Medical Management Guidelines for Chlordane
(C10H6Cl8)
CAS#: 57-74-9
UN#: 2996
PDF Versionpdf icon[90 KB]
Synonyms include a wide variety of trade names: Chlordan, Chlor-Kil, CD-68, Octachlor, Termi-Ded, Toxichlor, Topichlor, and Velsicol 1068.
- Persons exposed only to chlordane vapor do not pose risks of secondary contamination to others. Persons whose skin or clothing is contaminated with liquid or powdered chlordane can cause secondary contamination by direct contact.
- Chlordane is a white powder or a colorless to amber/brown viscous liquid. Chlordane itself is not combustible, but it is often dissolved in solvents that are flammable. Chlordane has low volatility; however, solid residues can result in contaminated air and inhalation exposure. Odor generally provides inadequate warning of hazardous concentrations.
- Chlordane is absorbed well by the lungs and gastrointestinal tract and through intact skin. Exposure by any route can cause systemic effects.
General Information
Description
Technical-grade chlordane is a mixture
of chlordane isomers and more than 140 related reaction products.
Depending on the composition, the mixture may be an amber-to-brown,
viscous liquid or a white powder. At room temperature, chlordane
is almost odorless or may have a slight chlorine-like odor,
but the odor is inadequate as a warning of exposure. It is
semi-volatile, volatilizing in hot environments but not under
cooler conditions. Chlordane is insoluble in water and soluble
in hydrocarbon solvents. It is not combustible, but will decompose
when heated or reacted with strong oxidizers or alkaline agents
to produce corrosive and/or toxic gases: carbon monoxide,
hydrogen chloride gas, chlorine, and phosgene. As a commercial
pesticide, chlordane is usually dissolved in hydrocarbons
and used as a spray. Chlordane will attack some forms of plastics
and rubber and is corrosive to iron and zinc; it can be stored
in a cool, dry, well-ventilated area in aluminum, aluminum-clad
or high-baked phenolic enamel-lined metal containers.
Routes of Exposure
Inhalation
Acute inhalation of chlordane vapor is
unlikely because of chlordane's low vapor pressure at ordinary
temperatures; however, chlordane is semi-volatile and may
volatilize in hot environments. The odor threshold for
chlordane is about 10 times lower than the OSHA permissible
exposure limit (PEL); however, odor may not provide an adequate
warning for prolonged exposures because olfactory fatigue
may occur. Toxic effects can occur after acute inhalation
of a spray or mist containing chlordane and after chronic
inhalation, usually by occupants of contaminated houses. With
pesticide formulations, toxicity may also occur from inhalation
of the solvents used to dissolve chlordane.
Children exposed to the same levels
of chlordane as adults may receive 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 chlordane
found nearer to the ground.
Skin/Eye Contact
Chlordane is rapidly absorbed through
the skin, which can lead to systemic toxicity. Oils applied
to the skin increase the absorption of chlordane. Early formulations
of chlordane were irritating to the skin and mucous membranes.
Children are more vulnerable to toxicants
absorbed through the skin because of their larger surface
area:weight ratio.
Ingestion
Acute toxic effects, including death,
can result from ingestion of chlordane.
Sources/Uses
Chlordane is a synthetic compound. It
was used widely as an insecticide on food crops and as a termiticide
in buildings and homes. Since 1988, the use and commercial
production of chlordane (except for export) has been prohibited
in the United States and many other countries. However, chlordane
residue is still present from prior use in many homes and
other structures, as well as the surrounding soil. Old supplies
of chlordane may still exist in locations such as warehouses,
garages, and landfills.
Standards and Guidelines
OSHA PEL (permissible exposure limit)
= 0.5 mg/mĀ³ (skin) (averaged over an 8-hour work shift)
NIOSH IDLH (immediately dangerous to
life or health) = 100 mg/mĀ³
Physical Properties
Description: Amber, viscous liquid
Warning properties: Nearly odorless;
inadequate warning for acute or chronic exposure.
