Medical Management Guidelines for Methylene Chloride
(CH2Cl2)
CAS# 75-09-2
UN# 1593
PDF Versionpdf icon[61.6 KB]
Synonyms include dichloromethane, methylene
bichloride, methane dichloride, and methylenedichloride.
- Persons exposed only to methylene chloride vapor do not
pose risks of secondary contamination. Persons whose clothing
or skin is contaminated with liquid methylene
chloride can cause secondary contamination by direct contact
or through off-gassing vapor.
- Odor is not an adequate warning property for methylene
chloride
- Methylene chloride is a combustible liquid, but its vapor
is flammable only when present in relatively high concentrations
(14% to 22% in air).
- Methylene chloride is absorbed readily after inhalation
and ingestion. Skin absorption is slow but may contribute
to total body burden.
General Information
Description
At room temperature, methylene chloride is a clear, colorless liquid with a pleasant odor. It is volatile, producing potentially toxic concentrations at room temperature. It is slightly soluble in water and miscible with most organic solvents.
Routes of Exposure
Inhalation
Inhalation is the most important route
of exposure and methylene chloride vapor is absorbed readily
from the lungs. Odor is not an adequate warning property
for methylene chloride, the odor threshold is 250 ppm,
which is 10 times higher than the OSHA PEL (25 ppm). Olfactory
fatigue may also occur at high concentrations. Methylene chloride
is heavier than air and may cause asphyxiation in enclosed,
poorly ventilated, or low-lying areas.
Children exposed to the same levels of
methylene chloride vapor as adults may receive larger doses
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 methylene
chloride vapor found nearer to the ground.
Skin/Eye Contact
Exposure to high levels of methylene
chloride vapor can cause skin and eye irritation. Prolonged
dermal contact with liquid methylene chloride may produce
chemical burns. Methylene chloride is absorbed slowly through
intact skin but probably not in quantities that cause acute
systemic toxicity.
Children are more vulnerable to toxicants
absorbed through the skin because of their relatively larger
surface area:body weight ratio.
Ingestion
Acute toxic effects, including death,
can result from ingestion.
Sources/Uses
Methylene chloride is produced commercially
in large volumes by direct chlorination of methane or methyl
chloride. Methylene chloride is an important solvent in paint
and varnish strippers and in degreasing agents. It is used
in the production of photographic films, synthetic fibers,
pharmaceuticals, adhesives, inks, and printed circuit boards.
It is employed as a blowing agent for polyurethane foams and
as a propellant for insecticides, air fresheners, and paints.
Standards and Guidelines
OSHA PEL (permissible exposure limit)
= 25 ppm (averaged over an 8-hour workshift)
OSHA STEL (short-term exposure limit)
= 125 ppm (over a 15-minute time period)
NIOSH IDLH (immediately dangerous to
life or health) = 2,300 ppm
AIHA ERPG-2 (maximum airborne concentration
below which it is believed that nearly all persons could be
exposed for up to 1 hour without experiencing or developing
irreversible or other serious health effects or symptoms that
could impair their abilities to take protective action) =
750 ppm
Physical Properties
Description: Clear, colorless
liquid
Warning properties: Sweet, ether-like
odor at 250 ppm; inadequate warning for hazardous exposures.
Molecular weight: 84.9 daltons
Boiling point (760 mm Hg): 104.2ĀŗF
(39.8ĀŗC)
Freezing point: -139ĀŗF (-95ĀŗC)
Specific gravity: 1.33 (water
= 1)
Vapor pressure: 349 mm Hg at 68ĀŗF
(20ĀŗC)
Gas density: 2.9 (air = 1)
Water solubility: Water soluble
(2% at 68ĀŗF) (20ĀŗC)
Flammability: Combustible liquid
Flammable range: 14% to 22% (concentration
in air)
Incompatibilities
Methylene chloride reacts with strong
oxidizers, caustic substances, chemically active metals such
as aluminum and magnesium powders, potassium, sodium, and
concentrated nitric acid.
