Medical Management Guidelines for Aniline
(C
6H
5NH
2)
CAS# 62-53-3
UN# 1547
PDF Versionpdf icon[200 KB]
Synonyms include aminobenzene, aminophen, arylamine, benzenamine, aniline oil, and phenylamine.
- Persons exposed only to aniline vapor do not pose risks of secondary contamination to others. Persons whose clothing or skin is contaminated with liquid aniline can cause secondary contamination by direct contact or through off-gassing vapor.
- Aniline vapor is heavier than air and may accumulate in low-lying areas. The vapor is combustible. Aniline has a characteristic aromatic or fishy odor which provides adequate warning of acute exposure.
- Aniline is rapidly absorbed after inhalation and ingestion. Aniline liquid and vapor are also absorbed well through skin, and this can contribute to systemic toxicity.
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General Information
Description
At room temperature, aniline, the simplest aromatic amine, is a clear to slightly yellow, oily liquid that darkens to a brown color on exposure to air. It has a low vapor pressure at room temperature. Aniline is slightly soluble in water and is miscible with most organic solvents.
Routes of Exposure
Inhalation
Inhaled aniline is rapidly and almost
completely absorbed from the lungs, leading to systemic toxicity. Its aromatic or fishy odor can generally be perceived at 1 ppm which is below established occupational safety limits (OSHA PEL-TWA is 5 ppm), and thus, odor usually provides an adequate indication of hazardous concentrations. Aniline vapor is heavier than air and may cause asphyxiation in enclosed, poorly ventilated, or low-lying areas.
Children exposed to the same levels of aniline vapor 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 aniline vapor found nearer to the ground.
Skin/Eye Contact
Contact with liquid aniline may cause
mild irritation to skin or eyes. Aniline is absorbed well
through the skin, and this can contribute to systemic toxicity.
The effects of skin absorption can be delayed for several
hours.
Children are more vulnerable to toxicants
absorbed through the skin because of their relatively larger
surface area:body weight ratio.
Ingestion
Aniline is rapidly absorbed from the
gastrointestinal tract. Ingestion can lead rapidly to severe
systemic toxicity, nausea and vomiting usually occur.
Sources/Uses
Aniline is synthesized by catalytic hydrogenation
of nitrobenzene or by ammonolysis of phenol. In industry,
aniline is an initiator or intermediary in the synthesis of
a wide variety of products, most notably polyurethane foam,
agricultural chemicals, analgesics, synthetic dyes, antioxidants,
stabilizers for the rubber industry, and hydroquinone for
photographic developing. Aniline has been used as an octane
booster in gasoline.
Standards and Guidelines
OSHA PEL (permissible exposure limit)
= 5 ppm (skin) (averaged over an 8-hour workshift)
NIOSH IDLH (immediately dangerous to
life or health) = 100 ppm
Physical Properties
Description: Slightly yellow-to-brown,
clear oily liquid
Warning properties: Aromatic
or fishy odor at about 1 ppm; adequate warning for acute exposure
Molecular weight: 93.1 daltons
Boiling point (760 mm Hg): 363ĀŗF
(184.4ĀŗC)
Freezing point: 21ĀŗF (-6.2ĀŗC)
Specific gravity: 1.02 (water
= 1)
Vapor pressure: 0.6 mm Hg at
68ĀŗF (20ĀŗC)
Gas density: 3.2 (air = 1)
Water solubility: Water soluble
(4% at 68ĀŗF) (20ĀŗC)
Flammability: Flammable at temperatures
>158ĀŗF (70ĀŗC)
Flammable range: 1.3% to 25%
(concentration in air)
Incompatibilities
Aniline reacts with strong oxidizers,
strong acids, alkalis and toluene diisocyanate. It reacts
violently with benzenediazonium-2-carboxylate, boron trichloride,
dibenzoyl peroxide 90% performic acid, N-bromosuccinimide,
trichloronitromethane, and perchromate, and it spontaneously
ignites in the presence of red fuming nitric acid.
Health Effects
- Aniline is irritating to the skin, eyes, and respiratory
tract. Effects can result from all routes of exposure. Aniline
induces methemoglobinemia, which impairs the delivery of
oxygen to tissues.
- Aniline may also cause the destruction of red blood cells,
which manifests as acute or delayed hemolytic anemia. Heart,
liver, and kidney effects may be secondary to hemolysis.
- Insufficient delivery of oxygen and destruction of red
blood cells may cause cardiopulmonary complaints with the
development of ischemia, arrhythmia and shock.