Molecular weight: 409.8 daltons
Boiling point (2 mm Hg): 347ĀŗF
(175ĀŗC)
Melting point (cis isomer):
225-228ĀŗF (107-109ĀŗC)
Melting point (trans isomer):
217-221ĀŗF (103-105ĀŗC)
Vapor pressure: 0.00001 (1 x 10-5)
mm Hg at 77ĀŗF (25ĀŗC)
Specific gravity: 1.59-1.63 at
77ĀŗF (water = 1)
Water solubility: Water insoluble
Flammability: Noncombustible liquid
(but the commercial product may be dissolved in various flammable
solvents).
Incompatibilities
Chlordane reacts with strong oxidizers
and alkaline reagents; decomposition produces corrosive/toxic
fumes of carbon monoxide, hydrogen chloride gas, chlorine,
and phosgene. Chlordane will attack some forms of plastic,
rubber, and coatings. It is corrosive to iron and zinc.
Health Effects
- Significant chlordane exposure by any route disrupts the
transmission of nerve impulses, resulting in CNS excitation,
convulsions, and respiratory depression.
- Chlordane is absorbed well through intact skin. Early
formulations contained impurities that were skin and mucous-membrane
irritants.
- Common symptoms of chlordane poisoning include headache,
nausea, excitability, confusion, and muscle tremors that
may precede convulsions.
Acute Exposure
Adverse health effects of chlordane are
due both to the parent compound and its metabolites. The mechanism
of neurotoxic effects may involve competitive inhibition of
gamma aminobutyric acid (GABA), reducing GABA-mediated inhibition
of post-synaptic neuronal excitability.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
CNS
Chlordane poisoning by any exposure route
can cause blurred vision, sensory disturbances, headache,
refractory convulsions, muscle tremors, excitability, confusion,
loss of consciousness, coma, and death. Serious poisonings
are characterized by onset of violent convulsions within 0.5
to 3 hours, with death or remission of convulsions following
shortly thereafter.
Gastrointestinal
Nausea, vomiting, and diarrhea can occur,
especially after ingestion.
Dermal
Extensive skin contact may result in
dermal irritation. Chlordane produced prior to 1951 had a
high percentage of irritant impurities; chlordane produced
after that date is generally nonirritating. Chlordane is absorbed
well even through intact skin, and dermal absorption can lead
to systemic toxicity and death.
Because of their larger surface area:body
weight ratio, children are more vulnerable to toxicants absorbed
through the skin
Ocular
When splashed in the eye, chlordane may
produce redness and pain.
Respiratory
Respiratory depression, irritation, reduced
gas exchange, and chemical pneumonitis may occur.
Musculoskeletal
In serious acute exposures, myoclonic
jerking may be so intense as to cause compression fractures
of the vertebrae.
Hepatic
Chlordane induces liver microsomal enzymes,
thereby enhancing the metabolism of and reducing the efficacy
of therapeutic drugs such as phenobarbital, which may be administered
as an anticonvulsant.
Potential Sequelae
Chlordane poisoning by any exposure route
can cause permanent alterations of nervous system function,
including problems with memory, learning, thinking, sleeping,
personality changes, depression, numbness in the extremities,
headache, and sensory and perceptual changes. Inflammation
of the lungs due to pulmonary aspiration of vomitus, accumulation
of fluid in the lungs, and acute kidney failure may occur
after acute poisoning. If a toxic or lethal dose has been
absorbed, anorexia and loss of body weight may be marked if
death is delayed.
Chronic Exposure
Chronic chlordane exposure can cause
permanent alterations of nervous system function, including
problems with memory, learning, thinking, sleeping, personality
changes, depression, numbness in the extremities, headache,
and sensory and perceptual changes. It has been suggested
that chronic exposure can cause blood disorders, but these
disorders were not shown to have an increased incidence in
heavily exposed groups of workers. Besides blood disorders,
jaundice has been reported in persons living in homes treated
with chlordane for termite control, but liver-function tests
were normal in workers who manufactured chlordane. Chronic
exposures may be more serious for children because of their
potential longer latency period.