Health Effects
- Methylene chloride is irritating to the skin, eyes, and
respiratory tract. These effects can result from inhalation
or dermal exposure to methylene chloride. Prolonged skin
contact may cause chemical burns.
- Exposure by any route can cause CNS depression. Ingestion
of methylene chloride can cause severe gastrointestinal
irritation.
- Carbon monoxide, a metabolite of methylene chloride, may
contribute to delayed toxic effects. The fetus and neonates
are particularly vulnerable to poisoning with carbon monoxide.
Acute Exposure
Adverse health effects of methylene chloride
are due both to the parent compound and carbon monoxide which
is a metabolite of methylene chloride. The mechanism of neurotoxic effects of the parent compound is unknown but may be related to the lipophilic properties of the compound. Carbon monoxide induces the formation of carboxyhemoglobin, thus depriving the brain from normal oxygen delivery and utilization. Signs and symptoms of exposure to very high levels (>750 ppm) of methylene chloride may be evident within minutes of exposure onset. Less pronounced exposures may induce adverse signs and symptoms within hours.
Children do not always respond to chemicals in the same way that adults do. Different protocols for managing their care may be needed.
CNS
Methylene chloride exposure causes dose-related
CNS depression. Typical acute symptoms (within minutes to
hours) include headache, drowsiness, lightheadedness, slurred
speech, decreased alertness, slowed reaction times, irritability,
impaired gait, and stupor. Rapid loss of consciousness, coma,
seizures, and death have been reported.
Metabolic
Methylene chloride is metabolized in the liver, in part to carbon monoxide, which will produce elevated carboxyhemoglobin levels and decrease the oxygen-carrying capacity of the blood. Carboxyhemoglobin levels may continue to rise for several hours after exposure has ceased. The fetus is particularly vulnerable to poisoning with carbon monoxide.
Because of their relatively higher metabolic rate, children may be more vulnerable to toxicants interfering with basic metabolism.
Cardiovascular
Methylene chloride may cause electrocardiographic changes resembling those of carbon monoxide poisoning. Elevated carboxyhemoglobin and carboxymyoglobin levels may cause insufficient oxygen supply to the heart in persons who have preexisting coronary disease. Angina, myocardial infarction, and cardiac arrest associated with methylene chloride inhalation was reported in one patient, but no adverse cardiovascular effects from methylene chloride have been reported for occupationally exposed workers.
Respiratory
Victims of acute, high-level inhalation
exposures may suffer airway irritation, inflammation of the
lungs, and accumulation of fluid in the lungs.
Children may be more vulnerable because
of relatively increased minute ventilation per kg and failure
to evacuate an area promptly when exposed.
Hydrocarbon pneumonitis may be a problem
in children.
Gastrointestinal
Nausea, vomiting, gastrointestinal ulceration
and bleeding have been reported after ingestion.
Hepatic
Liver dysfunction may result from acute,
high-level exposure to methylene chloride.
Dermal
Methylene chloride causes skin irritation
and blistering. Prolonged dermal contact may result in second-
and third-degree chemical burns.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
absorbed through the skin.
Ocular
High concentrations of methylene chloride
vapor may cause eye irritation and tearing. When splashed
in the eye, methylene chloride can cause burning pain, inflammation of the eye surface, and inflammation of the iris.
Potential Sequelae
Survivors of severe, acute exposure (e.g.,
cases of coma, seizures, or respiratory arrest) may suffer
brain or heart damage from lack of oxygen to these organs.
Exposure to high levels of methylene chloride, which may lead
to the formation of high amounts of the metabolite carbon
monoxide, may lead to permanent sequelae, including mental
deterioration, urinary and fecal incontinence, and gait disturbance. However, most cases of delayed neurologic sequelae are associated with loss of consciousness in the acute phase of intoxication.
