Medical Management Guidelines for Trichloroethylene
(Cl2C=CHCl)
CAS# 79-01-6
UN# 1710
PDF Versionpdf icon[271 KB]
Synonyms include acetylene trichloride, ethylene trichloride, ethinyl trichloride, trichloroethene, TCE, and tri.
- Persons exposed only to trichloroethylene vapor do not
pose significant risks of secondary contamination. Persons
whose clothing or skin is contaminated with liquid
trichloroethylene can cause secondary contamination by
direct contact or through off-gassing vapor.
- Trichloroethylene is a colorless liquid at room
temperature with a somewhat sweet chloroform-like odor and
sweet burning taste. It is flammable at high temperatures.
At temperatures >600°F, it forms hydrogen chloride and
phosgene, which are serious pulmonary irritants.
- When trichloroethylene contacts alkali or thermally
decomposes, it may form dichloroacetylene, an explosive and
neurotoxic compound. Odor generally provides inadequate
warning of hazardous concentrations.
- Trichloroethylene is absorbed readily after inhalation
and ingestion, and to a lesser extent, through the skin.
Trichloroethylene can cross the placenta and has been
detected in breast milk.
General Information
Description
At room temperature, trichloroethylene
is a clear, colorless liquid with a sweet, chloroform-like
odor. It is volatile, producing potentially toxic
concentrations at room temperature. It is nearly insoluble
in water, but miscible with most organic solvents.
Industrial grade trichloroethylene contains small amounts of
stabilizers (0.1% by weight) such as epichlorohydrin, which
may increase the irritant effects. At elevated temperatures
and in the presence of alkali, trichloroethylene may form
more toxic compounds such as phosgene, a serious pulmonary
irritant, or dichloroacetylene, a neurotoxin. Since
trichloroethylene decomposes photolytically, it should be
stored in cans or dark glass bottles to minimize
decomposition. Storage areas should be cool, well
ventilated, flame-proof, and shielded from direct sunlight,
high-temperature surfaces, or sparks.
Routes of Exposure
Inhalation
Trichloroethylene vapor is readily
absorbed from the lungs, and inhalation is the main route of
exposure. The recognition odor threshold of
trichloroethylene is 110 ppm which is slightly higher than
the OSHA PEL (100 ppm); thus, odor generally provides an
inadequate indication of hazardous concentrations.
Trichloroethylene is heavier than air and may cause
asphyxiation in poorly ventilated or enclosed spaces and in
low-lying areas.
Children exposed to the same levels of
trichloroethylene vapor as adults may receive a larger dose
because they have greater lung surface area:body weight
ratios and increased minute volumes:weight ratios. In
addition, they may be exposed to higher levels than adults
in the same location because of their short stature and the
higher levels of trichloroethylene vapor found nearer to the
ground.
Skin/Eye Contact
Exposure to liquid trichloroethylene
can result in skin irritation and minor corneal injury.
Trichloroethylene is absorbed through intact skin, although
not in quantities sufficient to cause systemic toxicity.
Children are more vulnerable to
toxicants affecting the skin because of their relatively
larger surface area:body weight ratio.
Ingestion
Gastrointestinal absorption is rapid
and substantial. Ingestion can produce significant CNS
depression. Pulmonary aspiration can cause chemical
pneumonitis.
Sources/Uses
Trichloroethylene is manufactured
either by oxychlorination of ethylene dichloride or by
direct chlorination of ethylene dichloride.
Trichloroethylene has wide use as a
metal degreasing agent. It is a common ingredient in
cleaning agents, paints, adhesives, varnishes, and inks. In
the past, it was used as a dry cleaning agent and for food
extractions such as removal of caffeine from coffee. It also
had limited use as an analgesic and an anesthetic agent, but
is no longer used for these purposes because it is now
recognized as a potential human carcinogen.
Standards and Guidelines
OSHA PEL (permissible exposure limit) =
100 ppm (averaged over an 8-hour workshift)
OSHA ceiling = 200 ppm
OSHA STEL (short-term exposure limit) =
300 ppm (5-minute exposure in any 2 hours)
NIOSH IDLH (immediately dangerous to
life or health) = 1,000 ppm
AIHA ERPG-2 (emergency response planning guideline) (maximum
airborne concentration below which it is believed that
nearly all individuals could be exposed for up to 1 hour
without experiencing or developing irreversible or other
serious health effects or symptoms which could impair an
individual's ability to take protective action) = 500 ppm.
Physical Properties
Description: Clear, colorless
liquid with a chloroform-like odor.
