diisocyanate. Treatment
consists of bronchodilators and respiratory and cardiovascular
support.
Hot Zone
Rescuers should be trained and appropriately
attired before entering the Hot Zone. If the proper equipment
is not available, or if rescuers have not been trained in
its use, assistance should be obtained from a local or regional
HAZMAT team or other properly equipped response organization.
Rescuer Protection
Toluene diisocyanate is a severe respiratory
tract and skin irritant and sensitizer.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of toluene diisocyanate.
Skin Protection: Chemical-protective
clothing is recommended because toluene diisocyanate can cause
skin irritation, burns, and sensitization.
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, maintain
cervical immobilization manually and apply a cervical collar
and a backboard when feasible.
Victim Removal
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk may be removed on backboards or gurneys; if
these are not available, carefully carry or drag victims to
safety.
Consider appropriate management of chemically-contaminated
children, such as measures to reduce separation anxiety if
a child is separated from a parent or other adult.
Decontamination Zone
Patients exposed only to toluene diisocyanate
vapor who have no skin or eye irritation may be transferred
immediately to the Support Zone. Other patients will require
decontamination as described below.
Rescuer Protection
If exposure levels are determined to
be safe, decontamination may be conducted by personnel wearing
a lower level of protection than that worn in the Hot Zone
(described above).
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. Stabilize the cervical spine
with a collar and a backboard if trauma is suspected. Administer
supplemental oxygen as required. Assist ventilation with a
bag-valve-mask device if necessary.
Basic Decontamination
Victims who are able may assist with
their own decontamination. Quickly remove and double-bag contaminated
clothing and personal belongings.
Flush exposed skin and hair with water
for 2 to 3 minutes, then wash twice with mild soap. Rinse
thoroughly with water. Use caution to avoid hypothermia when
decontaminating children or the elderly. Use blankets or warmers
when appropriate.
Flush exposed or irritated eyes with
plain water or saline for 15 minutes. Remove contact lenses
if easily removable without additional trauma to the eye.
Continue eye irrigation during other basic care and transport.
If a corrosive material is suspected or if pain or injury
is evident, continue irrigation while transferring the victim
to the Support Zone.
In cases of ingestion, do not induce
emesis. If the victim is alert, asymptomatic, and has
a gag reflex, administer a slurry of activated charcoal at
1 gm/kg (usual adult dose 60-90 g, child dose 25-50 g). A
soda can and a straw may be of assistance when offering charcoal
to a child.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of milk or water (not
to exceed 15 mL/kg in a child). If the victim is symptomatic,
delay decontamination until other emergency measures have
been instituted.
Consider appropriate management of chemically
contaminated children at the exposure site. Provide reassurance
to the child during decontamination, especially if separation
from a parent occurs.
Transfer to Support Zone
As soon as basic decontamination is complete,
move the victim to the Support Zone.
Support Zone
Be certain that victims have been decontaminated
properly (see Decontamination Zone, above). Victims
who have undergone decontamination or have been exposed only
to vapor pose no serious risks of secondary contamination
to rescuers. In such cases, Support Zone personnel require
no specialized protective gear.
ABC Reminders
Quickly access for a patent airway. If
trauma is suspected, maintain cervical immobilization manually
and apply a cervical collar and a backboard when feasible.
Ensure adequate respiration and pulse. Administer supplemental
oxygen as required and establish intravenous access if necessary.
Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and
eyes, as appropriate.
In cases of ingestion, do not induce
emesis. If the victim is alert, asymptomatic, and has
a gag reflex, administer a slurry of activated charcoal at
1 gm/kg (usual adult dose 60-90 g, child dose 25-50 g) if
it has not already been administered. A soda can and a straw
may be of assistance when offering charcoal to a child.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of milk or water (not
to exceed 15 mL/kg in a child) if it has not been given previously.
If the victim is symptomatic, delay decontamination until
other emergency measures have been instituted.
Advanced Treatment
In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, perform cricothyroidotomy if equipped and trained
to do so.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Toluene diisocyanate poisoning is not known
to pose additional risk during the use of bronchial or cardiac
sensitizing agents. Administer corticosteroids as indicated
to patients who have persistent wheezing or hypersensitivity
pneumonitis.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or having seizures or cardiac arrhythmias should be treated
according to advanced life support (ALS) protocols.
Transport to Medical Facility
Only decontaminated patients or patients
not requiring decontamination should be transported to a medical
facility. "Body bags" are not recommended.