Acute Exposure
Many of the adverse health effects of
aniline are due in part to the formation of methemoglobinemia.
Aniline converts the Fe+2 in hemoglobin to Fe+3
which impairs its oxygen transport capacity. The mechanism
by which aniline produces methemoglobin in the blood appears
to be related to an active metabolite. Methemoglobin formation
from aniline exposure may develop insidiously, and onset of
symptoms may be delayed for hours. Production of methemoglobin
may continue for up to 20 hours after exposure. Exposure to
7-53 ppm aniline vapor causes slight symptoms after several
hours, and concentrations greater than 100-160 ppm cause serious
disturbances. As little as 1 g of ingested aniline can be
fatal to humans, the mean lethal dose is 5-30 g (HSDB 2000).
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed. The very young and the very old
can be more adversely affected by aniline in an acute exposure.
Hematologic
Aniline causes metheglobinemia and hemolysis;
these changes can be detected by blood tests or by the color
and appearance of the blood. Methemoglobinemia is a concern
in infants up to 1 year old. Children may be more vulnerable
to loss of effectiveness of hemoglobin because of their relative
anemia, higher metabolic rate and greater sensitivity to hypoxia
compared to adults. The elderly are more vulnerable due to
limited cardiovascular reserves. Signs and symptoms expected
at various percentages of methemoglobin formation are outlined
below. Patients who have underlying diseases may develop signs
and symptoms at even lower methemoglobin percentages.
Methemoglobin Level:
|
Signs and Symptoms:
|
30-50%
| Headache, fatigue, dizziness, rapid heart
rate, mild shortness of breath
|
50-70%
| Stupor, slow heart rate, respiratory depression,
irregular heart rhythm, acid-base imbalance
|
60-70%
| Cardiac arrest, loss of consciousness, coma,
death
|
When methemoglobin levels are 15% to
30%, the patient's skin may become bluish in color, which
is due to the dark color of methemoglobin and not to inadequate
oxygen in the blood. The blood itself has a chocolate-brown
appearance. Methemoglobin levels exceeding 70% are potentially
lethal if untreated.
Acute or delayed (2 to 7 days) hemolytic
anemia (caused by destruction of red blood cells) also results
from aniline exposure. Aniline induces the formation of Heinz
bodies. Persons with glucose-6-phosphate dehydrogenase (G6PD)
deficiency or alcoholism are at increased risk of aniline-induced
hemolysis.
Cardiovascular
Cardiac effects of acute aniline exposure,
such as irregular heart rhythm, heart block, and acute congestive
heart failure, may be caused by decreased oxygen delivery
to the tissues. Death can result from progressive acidosis,
ischemia and cardiovascular collapse.
CNS
Acute aniline exposure can cause confusion,
ringing in the ears, weakness, disorientation, dizziness,
impaired gait, lethargy drowsiness, convulsions, loss of consciousness,
and coma. These effects are usually transitory and probably
secondary to lack of oxygen.
Renal
Acute aniline exposure can cause painful
urination; blood, hemoglobin or methemoglobin in the urine;
decreased urinary output; and acute kidney failure. Bladder-wall
irritation, kidney ulceration, and tissue death can also occur.
Dermal
Moderate skin irritation and sensitization
and dermatitis have been reported. Systemic effects can result
from skin contact with aniline vapor or liquid. Patients who
have methemoglobinemia can appear gray, bronze, or blue.
Because of their larger surface area:body
weight ratio, children are more vulnerable to toxicants absorbed
through the skin.
Ocular
Aniline can cause mild to severe eye
irritation, corneal damage, and discoloration.
Hepatic
Liver damage and jaundice may occur.
Gastrointestinal
Nausea and vomiting can occur.
Respiratory
Inhalation of aniline can cause respiratory
tract irritation with cough, or difficulty in breathing. Methemoglobin
causes absorption interference with pulse oximetry reading,
rendering falsely high values as with the calculated value
from the arterial blood gas (ABG) analyzer. Accurate oxygen
saturation determinations require co-oximeter measurements.
Children may be more vulnerable because
of increased minute ventilation per kg and failure to evacuate
an area promptly when exposed.
Potential Sequelae
Persons exposed to aniline may have chronic
effects due to the persistence of acutely produced damage
to the brain, heart, and kidneys.
Chronic Exposure
Chronic exposure to aniline may cause
anemia, headaches, tremor, parathesis, pain, narcosis or coma,
and cardiac arrhythmia. Heart, kidney, and liver damage may
also occur, possibly as secondary effects of hemolysis.