Warning properties: Inadequate;
chloroform-like odor at 110 ppm.
Molecular weight: 131.4 daltons
Boiling point (760 mm Hg): 189°F
(87°C)
Freezing point: -99°F (-73°C)
Specific gravity: 1.46 at 68°F
(20°C) (water = 1)
Vapor pressure: 58 mm Hg at 68°F
(20°C)
Gas density: 4.53 (air = 1)
Water solubility: minimal; 0.1%
at 77°F (25°C)
Flammability: Flammable liquid
that does not burn easily; at temperatures >600°F (316°C),
it forms hydrogen chloride and phosgene.
Flammable range: 8% to 10.5 %
(concentration in air)
Incompatibilities
Trichloroethylene reacts with strong
alkalies and chemically active metals such as barium,
lithium, sodium, magnesium, titanium, and beryllium.
Health Effects
- Trichloroethylene is a mild skin, eye, and respiratory
tract irritant. Inhalation or ingestion of trichloroethylene
can produce CNS effects including headache, dizziness, lack
of coordination, stupor, and coma. Respiratory depression or
cardiac dysrhythmia from high-level exposures can result in
death. Other effects of acute exposure include hypotension,
nausea, vomiting, and diarrhea.
- Trichloroethylene sensitizes the heart to epinephrine,
making it more susceptible to epinephrine-induced
arrhythmias. Trichloroethylene can cross the placenta and
has been detected in breast milk.
Acute Exposure
Trichloroethylene is thought to depress
the CNS via a solvent effect on lipids and protein
components of neural membranes. It sensitizes the heart to
epinephrine, making it more susceptible to
epinephrine-induced arrhythmias. Direct exposure to liquid
trichloroethylene degreases the skin, causing redness,
blistering, and scaling. Trichloroethylene can cause
respiratory and CNS depression and abnormal heart rhythm.
Death may result from respiratory depression. Liver necrosis
has been reported for some people exposed to fatal levels of
trichloroethylene, but individuals exposed to
trichloroethylene as an anesthetic showed only minimal
effects on liver function.
Children do not always respond to
chemicals in the same way that adults do. Different
protocols for managing their care may be needed.
CNS
Trichloroethylene exposure causes
concentration-related CNS effects. In the past,
concentrations as high as 5,000 to 20,000 ppm were used to
produce light-to moderate surgical anesthesia. Typical
symptoms of exposure to lower levels of trichloroethylene
(>500 ppm) include excitation, lightheadedness, headache,
nausea, incoordination, and impaired ability to concentrate.
At higher doses (>1,000 ppm), lack of muscle tone, decreased
deep-tendon reflexes, drowsiness, dizziness, impaired gait,
and stupor may develop. Death may result from respiratory
depression.
Peripheral Neurologic
In a few cases, trichloroethylene
exposure has been associated with peripheral and cranial
nerve damage. A decomposition product of trichloroethylene,
dichloroacetylene, is neurotoxic and may be responsible for
the cranial nerve effects.
Cardiovascular
At near anesthetic levels of exposure,
trichloroethylene may cause acute cardiovascular effects
including decreased contraction of the heart's muscle
fibers, disordered electrical conduction, and lowered
threshold of the heart to the effects of epinephrine,
potentially disrupting the heartbeat. Trichloroethylene can
also cause blood vessel dilation and low blood pressure.
Respiratory
Trichloroethylene is a mild irritant to
the lungs and respiratory tract; however, its thermal
breakdown products, phosgene and hydrogen chloride, are
severe pulmonary irritants, and phosgene is a suffocating
agent. Accumulation of fluid in the lungs has been reported
after severe trichloroethylene exposure; the exact role of
trichloroethylene breakdown products is unknown.
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.
Hepatic
Liver toxicity can occur after
prolonged inhalation of high concentrations of
trichloroethylene. Ingestion of alcohol may increase this
risk. However, liver effects have not been reported in
acute-duration human exposure studies, although some older
case reports have provided limited evidence of liver damage.
Renal
Kidney effects have not been reported
for acute-duration human exposure studies, although some
older case reports have provided limited evidence of kidney
damage. Minor changes in indicators of renal function have
been reported for some workers occupationally exposed to
trichloroethylene.
Dermal
Liquid trichloroethylene can irritate
the skin. When in prolonged contact with the skin, as under
tight-fitting clothing or shoes, trichloroethylene can cause
chemical burns. Exfoliative dermatitis and erythema have
also been reported after 2 to 5 weeks exposure to
trichloroethylene. Trichloroethylene inhalation in
combination with alcohol ingestion may cause a red, blotchy
appearance of the face and upper portion of the body,
commonly referred to as "degreaser's flush."