Report to the base station and the receiving
medical facility the condition of the patient, treatment given,
and estimated time of arrival at the medical facility.
If toluene diisocyanate has been ingested,
prepare the ambulance in case the victim vomits toxic material.
Have ready several towels and open plastic bags to quickly
clean up and isolate vomitus.
Multi-Casualty Triage
Consult with the base station physician
or the regional poison control center for advice regarding
triage of multiple victims.
Patients who are seriously symptomatic
(as in cases of chest tightness or wheezing), patients who
have histories or evidence of significant exposure, and all
patients who have ingested toluene diisocyanate should be
transported to a medical facility for evaluation. Others may
be discharged at the scene after their names, addresses, and
telephone numbers are recorded. Those discharged should be
advised to seek medical care promptly if symptoms develop
(see Patient Information Sheet below).
Emergency Department Management
- Hospital personnel in an enclosed area can be secondarily
contaminated by direct contact or by off-gassing vapor from
soaked skin or clothing. Patients do not pose contamination
risks after contaminated clothing is removed and the skin
is washed.
- Toluene diisocyanate is irritating to mucous membranes,
skin, eyes, and the respiratory tract. Acute inhalation
exposure may lead to euphoria, ataxia, mental aberrations,
vomiting, abdominal pain, bronchospasm, chemical bronchitis,
hypersensitivity pneumonitis, and noncardiogenic pulmonary
edema.
- There is no antidote for toluene diisocyanate. Treatment
consists of bronchodilators and respiratory and cardiovascular
support.
Decontamination Area
Unless previously decontaminated, all
patients suspected of contact with toluene diisocyanate liquid
and all victims with skin or eye irritation require decontamination
as described below. All other patients may be transferred
immediately to the Critical Care Area.
Be aware that use of protective equipment
by the provider may cause fear in children, resulting in decreased
compliance with further management efforts.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
absorbed through the skin. Also emergency room personnel should
examine children's mouths because of the frequency of hand-to-mouth
activity among children.
ABC Reminders
Evaluate and support airway, breathing,
and circulation. In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, surgically create an airway.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Toluene diisocyanate poisoning is not known
to pose additional risk during the use of bronchial or cardiac
sensitizing agents. Administer corticosteroids as indicated
to patients who have persistent wheezing or hypersensitivity
pneumonitis.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or have seizures or ventricular arrhythmias should be treated
in the conventional manner.
Basic Decontamination
Patients who are able and cooperative
may assist with their own decontamination. Remove and double-bag
contaminated clothing and all personal belongings.
Flush exposed skin and hair with water
for 2 to 3 minutes (preferably under a shower), then wash
thoroughly with mild soap. Rinse thoroughly with water.
Use caution when flushing a child's skin
to avoid the complication of hypothermia. Use blankets to
keep children warm after decontamination.
Flush exposed eyes with plain water or
saline for at least 15 minutes. Remove contact lenses if easily
removable without additional trauma to the eye. If a corrosive
material is present or if pain or injury is evident, continue
irrigation while transporting the patient to the Critical
Care Area.
In cases of ingestion, do not induce
emesis. If the victim is alert, asymptomatic, and has
a gag reflex, administer a slurry of activated charcoal at
1 gm/kg (usual adult dose 60-90 g, child dose 25-50 g) if
it has not already been administered. A soda can and a straw
may be of assistance when offering charcoal to a child.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of milk or water (not
to exceed 15 mL/kg in a child) if it has not been given previously
(see Critical Care Area below for more information
on ingestion exposure).
Critical Care Area
Be certain that appropriate decontamination
has been carried out (see Decontamination Area above).
ABC Reminders
Evaluate and support airway, breathing,
and circulation as in ABC Reminders above under Decontamination
Zone. Establish intravenous access in seriously ill patients
if this has not been done previously. Continuously monitor
cardiac rhythm.
Patients who are comatose, hypotensive,
or have seizures or cardiac arrhythmias should be treated
in the conventional manner.
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory symptoms. Treat patients
who have bronchospasm with aerosolized bronchodilators. The
use of bronchial sensitizing agents in situations of multiple
chemical exposures may pose additional risks. Consider the
health of the myocardium before choosing which type of bronchodilator
should be administered. Cardiac sensitizing agents may be
appropriate; however, the use of cardiac sensitizing agents
after exposure to certain chemicals may pose enhanced risk
of cardiac arrhythmias (especially in the elderly). Toluene
diisocyanate poisoning is not known to pose additional risk
during the use of bronchial or cardiac sensitizing agents.