Chronic exposure may be more serious
for children because of their potential longer latency period.
Carcinogenicity
The International Agency for Research
on Cancer (IARC) has determined that aniline is not classifiable
as to its carcinogenicity to humans. Bladder cancers reported
in aniline-exposed workers, but have been attributed to concurrent
exposure to chemicals other than aniline.
Reproductive and Developmental Effects
Aniline is not listed in the TERIS or
Reprotext databases. One gavage study in pregnant rats is
noted in Shepard's Catalog of Teratogenic Agents, and this
study resulted in no teratogenic effects. Aniline 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. A high incidence
of gynecological disorders and excess frequency of spontaneous
abortions have been reported in chemically exposed women.
Aniline can cross the placental barrier.
Aniline induces the production of methemoglobin in both adults
and children. The fetal liver can also N-oxygenate aniline
to form phenylhydroxylamine which has a high potency for methemoglobin
production. Because fetal hemoglobin is more easily oxidized
to methemoglobin than is adult hemoglobin and is less easily
reduced back to normal hemoglobin, methemoglobin is likely
to be at higher levels in fetuses than in exposed mothers.
No data were located to assess potential transfer of aniline
to nursing infants via breast milk.
Prehospital Management
- Persons exposed only to aniline vapor do not pose secondary
contamination risks to rescuers. Those whose clothing or
skin is contaminated with liquid aniline can secondarily
contaminate response personnel by direct contact or through
off-gassing vapor.
- Aniline is irritating to the eyes and skin. Systemic effects
occur from all routes of exposure and can include methemoglobinemia
and hemolysis. CNS depression and cardiovascular collapse
may also result, primarily secondary to hypoxia.
- Immediate treatment for aniline overexposure consists
of decontamination and cardiopulmonary support. Symptomatic
individuals should be administered supplemental oxygen and
the methemoglobin antidote, methylene blue, as soon as possible.
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
Aniline is a highly toxic systemic poison
that is absorbed well by inhalation and through the skin.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to potentially unsafe
levels of aniline vapor.
Skin Protection: Chemical-protective
clothing is recommended because aniline vapor and liquid can
be dermally absorbed and may contribute to systemic toxicity.
Direct contact with liquid aniline can cause skin burns.
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. Victims should not be allowed to overexert themselves,
as exposure to aniline can produce hypoxia (due to methemoglobinemia)
which can be exacerbated by physical effort.
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 aniline 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. Assist ventilation with a bag-valve-mask
device if necessary.
Basic Decontamination
Victims who are able may assist with
their own decontamination, but minimize patient exertion since
this could exacerbate symptoms of hypoxemia. Because aniline
is absorbed through the skin, it is important to remove wet
clothing quickly. Remove and double-bag contaminated clothing
and personal belongings.
Flush exposed skin and hair with plain
water for 2 to 3 minutes, then wash thoroughly 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
tepid water for 15 minutes. Remove contact lenses if easily
removable without additional trauma to the eye. 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 and asymptomatic, 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. 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 who have been exposed only to
vapor pose no serious risks of secondary contamination to
rescuers. Support Zone personnel require no specialized protective
gear in such cases.
ABC Reminders
Quickly access for a patent airway. If
trauma is suspected, maintain cervical immobilization manually
and apply a cervical collar and a backboard. Ensure adequate
respiration and pulse; administer supplemental oxygen. Establish
intravenous access if necessary. At low levels of methemoglobin,
skin color is not a reliable sign for judging hypoxemia or
poor perfusion because the apparent cyanosis is not caused
by true hypoxemia but by methemoglobin pigmentation. 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 and asymptomatic, administer
a slurry of activated charcoal if it has not been given previously
(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.
Advanced Treatment
In cases of respiratory compromise secure
airway and respiration by 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. Also 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). Aniline poisoning is not known to pose additional
risk during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in water, repeat every 20 minutes
as needed cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or have seizures or cardiac dysrhythmias should be treated
according to advanced life support (ALS) protocols.
Antidotes
Administer methylene blue antidote to
patients who have cardiopulmonary symptoms. The standard intravenous
dose is 1 to 2 mg of methylene blue per kg of body weight
(0.1 to 0.2 mL/kg of a 1% solution) over 5 to 10 minutes,
repeated in one hour if needed. Clinical response is usually
observed within 30 to 60 minutes. The total dose over a 24
hour period should not exceed 7 mg/kg, methylene blue itself
can cause hemolysis at greater doses.