Chronic Exposure
Cardiovascular effects have been documented
in case reports but have not been demonstrated in epidemiologic
studies of workers exposed to methylene chloride. Irritant
contact dermatitis manifested by inflammation and hives has
been noted in workers who have chronic skin exposure.
Chronic exposure may be more serious
for children because of their potential longer latency period.
Carcinogenicity
The DHHS has determined that methylene
chloride may be reasonably anticipated to be a human carcinogen
based on adequate evidence in experimental animals.
Reproductive and Developmental Effects
In experimental animals, methylene chloride
did not produce structural abnormalities but produced behavioral
alterations and retarded development in offspring. The levels
used in these studies were greater than 1,000 ppm. Whether
these effects would have occurred in the absence of maternal
toxicity is not clear. Embryotoxic effects have not been documented in humans. Methylene chloride 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.
Methylene chloride has been shown to cross the placenta in animals and has been found in human breast milk. The fetus and neonates are more susceptible to carbon monoxide, a methylene chloride metabolite, poisoning. Acute, nonlethal maternal intoxication with carbon monoxide may result in fetal death or permanent neurologic sequelae.
Prehospital Management
- Victims exposed only to methylene chloride vapor do not
pose contamination risks to rescuers. Victims whose clothing
or skin is contaminated with liquid methylene chloride can
secondarily contaminate response personnel by direct contact
or through off-gassing vapor. Methylene chloride vapor may
also off-gas from the toxic vomitus of victims who have
ingested methylene chloride.
- Methylene chloride can cause acute CNS and respiratory
depression, with resultant cardiac dysrhythmia. If inhaled
at high levels, methylene chloride can cause respiratory
tract irritation, and noncardiogenic pulmonary edema may
ensue. Methylene chloride is metabolized slowly to carbon
monoxide.
- There is no antidote for methylene chloride. Treatment
consists of support of respiratory and cardiovascular functions.
Oxygen is an antagonist of metabolically released carbon
monoxide.
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
Methylene chloride vapor is absorbed
well by inhalation and is a respiratory-tract irritant. The
liquid is a mild skin irritant with slow skin absorption.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of methylene chloride vapor.
Skin Protection: Chemical-protective
clothing is not generally required when only vapor exposure
is expected because methylene chloride vapor is neither highly
irritating nor absorbed well through the skin. Chemical-protective clothing is recommended when repeated or prolonged contact with liquid methylene chloride is anticipated because skin irritation and dermal absorption may occur.
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
Victims exposed only to methylene chloride
vapor who have no skin or eye irritation do not need decontamination.
They may be transferred immediately to the Support Zone. All
others require decontamination (see Basic Decontamination
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. Remove and double-bag contaminated
clothing and personal belongings.
Flush exposed skin and hair with plain
water for 3 to 5 minutes, then wash with mild soap. Rinse
thoroughly with water. Use caution to avoid hypothermia when
decontaminating children or the elderly. Use blankets or warmers
when appropriate.
Irrigate exposed or irritated eyes with
plain water or saline for at least 15 minutes. Remove contact
lenses if easily removable without additional trauma to the
eye.
In cases of ingestion, do not induce
emesis. If the victim is alert and able to swallow, 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 straw may be of assistance when offering charcoal to a child.
Consider appropriate management of chemically
contaminated children at the exposure site. Also, provide
reassurance to the child during decontamination, especially
if separation from a parent occurs. If possible, seek assistance
from a child separation expert.
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 undergone
appropriate decontamination (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 activated charcoal has not been given previously
and the patient is alert and able to swallow, administer activated charcoal at 1 gm/kg (usual adult dose 60-90 g, child dose 25-50 g).
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).
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 are 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 methylene chloride 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 have evidence suggesting
substantial exposure and all patients who have ingested methylene
chloride should be transported to a medical facility for evaluation.