Because of their relatively larger
surface area:body weight ratio, children are more vulnerable
to toxicants affecting the skin.
Ocular
Trichloroethylene splashed in the eye
produces pain and transient eye injury with complete
recovery in a few days. Exposure to high concentrations of
vapor may also cause these effects.
Potential Sequelae
Some survivors of ingestion or severe
inhalation exposure have experienced chronic nerve
disorders. Inflammation of the nerves of the eye and
blindness have been reported after ingestion.
Chronic Exposure
Chronic exposure has been reported to
be associated with damage to the cranial nerves and
neurological effects such as memory loss and impaired
cognitive function. However, these studies did not have
accurate exposure data and individuals were often exposed to
mixtures of chemicals. Prolonged or repeated application of
trichloroethylene to skin causes degreasing and inflammation
of the skin (i.e., contact dermatitis and exfoliative
dermatitis). Diffuse fasciitis with eosinophilia and symptoms of systemic lupus erythematosus have been reported with chronic exposure (HSDB, 2014).
Chronic exposure may be more serious
for children because of their potential longer latency
period.
Carcinogenicity
The DHHS is currently reviewing the
classification of trichloroethylene; the NTP Board
Subcommittee has recommended that it be listed as
"reasonably anticipated to be a human carcinogen." The
International Agency for Research on Cancer has determined
that trichloroethylene is probably carcinogenic to humans
(Group 2A).
Reproductive and Developmental Effects
Trichloroethylene 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.
Trichloroethylene readily crosses the placenta and is found
in fetal blood at levels comparable to those of the mother.
Evidence that acute trichloroethylene exposure causes
reproductive or developmental toxicity in humans is
inconclusive. There have been some reports suggesting an
increased incidence of birth defects in children whose
mothers were chronically exposed to trichloroethylene in
drinking water, but these studies are limited by several
factors including poor exposure data and small study
populations.
Prehospital Management
- Victims exposed only to trichloroethylene vapor do not
pose secondary contamination risks to rescuers. Victims
whose clothing or skin is contaminated with liquid
trichloroethylene can secondarily contaminate response
personnel by direct contact or through off-gassing vapor.
Trichloroethylene vapor may also off-gas from the vomitus of
victims who have ingested trichloroethylene.
- Trichloroethylene is a mild to severe skin, eye, and
respiratory-tract irritant. Acute exposure can cause CNS and
respiratory depression and cardiac dysrhythmias by
inhalation or ingestion. Other effects include hypotension,
nausea, vomiting, and diarrhea.
- There is no antidote for trichloroethylene poisoning.
Treatment consists of support of respiratory and
cardiovascular functions.
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
Trichloroethylene vapor is absorbed
well by inhalation and is a mild 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 trichloroethylene vapor.
Skin Protection:
Chemical-protective clothing is not generally required when
only vapor exposure is expected because trichloroethylene
vapor is neither irritating nor absorbed well through the
skin. Chemical protective clothing is recommended when
repeated or prolonged contact with the liquid 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.
Care should be taken that victims
(particularly children) do not have problems due to
trichloroethylene being heavier than air and settling in
pockets close to the ground.
Decontamination Zone
Patients exposed only to
trichloroethylene vapor who have no skin or eye irritation
may be transferred immediately to the Support Zone. Other
patients will require decontamination as described below.
Rescuer Protection
If exposure levels are determined to be
safe, decontamination may be conducted by personnel wearing
a lower level of protection than that worn in the Hot Zone
(described above).
ABC Reminders
Quickly access for a patent airway,
ensure adequate respiration and pulse. Stabilize the
cervical spine with a collar and a backboard if trauma is
suspected. Administer supplemental oxygen as required.
Assist ventilation with a bag-valve-mask device if
necessary.
Basic Decontamination
Victims who are able may assist with
their own decontamination. Quickly remove and double-bag
contaminated clothing and personal belongings.
Flush exposed skin and hair with water
for 3 to 5 minutes. Wash with mild soap and water
(preferably under a shower). 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 15 to 20 minutes. Remove contact
lenses if easily removable without additional trauma to the
eye. If a corrosive material is suspected or if pain or
injury is evident, continue irrigation while transferring
the victim to the Support Zone.