Consider hyperbaric oxygen therapy in
patients who are refractory to methylene blue therapy.
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 aniline has been ingested, prepare
the ambulance in case the patient vomits toxic material. Have
ready several towels and open plastic bags to quickly clean
up and isolate toxic material.
Multi-Casualty Triage
Consult with the base station physician
or the regional poison control center for advice regarding
triage of multiple victims.
Patients with evidence of significant
exposure (e.g., cyanosis, dizziness, headache or severe skin
irritation) should be transported to a medical facility for
evaluation. Others may be discharged from the scene after
their names, addresses, and telephone numbers are recorded.
They 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
exposed by vapor off-gassing from heavily contaminated clothing
or from the vomitus of victims who have ingested aniline.
Patients exposed only to aniline vapor or who have been
decontaminated do not pose secondary contamination risks
to hospital personnel.
- Aniline exposure can cause methemoglobinemia and hemolysis.
CNS depression and cardiovascular collapse may result, primarily
secondary to hypoxia.
- Immediate treatment for aniline overexposure consists
of cardiopulmonary support and administration of the methemoglobinemia
antidote, methylene blue.
Decontamination Area
Patients who have been decontaminated
should be taken immediately to the Critical Care area. Patients
who have ingested aniline or have skin contact with liquid
aniline 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 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. Children may be more vulnerable to corrosive
agents than adults because of the smaller diameter of their
airways. Secure the airway and respiration via endotracheal
intubation in cases of respiratory compromise. If the patient's
condition precludes intubation, 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. Also 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). Aniline poisoning is not known to pose additional
risk during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 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 may assist with
their own decontamination. Because aniline is absorbed through
the skin, hospital personnel should don 2 layers of latex
gloves when decontaminating patients. If the patient's clothing
is wet with aniline, quickly remove the contaminated clothing
while flushing exposed skin and hair with plain water for
2 to 3 minutes (preferably under a shower). Then wash twice
with mild soap. Rinse thoroughly with water. Double-bag the
contaminated clothing and all personal belongings.
Use caution to avoid hypothermia when
decontaminating children or the elderly. Use blankets or warmers
when appropriate.
Irrigate exposed eyes with tepid water
for at least 15 minutes. Remove contact lenses if easily removable
without additional trauma. If pain or injury is evident, continue
irrigation while transferring the patient to the Critical
Care Area.
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
(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.
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. Children may be
more vulnerable to corrosive agents than adults because of
the smaller diameter of their airways. Establish intravenous
access in ill patients if this has not been done previously.
Continuously monitor cardiac rhythm. Place symptomatic patients
on oxygen.
Patients who are comatose, hypotensive,
or have seizures or cardiac arrhythmias should be treated
in the conventional manner.
Inhalation Exposure
Administer supplemental oxygen and treat
patients who have bronchospasm with aerosolized bronchodilators.
The use of bronchial sensitizing agents in situations of multiple
chemical exposures may pose additional risks. Also 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). Aniline
poisoning is not known to pose additional risk during the
use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in water, repeat every 20 minutes
as needed cautioning for myocardial variability.
Skin Exposure
Treat dermal irritation or burns with
standard topical therapy. Patients developing hypersensitivity
reactions may require treatment with systemic or topical corticosteroids
or antihistamines.
Eye Exposure
Ensure that adequate eye irrigation
has been completed. If eye irritation or injury is evident,
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.
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 has oral
lesions or persistant esophageal discomfort; and (3) the lavage
can be performed 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.
Consider endoscopy to evaluate the extent
of gastrointestinal tract injury. Extreme throat swelling
may require endotracheal intubation or cricothyriodotomy.
Because children do not ingest large
amounts or corrosive materials, and because of the risk of
perforation from NG intubation, lavage is discouraged in children
unless intubation is 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
Methylene blue (tetramethylthionine chloride)
should be considered for patients who have signs and symptoms
of hypoxia (other than cyanosis) or for patients who have
methemoglobin levels >30%. Cyanosis alone does not require
treatment. Methylene blue may not be effective in patients
who have G6PD deficiency and may cause hemolysis.
The standard dose of methylene blue is
1 to 2 mg/kg body weight (0.1 to 0.2 mL/kg of a 1% solution)
intravenously over 5 to 10 minutes, repeated in one hour if
needed. The total 24 hour dose should not exceed 7 mg/kg.