Administer corticosteroids as indicated to patients who have
persistent wheezing or hypersensitivity pneumonitis.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Skin Exposure
If the skin was in contact with liquid
toluene diisocyanate, chemical burns may occur; treat as thermal
burns.
Because of their larger surface area:body
weight ratio, children are more vulnerable to toxicants affecting
the skin.
Eye Exposure
Continue irrigation for at least 15 minutes.
Test visual acuity. Examine the eyes for corneal damage and
treat appropriately. Immediately consult an ophthalmologist
for patients who have corneal injuries.
Ingestion Exposure
Do not induce emesis.
If the victim is alert, asymptomatic,
and has a gag reflex, administer a slurry of activated charcoal
at 1 gm/kg (usual adult dose 60-90 g, child dose 25-50 g)
if it has not already been administered. A soda can and a
straw may be of assistance when offering charcoal to a child.
Victims who are conscious and able to
swallow should be given 4 to 8 ounces of milk or water (not
to exceed 15 mL/kg in a child) if it has not been given previously.
Consider endoscopy to evaluate the extent
of gastrointestinal-tract injury. Extreme throat swelling
may require endotracheal intubation or cricothyriodotomy.
Gastric lavage is useful in certain circumstances to remove
caustic material and prepare for endoscopic examination. Consider
gastric lavage with a small nasogastric tube if: (1) a large
dose has been ingested; (2) the patient's condition is evaluated
within 30 minutes; (3) the patient has oral lesions or persistent
esophageal discomfort; and (4) the lavage can be administered
within one hour of ingestion. Care must be taken when placing
the gastric tube because blind gastric-tube placement may
further injure the chemically damaged esophagus or stomach.
Because children do not ingest large
amounts of corrosive materials, and because of the risk of
perforation from NG intubation, lavage is discouraged in children
unless performed under endoscopic guidance.
Toxic vomitus or gastric washings should
be isolated, e.g., by attaching the lavage tube to isolated
wall suction or another closed container.
Antidotes and Other Treatments
There is no antidote for toluene diisocyanate.
Treatment is supportive of respiratory function.
Laboratory Tests
Routine laboratory studies for all exposed
patients include CBC, glucose, and electrolyte determinations.
Patients who have respiratory complaints may require pulse
oximetry (or ABG measurements), chest radiography, and peak-flow
spirometry.
Disposition and Follow-up
Consider hospitalizing patients who have
histories of significant inhalation exposure and are symptomatic
(e.g., chest tightness or wheezing) or who have ingested toluene
diisocyanate.
Delayed Effects
Toluene diisocyanate-induced bronchospasm
can occur 4 to 8 hours after inhalation exposure.
Patient Release
Patients who remain asymptomatic for
8 to 12 hours after exposure may be discharged with instructions
to seek medical care promptly if symptoms develop (see the
Toluene Diisocyanate-Patient Information Sheet below).
Follow-up
Obtain the name of the patient's primary
care physician so that the hospital can send a copy of the
ED visit to the patient's doctor.
If significant inhalation or skin contact
has occurred, monitor pulmonary function. Persons who have
wheezing episodes may be permanently sensitized and may need
to be removed from future work with toluene diisocyanate;
patients should consult an occupational medicine or pulmonary
specialist before returning to work that entails exposure
to toluene diisocyanate.
Toluene diisocyanate poisoning can cause
permanent alterations of nervous system function, including
problems with memory, learning, thinking, sleeping, personality
changes, depression, headache, and sensory and perceptual
changes. Patients who have shown symptoms such as seizures,
convulsions, headache or confusion should be followed for
permanent nervous system dysfunction with neurobehavioral
toxicity testing.
Patients who have corneal injuries should
be reexamined within 24 hours.
Reporting
If a work-related incident has occurred,
you may be legally required to file a report; contact your
state or local health department.
Other persons may still be at risk in
the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
may prevent future incidents. If a public health risk exists,
notify your state or local health department or other responsible
public agency. When appropriate, inform patients that they
may request an evaluation of their workplace from OSHA or
NIOSH. See Appendices III and IV for a list of agencies that
may be of assistance.
Patient Information Sheet
This handout provides information and
follow-up instructions for persons who have been exposed to
toluene diisocyanate.
Print this handout only.pdf icon[43.5 KB]
What is toluene diisocyanate?