In cases of ingestion, do not induce
emesis. If the victim is alert, asymptomatic, and has a
gag reflex, administer a slurry of activated charcoal at 1
gm/kg (usual adult dose 60-90 g, child dose 25-50 g). A soda
can and straw may be of assistance when offering charcoal to
a child. The efficacy of activated charcoal has not been
demonstrated for trichloroethylene, but it may be of
assistance, particularly in cases of mixed ingestion.
Consider appropriate management of
chemically contaminated children at the exposure site.
Provide reassurance to the child during decontamination,
especially if separation from a parent occurs.
Transfer to Support Zone
As soon as basic decontamination is
complete, move the victim to the Support Zone.
Support Zone
Be certain that victims have been
decontaminated properly (see Decontamination Zone
above). Victims who have undergone decontamination or have
been exposed only to vapor generally pose no serious risks
of secondary contamination. In such cases, Support Zone
personnel require no specialized protective gear.
ABC Reminders
Quickly access for a patent airway. If
trauma is suspected, maintain cervical immobilization
manually and apply a cervical collar and a backboard when
feasible. Ensure adequate respiration and pulse. Administer
supplemental oxygen as required and establish intravenous
access if necessary. Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and
eyes, as appropriate.
In cases of ingestion, do not
induce emesis. If the victim is alert, asymptomatic, and
has a gag reflex, administer a slurry of activated charcoal
at 1 gm/kg (usual adult dose 60-90 g, child dose 25-50 g),
if it has not been administered previously. A soda can and
straw may be of assistance when offering charcoal to a
child. The efficacy of activated charcoal has not been
demonstrated for trichloroethylene, but it may be of
assistance, particularly in cases of mixed ingestion.
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.
Patients who have bronchospasm may be
treated with aerosolized bronchodilators. However, the use
of sympathomimetic agents such as epinephrine and
isoproterenol could precipitate fatal dysrhythmias and
should be avoided. Selective beta-2 agonists would be
preferred, but clinical reports of their use are lacking.
Theophylline derivatives have not been studied. Use all
catecholamines with caution because of the enhanced risk of
cardiac dysrhythmias. Also consider the health of the
myocardium before choosing which type of bronchodilator
should be administered.
Patients who are comatose, hypotensive,
or having seizures or cardiac arrhythmias should be treated
according to advanced life support (ALS) protocols.
Transport to Medical Facility
Only decontaminated patients or
patients not requiring decontamination should be transported
to a medical facility. "Body bags" are not recommended.
Report to the base station and the
receiving medical facility the condition of the patient,
treatment given, and estimated time of arrival at the
medical facility.
If trichloroethylene 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 with evidence of significant
inhalation exposure such as CNS disruption, breathing
difficulties, or cardiac dysrhythmia and patients who
ingested trichloroethylene 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. Those discharged should be advised to
seek medical care promptly if symptoms develop (see
Patient Information Sheet below).
Emergency Department Management
- Patients exposed only to trichloroethylene vapor do not
pose secondary contamination risks to hospital personnel.
Patients whose clothing or skin is contaminated with liquid
trichloroethylene can secondarily contaminate response
personnel by direct contact or through off-gassing vapor.
Toxic vomitus from patients who have ingested
trichloroethylene may also off-gas the solvent.
- Trichloroethylene is a mild skin, eye, and
respiratory-tract irritant. Acute exposures can cause CNS
and respiratory depression and cardiac dysrhythmias by
inhalation or ingestion. Other effects include hypotension,
nausea, vomiting, and diarrhea.
- There is no antidote for trichloroethylene poisoning.
Treatment consists of support of respiratory and
cardiovascular functions.
Decontamination Area
Unless previously decontaminated, all
patients suspected of contact with liquid trichloroethylene
and all victims with skin or eye irritation require
decontamination as described below. All other patients 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 relatively larger
surface area:body weight ratio, children are more vulnerable
to toxicants affecting the skin. Also, emergency room
personnel should examine children's mouths because of the
frequency of hand-to-mouth activity among children.
ABC Reminders
Evaluate and support airway, breathing,
and circulation. In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, surgically create an airway.
Patients who have bronchospasm may be
treated with aerosolized bronchodilators. However, the use
of sympathomimetic agents such as epinephrine and
isoproterenol could precipitate fatal dysrhythmias and
should be avoided. Selective beta-2 agonists would be
preferred, but clinical reports of their use are lacking.
Theophylline derivatives have not been studied. Use all
catecholamines with caution because of the enhanced risk of
cardiac dysrhythmias. Also consider the health of the
myocardium before choosing which type of bronchodilator
should be administered.