(Doses greater than 15 mg/kg may cause hemolysis.) Clinical
response to methylene blue treatment is usually observed within
30 to 60 minutes. Side effects include nausea, vomiting, abdominal
and chest pain, dizziness, diaphoresis, and dysuria.
Consider hyperbaric oxygen therapy in
patients who are refractory to methylene blue therapy.
Consider exchange transfusions for severely
poisoned patients who are deteriorating clinically in spite
of methylene blue treatment. Intravenous ascorbic acid administered
to severely poisoned patients has not proved to be effective.
Laboratory Tests
Routine laboratory studies for all exposed
patients include CBC, glucose, and electrolyte determinations.
Additional studies for patients exposed to aniline include
peripheral blood smear, renal-function tests, and determination
of methemoglobin and unconjugated bilirubin levels. ABG measurements,
chest radiography, and ECG should be performed if cyanosis
or dyspnea are present. Methemoglobin causes absorption interference
with pulse oximetry reading, rendering falsely high values
as with the calculated value from the arterial blood gas (ABG)
analyzer. Accurate oxygen saturation determinations require
co-oximeter measurements.
Methemoglobinemia can be detected at
the bedside by the characteristic chocolate-brown color that
it imparts to blood. Methemoglobin levels greater than 10%
can usually be detected by comparing a drop of the patient's
blood with a drop of normal blood on white filter paper or
gauze.
Measurement of methemoglobin should be
repeated at frequent intervals for 24 hours to ensure that
the level is decreasing.
Disposition and Follow-up
Patients should be observed for at least
6 hours for the delayed development of methemoglobinemia.
Consider hospitalization for symptomatic patients who have
elevated methemoglobin levels.
Delayed Effects
Hemolysis may begin 24 or more hours
after exposure. Observe hospitalized patients for signs of
acute renal failure and arrhythmias.
Patient Release
Patients who have remained asymptomatic
for 6 to 12 hours after exposure may be discharged and advised
to seek medical care promptly if symptoms develop (see the
Aniline-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.
Monitor patients who have received significant
exposure (as determined by symptoms and methemoglobin levels)
for effects of hypoxia and hemolysis. A Heinz-body hemolytic
crisis may follow the development of methemoglobinemia by
2 to 7 days. Heart, liver, and kidney effects may be secondary
to hemolysis.
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
aniline.
Print this handout only.pdf icon[33 KB]
What is aniline?
Aniline is a manufactured chemical used
to make a variety of products including polyurethane foam,
photographic developers, rubber, dyes, and pesticides. At
room temperature, it is a clear to slightly yellow, oily liquid
that may turn brown if left in contact with air. It has a
weak fishy odor.
What immediate
health effects can be caused by exposure to aniline?
Aniline can cause effects when it is
breathed or swallowed. It can also pass rapidly through the
skin. Aniline causes changes in hemoglobin, which carries
oxygen in the blood; hence, the blood turns brown and tissues
are unable to get enough oxygen (a condition known as methemoglobinemia).
Headaches, weakness, drowsiness, and shortness of breath can
occur. The skin, lips, and nailbeds can turn blue or slate
gray. Aniline can cause the membrane of the red blood cells
to burst (hemolysis), which also will prevent oxygen from
reaching tissues. Generally, the more serious the exposure,
the more severe the symptoms.
Can aniline poisoning
be treated?
A solution of methylene blue may be given
through a vein to patients who have been seriously exposed
to aniline. Most patients recover within 24 hours, but they
may need to be hospitalized for several days. The urine of
a patient who has received methylene blue treatment may temporarily
become blue to blue-green.
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
to aniline, anemia can occur. There is no evidence that aniline
causes cancer. Some workers exposed to aniline over many years
developed bladder cancer, but this was probably due to simultaneous
exposure to other chemicals. High incidences of gynecological
disorders and excess frequency of spontaneous abortions have
been reported for women chemically exposed to aniline.
What, tests can
be done if a person has been exposed to aniline?
Specific blood tests for the presence
of methemoglobin may be useful. If a severe exposure has occurred,
blood and urine analyses, and other tests may show whether
damage has been done to the liver, heart, and brain. Testing
is not needed in every case.
Where can more
information about aniline be found?
More information about aniline 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.pdf icon[33 KB]
[ ] Call your doctor or the Emergency Department if you
develop any unusual signs or symptoms within the next 24
hours, especially:
- difficulty breathing, shortness of breath, or chest pain
- weakness, nausea, or vomiting
- blood in the urine (brown- or bronze-colored urine)
- blue, brown, or gray color of the skin, lips, or nailbeds
[ ] 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.