Patients who have brief or mild exposure
and who are asymptomatic may be discharged from the scene
after their names, addresses, and telephone numbers are recorded.
These patients should be advised to rest and to seek medical
care promptly if symptoms develop (see Patient Information
Sheet below).
Emergency Department Management
- Patients exposed only to methylene chloride vapor do not
pose secondary contamination risks to hospital personnel.
Patients whose clothing or skin is contaminated with liquid
methylene chloride can secondarily contaminate hospital
personnel by direct contact or through off-gassing vapor.
Methylene chloride vapor may also off-gas from the toxic
vomitus of victims who have ingested methylene chloride.
- Methylene chloride can cause acute CNS and respiratory
depression with resultant cardiac dysrhythmias. If inhaled
at high levels, methylene chloride may cause irritation
of the respiratory tract, and noncardiogenic pulmonary edema
may ensue. Methylene chloride is metabolized slowly to carbon
monoxide.
- There is no antidote for methylene chloride. Treatment
consists of support of respiratory and cardiovascular functions.
Oxygen is an antagonist of metabolically released carbon
monoxide.
Decontamination Area
Previously decontaminated patients and
patients exposed only to methylene chloride vapor who have
no skin or eye irritation may be transferred immediately to
the Critical Care Area. Others require decontamination as
described below.
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 mouth 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).
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 arrhythmia should be treated
in the conventional manner.
Basic Decontamination
Patients who are able may assist with
their own decontamination. Remove and double-bag the contaminated
clothing and personal belongings.
Flush exposed skin and hair with plain
water for 2 to 3 minutes (preferably under a shower), then
wash with mild soap. Rinse thoroughly with water. Use caution
to avoid hypothermia when decontaminating children or the
elderly. Use blankets or warmers when appropriate.
Irrigate exposed eyes with plain water
or saline for at least 15 minutes. Remove contact lenses if
easily removable without additional trauma to the eye.
In cases of ingestion, do not induce
emesis. If the victim is alert and asymptomatic, administer
a slurry of activated charcoal if it has not been given previously.
(More information is provided in Ingestion Exposure
under Critical Care Area below).
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. Establish
intravenous access in seriously ill patients. Continuously
monitor cardiac rhythm.
Patients who are comatose, hypotensive,
or have seizures or ventricular 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).
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 prolonged contact
with liquid methylene chloride, chemical burns may result;
treat as thermal burns.
Because of their relatively larger surface
area:weight ratio, children are more vulnerable to toxicants
absorbed through the skin.
Eye Exposure
Ensure that adequate eye irrigation has
been completed. Examine the eyes for corneal damage and treat
appropriately. Immediately consult an ophthalmologist for
patients who have severe corneal injuries.
Ingestion Exposure
Do not induce emesis.
If the patient is alert and charcoal
has not been given previously, 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 straw may be of assistance when offering
charcoal to a child.
Consider endoscopy to evaluate the extent
of gastrointestinal tract injury. Extreme throat swelling
may require endotracheal intubation or cricothyroidotomy.
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 1 hour of ingestion. Care must be taken when placing
the gastric tube because blind-tube placement may further
injure the chemically damaged esophagus or stomach.
Because children do not ingest large
amounts of corrosive materials, and because the risk of perforation
from nasogastric intubation, lavage is discouraged in children
unless intubation is performed under endoscopic guidance.
Antidotes and Other Treatments
There is no antidote for methylene chloride.
It is unlikely that the carbon monoxide
produced from methylene chloride metabolism will justify hyperbaric
oxygen therapy; however, 100% oxygen at normal pressure is
a useful treatment. The comparative efficacy of 100% normobaric
oxygen compared with that of hyperbaric oxygen has not been
definitively studied.
Laboratory Tests
Routine laboratory studies for all exposed
patients include CBC, glucose, and electrolyte determinations.