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. Remove and double-bag
contaminated clothing and personal belongings.
Flush exposed skin and hair with water
for 3 to 5 minutes. Wash with mild soap and water
(preferably under a shower). Rinse thoroughly with water.
Use caution to avoid hypothermia when decontaminating
children or the elderly. Use blankets or warmers when
appropriate.
Flush exposed eyes with plain water or
saline for 15 to 20 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, asymptomatic, and has a
gag reflex, administer a slurry of activated charcoal at 1
gm/kg (usual adult dose 60-90 g, child dose 25-50 g), if it
has not been administered previously. A soda can and straw
may be of assistance when offering charcoal to a child. The
efficacy of activated charcoal has not been demonstrated for
trichloroethylene, but it may be of assistance, particularly
in cases of mixed ingestion.
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 symptomatic patients if this
has not been done previously. Continuously monitor cardiac
rhythm.
Patients who are comatose, hypotensive,
or have seizures or ventricular arrhythmias should be
treated in the conventional manner. Avoid sympathomimetics
or catecholamines or use them with caution. Beta-blockers
may be more effective than lidocaine in cases of prolonged
or resistant dysrhythmias.
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory complaints. Patients who
have bronchospasm may be treated with aerosolized
bronchodilators. However, the use of sympathomimetic agents
such as epinephrine and isoproterenol could precipitate
fatal dysrhythmias and should be avoided. Selective beta-2
agonists would be preferred, but clinical reports of their
use are lacking. Theophylline derivatives have not been
studied. Use all catecholamines with caution because of the
enhanced risk of cardiac dysrhythmias. Also consider the
health of the myocardium before choosing which type of
bronchodilator should be administered.
Skin Exposure
If the skin was in prolonged contact
with liquid trichloroethylene, chemical burns may result;
treat as thermal burns.
Because of their relatively larger
surface area:body weight ratio, children are more vulnerable
to toxicants affecting 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 corneal injuries.
Ingestion
Do not induce emesis.
If the victim is alert, asymptomatic,
and has a gag reflex, administer a slurry of activated
charcoal at 1 gm/kg (usual adult dose 60-90 g, child dose
25-50 g), if it has not been administered previously. A soda
can and straw may be of assistance when offering charcoal to
a child. The efficacy of activated charcoal has not been
demonstrated for trichloroethylene, but it may be of
assistance, particularly in cases of mixed ingestion.
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 toxic material and prepare for
endoscopic examination. Consider gastric lavage with a small
nasogastric tube if: (1) a large dose has been ingested; (2)
the patient's condition is evaluated within 30 minutes; (3)
the patient has oral lesions or persistent esophageal
discomfort; and (4) the lavage can be administered within
one hour of ingestion. Care must be taken when placing the
gastric tube because blind gastric-tube placement may
further injure the chemically damaged esophagus or stomach.
Because children do not ingest large
amounts of toxic materials, and because of the risk of
perforation from nasogastric intubation, lavage is
discouraged in children unless performed under endoscopic
guidance.
Toxic vomitus or gastric washings
should be isolated (e.g., by attaching the lavage tube to
isolated wall suction or another closed container).
Antidotes and Other Treatments
There is no antidote for
trichloroethylene poisoning. Treatment is supportive of
respiratory and cardiovascular functions.
Laboratory Tests
The diagnosis of acute
trichloroethylene toxicity is primarily clinical, based on
symptoms of CNS disruption or respiratory distress. However,
laboratory testing is useful for monitoring the patient and
evaluating complications. Routine laboratory studies for all
exposed patients include CBC, glucose, and electrolyte
determinations. Additional studies for patients exposed to
trichloroethylene include renal-function and liver-function
tests. Patients who have respiratory complaints should be
evaluated with pulse oximetry (or ABG measurements) and
chest radiography.
Trichloroethylene blood or plasma
levels are not clinically useful but may be used as a
qualitative index to document an exposure. Exposure to
trichloroethylene is also suggested by detection of
trichloroacetic acid or trichloroethanol in blood or urine;
however, these tests are not specific for trichloroethylene.
Disposition and Follow-up
Consider hospitalizing patients who
have had significant inhalation exposure (e.g., with loss of
consciousness) and patients who have ingested significant
amounts of trichloroethylene.
Delayed Effects
Development of cardiac dysrhythmia may
be delayed for 12 to 24 hours after exposure.