Toluene diisocyanate is a pale-yellow
liquid with a strong, sharp odor. It is used mainly to make
polyurethane foams and coatings.
What immediate health effects can be caused by exposure to toluene diisocyanate?
Low levels of toluene diisocyanate in
the air can irritate the eyes, nose, throat, and lungs and
cause cough, chest tightness, and shortness of breath. Higher
levels can cause a build-up of fluid in the lungs, which may
cause death. If liquid toluene diisocyanate comes in contact
with the skin or eyes, it can cause severe burns. Generally,
the more serious the exposure, the more severe the symptoms.
Can toluene diisocyanate poisoning be treated?
There is no antidote for toluene diisocyanate,
but its effects can be treated and most exposed persons get
well. Seriously exposed persons may need to be hospitalized.
Are any future health effects likely to occur?
After exposure to toluene diisocyanate,
certain persons can develop allergies in which even small
exposures to toluene diisocyanate or other irritants can trigger
asthma attacks or shortness of breath. Therefore, it is important
to tell your doctor that you have been exposed to toluene
diisocyanate. After a serious exposure or repeated exposures,
toluene diisocyanate can cause permanent lung damage. Toluene
diisocyanate poisoning can cause permanent alterations of
nervous system function, including problems with memory, learning,
thinking, sleeping, personality changes, depression, headache,
and sensory and perceptual changes.
What tests can be done if a person has been exposed to toluene diisocyanate?
Specific tests for the presence of toluene
diisocyanate in blood are not available. If a severe exposure
has occurred, respiratory function tests and a chest x-ray
may show whether damage has been done to the lungs. Patients
who have problems with memory, concentration, or personality
changes or who experienced seizures or convulsions when exposed
to toluene diisocyanate may need neurobehavioral toxicity
testing. Testing is not needed in every case.
Where can more information about toluene diisocyanate be found?
More information about toluene diisocyanate
can be obtained from your regional poison control center;
your state, county, or local health department; the Agency
for Toxic Substances and Disease Registry (ATSDR); your doctor;
or a clinic in your area that specializes in occupational
and environmental health. If the exposure happened at work,
you may wish to discuss it with your employer, the Occupational
Safety and Health Administration (OSHA), or the National Institute
for Occupational Safety and Health (NIOSH). Ask the person
who gave you this form for help in locating these telephone
numbers.
Follow-up Instructions
Keep this page and take it with you to
your next appointment. Follow only the instructions
checked below.
Print instructions only.pdf icon[43.5 KB]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- $ coughing, wheezing, difficulty breathing, shortness
of breath, or chest pain
- headache or lightheadedness
- increased pain or a discharge from your eyes
- increased redness or pain or a pus-like discharge in the
area of a skin burn
[ ] No follow-up appointment is necessary
unless you develop any of the symptoms listed above.
[ ] Call for an appointment with Dr.____
in the practice of ________.
When you call for your appointment, please
say that you were treated in the Emergency Department at _________
Hospital by________and were advised to be seen again in ____days.
[ ] Return to the Emergency Department/Clinic
on ____ (date) at _____ AM/PM for a follow-up examination.
[ ] Do not perform vigorous physical
activities for 1 to 2 days.
[ ] You may resume everyday activities
including driving and operating machinery.
[ ] Do not return to work for _____days.
[ ] You may return to work on a limited
basis. See instructions below.
[ ] Avoid exposure to cigarette smoke
for 72 hours; smoke may worsen the condition of your lungs.
[ ] Avoid drinking alcoholic beverages
for at least 24 hours; alcohol may worsen injury to your stomach
or have other effects.
[ ] Avoid taking the following medications:
________________
[ ] You may continue taking the following
medication(s) that your doctor(s) prescribed for you: _______________________________
[ ] Other instructions:
____________________________________
_____________________________________________________
- Provide the Emergency Department with the name and the
number of your primary care physician so that the ED can
send him or her a record of your emergency department visit.
- You or your physician can get more information on the
chemical by contacting: ____________ or _____________, or by
checking out the following Internet Web sites:
___________;__________.
Signature of patient _______________ Date ____________
Signature of physician _____________ Date ____________
Where can I get more information?
If you have questions or concerns, please contact your community or state health or environmental quality department or:
For more information, contact:
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Human Health Sciences
4770 Buford Highway
Chamblee, GA 30341-3717
Phone: 1-800-CDC-INFO 888-232-6348 (TTY)
Email: Contact CDC-INFO
ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.