In cases of substantial exposure, additional useful studies
include ECG monitoring, determinations of carboxyhemoglobin
levels, and liver-function tests. Chest radiography and pulse
oximetry (or ABG measurements) are recommended for severe
inhalation exposure or if pulmonary aspiration is suspected.
Levels of methylene chloride in blood are not clinically useful;
however, they may be used to qualitatively document exposure.
Carboxyhemoglobin levels of exposed patients rarely exceed
15% but may remain elevated for 1 to 2 days after exposure
due to continual metabolic conversion of fat-stored methylene
chloride.
Disposition and Follow-up
Consider hospitalizing symptomatic patients
who have a suspected serious exposure and are symptomatic.
Delayed Effects
In patients who have been seriously exposed,
cardiac dysrhythmias and skin burns may develop several hours
after exposure. Exposure to high amount of methylene chloride
may give rise to high blood concentration of its metabolite
carbon monoxide. This may lead to permanent sequelae including
mental deterioration, urinary and fecal incontinence, and
gait disturbance. However, most cases of delayed neurologic
sequelae are associated with loss of consciousness in the
acute phase of intoxication.
Patient Release
Patients who have not experienced respiratory
difficulty or alterations in mental status may be discharged.
Patients who initially had mild symptoms but who are asymptomatic
6 to 12 hours after exposure may also be discharged. Discharged
patients should be advised to rest and to seek medical care
promptly if symptoms develop or recur (see the Methylene
Chloride-Patient Information Sheet). Patients should not
be discharged solely on the basis of carboxyhemoglobin levels
because oxygen treatment may render carboxyhemoglobin levels
unreliable. Metabolic conversion of methylene chloride to
carbon monoxide may be ongoing, and carboxyhemoglobin levels
may rebound after oxygen therapy is stopped.
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.
Severely exposed patients should be monitored
for lung, brain, heart, and liver damage. Patients who have
skin burns or 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
methylene chloride.
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What is methylene chloride?
Methylene chloride is a colorless, volatile
liquid with a sweet smell. It is used in plastics processing,
as a paint and varnish remover, and as a cleaning liquid for
electronic boards and metal parts.
What immediate health effects can be caused by exposure to methylene chloride?
Methylene chloride can affect the body
if the vapor is inhaled, if the liquid touches the skin or
eyes, or if it is swallowed. In the body, some methylene chloride
is changed to carbon monoxide (a methylene chloride metabolite),
which prevents the blood from carrying oxygen to the tissues.
At moderate levels, methylene chloride can cause headaches,
fatigue, difficulty walking, and dizziness. High levels can
cause fainting and even death. Methylene chloride can irritate
the lungs, causing a build-up of fluid in the lungs. It can
also cause the heart to beat irregularly or to stop beating.
Generally, the more serious the exposure, the more severe
the symptoms. The fetus and neonates are particularly vulnerable
to poisoning with carbon monoxide.
Can methylene chloride poisoning be treated?
If a person has inhaled or swallowed
a large amount of methylene chloride, breathing 100% oxygen
is helpful. These patients may need to be hospitalized. Most
exposed patients get well.
Are any future health effects likely to occur?
A single small exposure from which a
person recovers quickly is not likely to cause delayed or
long-term effects. After a serious exposure or repeated exposures,
damage to the brain can cause memory loss, poor coordination,
and decreased ability to think. Long-term exposures over many
years have been associated with cancer.
What tests can be done if a person has been exposed to methylene chloride?
Specific tests for the presence of methylene
chloride in blood or urine generally are not useful to the
doctor. If a severe exposure has occurred, blood and urine
analyses and other tests may show whether the liver, brain,
heart, or lungs have been injured. Testing is not needed in
every case.
Where can more information about methylene chloride be found?
More information about methylene chloride
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.
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[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- headache, nausea, vomiting, dizziness
- chest pains, difficulty thinking, blurred vision
- dyspnea on exertion, weakness
- palpitations, tachycardia, tachypnea
[ ] 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.