Patient Release
Patients who have not experienced
alterations in mental status or cardiac dysrhythmia, or who
had initially mild symptoms and are asymptomatic 12 to 24
hours later may be discharged. Discharged patients should be
instructed to seek medical care promptly if symptoms develop
(see Trichloroethylene-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.
Neurologic examination for
post-hypoxic injury is recommended in cases of severe
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
trichloroethylene.
Print this handout only.pdf icon[32.3 KB]
What is trichloroethylene?
Trichloroethylene is a colorless liquid
with a sweet, chloroform-like smell. It is volatile and
flammable, but does not burn easily. Trichloroethylene is
used to degrease metal parts and to dry clean fabric. It is
also used as a solvent in printing inks, paints, lacquers,
varnishes, and adhesives.
What immediate health effects can result from trichloroethylene exposure?
At high levels of exposure,
trichloroethylene can cause dizziness, blurred vision, a
feeling of excitement, nausea, and vomiting. Breathing very
high levels can cause irregular heartbeat, fainting, brain
damage, and even death. If the skin has been in contact with
trichloroethylene for a long time, skin rash or chemical
burns may result. Generally, the more serious the exposure,
the more severe the symptoms.
Can trichloroethylene poisoning be treated?
There is no antidote for
trichloroethylene poisoning. Patients who have swallowed or
inhaled large amounts of trichloroethylene need to be
hospitalized. Most patients get completely 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 many
exposures, damage to the nerves can occur. Fatigue, memory
loss, headache, confusion, and depression have been reported
by workers using trichloroethylene for long periods at their
jobs. Trichloroethylene is believed to be a human
carcinogen.
What tests can be done if a person has been exposed to trichloroethylene?
Specific tests for the presence of
trichloroethylene breakdown products in blood and 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 nerves, heart, lungs, liver, or kidneys
have been damaged. Testing is not needed in every case.
Where can more information about trichloroethylene be found?
More information about
trichloroethylene can be obtained from your regional poison
control center; your state, county, or local health
department; the Agency for Toxic Substances and Disease
Registry (ATSDR); your doctor; or a clinic in your area that
specializes in occupational and environmental health. If the
exposure happened at work, you may wish to discuss it with
your employer, the Occupational Safety and Health
Administration (OSHA), or the National Institute for
Occupational Safety and Health (NIOSH). Ask the person who
gave you this form for help in locating these telephone
numbers.
Follow-up Instructions
Keep this page and take it with you to
your next appointment. Follow only the instructions
checked below.
Print instructions only.pdf icon[32.3 KB]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms
within the next 24 hours, especially:
- coughing, wheezing, or shortness of breath
- dizziness or distorted perceptions
- nausea or diarrhea
- increased pain or a discharge from your eyes
- increased redness or pain or a pus-like discharge in the
area of a skin burn
[ ] No follow-up appointment is
necessary unless you develop any of the symptoms listed
above.
[ ] Call for an appointment with
Dr.____ in the practice of ________.
When you call for your appointment,
please say that you were treated in the Emergency Department
at _________ Hospital by________and were advised to be seen
again in ____days.
[ ] Return to the Emergency
Department/Clinic on ____ (date) at _____ AM/PM for a
follow-up examination.
[ ] Do not perform vigorous physical
activities for 1 to 2 days.
[ ] You may resume everyday activities
including driving and operating machinery.
[ ] Do not return to work for
_____days.
[ ] You may return to work on a limited
basis. See instructions below.
[ ] Avoid exposure to cigarette smoke
for 72 hours; smoke may worsen the condition of your lungs.
[ ] Avoid drinking alcoholic beverages
for at least 24 hours; alcohol may worsen injury to your
stomach or have other effects.
[ ] Avoid taking the following
medications: ________________
[ ] You may continue taking the
following medication(s) that your doctor(s) prescribed for
you: _______________________________
[ ] Other instructions:
____________________________________
_____________________________________________________
- Provide the Emergency Department with the name and the
number of your primary care physician so that the ED can
send him or her a record of your emergency department visit.
- You or your physician can get more information on the
chemical by contacting: ____________ or _____________, or by
checking out the following Internet Web sites:
___________;__________.
Signature of patient _______________ Date ____________
Signature of physician _____________ Date ____________
Where can I get more information?
If you have questions or concerns, please contact your community or state health or environmental quality department or:
For more information, contact:
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Human Health Sciences
4770 Buford Highway
Chamblee, GA 30341-3717
Phone: 1-800-CDC-INFO 888-232-6348 (TTY)
Email: Contact CDC-INFO
ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.