Carcinogenicity
IARC has determined that chlordane is
possibly carcinogenic to humans (group 2B). The EPA has determined
that technical grade chlordane is a likely human carcinogen.
Chlordane is structurally similar to rodent carcinogens and
chronic chlordane exposure can cause hepatocellular carcinoma
in several strains of mice. The evidence for carcinogenicity
in humans is weak: a few case reports and mixed or equivocal
case-control study results associating exposure to chlordane
with leukemia and non-Hodgkin's lymphoma. Epidemiological
evidence for an association is supported by limited evidence
of mutagenicity in human and rodent lymphocytes tested in
vitro.
Reproductive and Developmental Effects
The TERIS database states that no epidemiologic
studies have reported birth defects among infants born to
mothers exposed to chlordane during pregnancy. Chlordane is
excreted in breast milk. Chlordane 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 teratogenic effects from acute
exposure have been reported. Prenatal exposure to chlordane
has been reported for a few cases of neuroblastoma, blood
dyscrasias, and depressed cell-mediated immunity, but no direct
link with the chemical was established.
Chlordane induces liver enzymes and enhances
metabolism of steroid hormones, including oral contraceptives;
sterility has been reported in animals.
Prehospital Management
- Chlordane is absorbed well through intact skin. Victims
whose skin or clothing is contaminated with liquid or powdered
chlordane can secondarily contaminate response personnel
by direct contact and in very severe contamination by off-gassing
of carrier solvents. In rare instances, toxic vomitus can
also secondarily contaminate rescuers by the same routes.
- Chlordane can cause CNS excitation, blurred vision, confusion,
and intractable seizures. Victims should be protected from
loud noises or other stimuli that might trigger seizures.
Do not administer epinephrine (or other adrenergic drug)
or atropine, since ventricular fibrillation may ensue.
- There is no specific antidote for chlordane poisoning.
Treatment consists of supportive measures.
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
Chlordane is a moderately toxic systemic
poison that is absorbed well by inhalation, and through the
skin. It is also irritating to the skin and eyes on direct
contact. Rescuers should wear chlordane-resistant gear.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of chlordane.
Skin Protection: Chemical-protective
clothing is recommended because skin irritation and dermal
absorption may occur and may contribute to systemic toxicity.
For chlordane hazards, NIOSH recommends suits made of CPF3ā¢
(Kappler Company), and Trellchem HPSā¢ (Trelleborg Company)
and gloves or boots made of Teflonā¢ (DuPont Company).
NTP recommends Tyvek-type clothing or sleeves and gloves made
of Viton (North F-091), Nitrile (Edmont 37-155), PVA (Edmont
15-554), or Neoprene (Pioneer N-44).
ABC Reminders
Quickly access 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 anxiety
if a child is separated from a parent or other adult.
Decontamination Zone
All victims who have contacted chlordane
liquid or powder require decontamination as described in this
section (see Basic Decontamination) Victims exposed
only to chlordane vapor who have no skin or eye irritation
do not need decontamination and may be transferred to the
Support Zone
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
(see Rescuer Protection above).
ABC Reminders
Quickly access a patent airway, ensure
adequate respiration and palpable pulse. Stabilize the cervical
spine with a collar and a backboard if trauma is suspected.
Apply artificial respiration if the victim is not breathing.
Assist ventilation with a bag-valve-mask device if necessary.
Do not use mouth-to-mouth resuscitation if the victim inhaled
or ingested chlordane. Administer supplemental oxygen as required.
For inhalation exposures, monitor for
respiratory distress. If cough or breathing difficulty develops,
evaluate for respiratory tract irritation, bronchitis, or
pneumonitis. Administer 100% humidified supplemental oxygen
if breathing is difficult.
Basic Decontamination
Victims who are able and cooperative
may assist with their own decontamination. Remove and double-bag
contaminated clothing and personal belongings. Leather absorbs
chlordane; therefore, items such as leather shoes, gloves,
and belts should be discarded.
If there has been direct contact with
liquid or powdered chlordane, flush exposed skin, hair, and
under nails with plain, running, tepid water for 20 minutes,
then wash twice with mild soap. Do not scrub, since
this can increase absorption through the skin. Rinse thoroughly
with water.
If eyes have been exposed directly, irrigate
with large amounts of plain, tepid water or saline for 20
minutes, occasionally lifting the lower and upper lids. During
this time, remove contact lenses, if easily removable without
additional trauma to the eye.
Keep victims (adults or children) warm
and quiet to avoid triggering seizures and the complication
of hypothermia.
In cases of chlordane ingestion, do
not induce emesis. If the victim is conscious and able
to swallow, administer an aqueous 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. (The efficacy of activated charcoal for chlordane
poisoning is uncertain).
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 Basic Decontamination above). Persons
who have undergone decontamination or who have been exposed
only to vapor pose no serious risks of secondary contamination
to rescuers. In such cases, Support Zone personnel require
no special protective gear.
ABC Reminders
Quickly access 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 chlordane ingestion, do
not induce emesis. If the exposure is recent (within 1-2
hours) and the patient is conscious 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) if it has not been given previously.
A soda can and straw may be of assistance when offering charcoal
to a child. (The efficacy of activated charcoal for chlordane
poisoning is uncertain.)
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.
To control metabolic acidosis, treat
with sodium bicarbonate under medical base control (adult
dose = 1 ampule; pediatric dose = 1 mEq/kg).
Patients who are comatose, hypotensive,
or have seizures or cardiac dysrhythmias should be treated
according to advanced life support (ALS) protocols.
High concentrations of chlordane can
increase cardiac irritability, use caution with cardiac or
bronchial sensitizing agents.
Transport to Medical Facility
Only decontaminated patients or patients
not requiring decontamination should be transported to a medical
facility. "Body bags" can cause added danger and
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 a chlordane-containing mixture 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.
Because of the rapidity of the onset
of intractable seizures in patients who have chlordane toxicity
and the potential for vomiting during seizures, suction should
be readily available. Be prepared to protect the airway by
positioning or intubation.
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 histories or symptoms
suggesting substantial exposure (CNS effects, eye irritation,
respiratory distress, or cardiac dysrhythmias) and all persons
who have ingested chlordane should be transported to a medical
facility for evaluation.
Asymptomatic patients exposed only by
inhalation may be released from the scene after their names,
addresses, and telephone numbers are recorded. Be certain
that no significant dermal exposure has occurred before releasing
a patient from the scene. Those released should be advised
to seek medical care promptly if symptoms develop (see the
Patient Information Sheet below).
Emergency Department Management
- Chlordane is absorbed well through intact skin. Patients
whose skin or clothing is contaminated with liquid or powdered
chlordane can secondarily contaminate response personnel
by direct contact and, in cases of severe contamination,
by off-gassing of carrier solvents. Rarely, toxic vomitus
can also secondarily contaminate rescuers by the same routes.
Patients do not pose serious contamination risks after contaminated
clothing is removed and the skin is thoroughly washed.
- Chlordane is irritating to the skin, eyes, and respiratory
tract. Systemic effects can occur from all routes of exposure
and may include CNS excitation, intractable seizures, respiratory
depression, and ventricular dysrhythmia. Sensory and motor
abnormalities may be early signs of convulsions.
- There is no specific antidote for chlordane poisoning.
Treatment consists of management of seizures and other measures
to support respiratory and cardiovascular function.
Decontamination Area
Unless previously decontaminated, all
patients suspected of direct contact with chlordane liquid
or solid and all patients with skin or eye irritation require
decontamination as described below. Because chlordane is absorbed
through the skin and can attack rubber and several kinds of
plastics, don Teflonā¢ gloves and suits before treating
patients. Patients exposed only to vapor who have no skin
or eye irritation do not need decontamination and may be transferred
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 larger surface area: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. Children may be more vulnerable to corrosive
or irritating agents than adults because of the smaller diameter
of their airways. Intubate the trachea in cases of respiratory
compromise. If the patient's condition precludes intubation,
surgically create an airway.
Chlordane exposure may cause cardiac
arrhythmias. Therefore, administration of epinephrine or other
adrenergics or atropine is not recommended unless absolutely
necessary.
Patients who have seizures or ventricular
dysrhythmias or who are comatose or hypotensive should be
treated in the conventional manner.
For seizures, administer a benzodiazepine:
Diazepam: adults, 5 to 10 mg i.v., repeated every 10
to 15 minutes as needed to a maximum of 30 mg; children,
0.2 to 0.5 mg/kg i.v., repeated every 5 minutes as needed
to a maximum of 10 mg in children over 5 years or to a maximum
of 5 mg in children under 5 years; or Lorazepam: adults,
4 to 8 mg i.v.; children, 0.05 to 0.1 mg/kg i.v.. Consider
phenobarbital and/or phenytoin or fosphenytoin if seizures
are uncontrollable or recur after diazepam.
Correct acidosis in the patient who has
coma, seizures, or cardiac dysrhythmias by administering intravenously
sodium bicarbonate (adult dose = 1 ampule; pediatric dose
= 1 Eq/kg). Further bicarbonate therapy should be guided by
arterial blood gas (ABG) measurements.
Basic Decontamination
Patients who are able may assist with
their own decontamination. If the patient's clothing is contaminated
with chlordane, remove and double-bag the contaminated clothing
and all personal belongings. Since leather absorbs chlordane,
items such as leather belts, shoes, and gloves should be discarded
and destroyed by incineration.
Flush exposed skin, hair, and under nails
with plain water for 20 minutes (preferably under a shower),
then wash twice with mild soap and shampoo. Rinse thoroughly
with water.
Exposed adults or children should be
kept warm and quiet to avoid seizures or the complications
of hypothermia.
Flush exposed eyes with plain water or
saline for at least 20 minutes, occasionally lifting the lower
and upper lids. During this time, remove contact lenses if
easily removable without additional trauma to the eye. Continue
irrigation while transporting the patient to the Critical
Care Area.
In cases of ingestion, do not induce
emesis. (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 under Decontamination
Zone. Children may be more vulnerable to corrosive agents
than adults because of the smaller diameter of their airways.
Establish intravenous access in symptomatic patients if this
has not been done previously. Continuously monitor cardiac
rhythm.
Patients exposed to high levels of chlordane
should be carefully observed for sensory or motor abnormalities
that might signal the onset of seizures.
Patients who are comatose or have seizures
should be treated in the conventional manner. Refractory seizures
may require more aggressive measures such as mechanical ventilation
or inducing muscle paralysis or barbiturate coma. Use continuous
EEG monitoring.
Control metabolic acidosis with sodium
bicarbonate (adult dose = 1 ampule; initial pediatric
dose = 1 mEq/kg).
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory symptoms (difficulty in breathing,
pneumonitis).
Do not administer epinephrine,
other adrenergic amines, or atropine, since enhanced chlordane-induced
myocardial irritability may predispose to ventricular fibrillation.
Skin Exposure
Washing the skin and hair with mild soap
and rinsing thoroughly with water is usually sufficient treatment
for skin exposure.
Because of their larger surface area:weight
ratio, children are more vulnerable to toxicants absorbed
through 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 severe corneal injuries.
Ingestion Exposure
Do not induce emesis because the
patient is at risk of CNS depression or seizures, which may
lead to pulmonary aspiration during vomiting. Control any
seizures first.
Consider cautious 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 gastric-tube placement may further injure
the chemically damaged esophagus or stomach.
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. (The efficacy of charcoal for chlordane
poisoning is uncertain.)
Because of the risk of perforation from
NG intubation, lavage is discouraged in children unless intubation
is performed under endoscopic guidance.
Antidotes and Other Treatments
There is no specific antidote for chlordane.
Repeated doses of cholestyramine (3 to 8 g four times a day
for several days) mixed with pulpy fruit or liquid, or activated
charcoal have been suggested to enhance the elimination of
chlordane in cases of severe poisoning. During convalescence,
enhance carbohydrate, protein, and vitamin intake by diet
or parenteral therapy.
The following treatments are NOT effective:
forced diuresis, hemodialysis, and hemoperfusion. Oil-based
cathartics should NEVER be used, as they may facilitate absorption.
Laboratory Tests
Routine laboratory studies for all exposed
patients include CBC, glucose, and electrolyte determinations.
Additional studies for patients exposed to chlordane include
liver and renal-function tests.
Determining chlordane or chlordane-metabolite
levels in blood after acute exposure is not clinically useful.
However, these tests may be useful in documenting massive
acute exposure.
If problems with memory, concentration,
and personality changes are present, or seizures or convulsions
have occurred, then neurobehavioral toxicity testing is indicated.
If numbness of the hands or feet is present, then nerve conduction
studies are indicated.
Disposition and Follow-up
Consider hospitalizing patients who have
a suspected serious exposure and are symptomatic.
Delayed Effects
Patients exposed by inhalation should
be observed for signs of pulmonary edema and those who have
ingested chlordane should be watched for signs of aspiration
pneumonitis.
Patient Release
Patients who are initially asymptomatic
and who remain so 2 to 3 hours after exposure may be discharged
with instructions to seek medical care promptly if symptoms
develop (see the Follow-up Instructions on the Chlordane
- 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.
Patients who have shown symptoms of
seizures, convulsions, headache or confusion, need to be followed
for permanent central nervous system dysfunction with neurobehavioral
toxicity testing, with particular attention to problems with
memory, personality changes, and perceptual dysfunction. If
peripheral numbness is present, then nerve conduction studies
are indicated.
Chlordane has been inconclusively implicated
in rare cases of megaloblastic anemia and a variety of other
blood dyscrasias. Patients should be evaluated for blood dyscrasias
after substantial exposure. Since kidney damage has been observed
in humans exposed to chlordane, a urinalysis should be repeated
on an annual basis. In addition, the condition of eyes, skin,
liver, and lungs should be evaluated following exposure to
chlordane.
Patients who have corneal injuries should
be reexamined within 24 hours.
Reporting
If a pesticide or 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
chlordane.
Print this handout only.pdf icon[32 KB]
What is chlordane?
Chlordane was produced as a thick, amber
liquid or white powder. It was used as an insecticide in the
form of a spray or powder on food crops and to rid homes and
buildings of termites. It has been banned in the United States
since 1988; however, many buildings and the soils around them
have residue from previous chlordane use. Old bottles of chlordane
may still be found in garages, warehouses, and landfills.
Chlordane is not flammable, but may be dissolved in flammable
solvents. On burning, or upon reaction with strong oxidizers
or alkalis, chlordane decomposes to produce toxic fumes that
include chlorine, phosgene (mustard gas), and hydrogen chloride.
What immediate health effects can result from chlordane exposure?
Chlordane may cause effects when it is
breathed or swallowed or when it touches the skin. Common
effects of poisoning are nausea, irritability, headaches,
stomach pain, and vomiting. Loss of coordination, tremors,
convulsions, and death can occur with severe exposures. Generally,
the higher the exposure, the more severe the symptoms. If
lactating mothers are exposed, chlordane will contaminate
the breast milk and may cause adverse effects in nursing infants.
Can chlordane poisoning be treated?
There is no antidote for chlordane, but
its effects can be treated, and most exposed persons get well.
Persons with serious symptoms may need to be hospitalized.
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. However, a single large exposure can result
in the same neurological effects seen with chronic exposure.
Exposure to chlordane over many years may cause blood disorders,
and neurological effects, such as memory loss, irritability,
numbness, loss of coordination, and seizures.
What tests can be done if a person has been exposed to chlordane?
Specific tests for the presence of chlordane
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 blood, brain or kidneys
have been injured. An electroencephalogram (EEG) may be used
for evaluation if seizures have occurred. Testing is not needed
in every case.
Where can more information about chlordane be found?
More information about chlordane 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:
- blurred vision
- coughing, difficulty breathing, or shortness of breath
- seizures or convulsions
- fever
[ ] 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.