Medical Management Guidelines for Tetrachloroethylene
(Cl2C=CCl2)
CAS# 127-18-4
UN# 1897
PDF Versionpdf icon[224 KB]
Synonyms include carbon bichloride, carbon dichloride, ethylene tetrachloride, PCE, perc, perchlor, perchloroethylene, Perclene, perk, 1,1,2,2-tetrachloroethylene, and tetrachloroethene.
- Persons exposed only to tetrachloroethylene vapor pose no risk of secondary contamination. Persons whose skin or clothing is contaminated with liquid tetrachloroethylene can contaminate rescuers by direct contact or through off-gassing vapor.
- Tetrachloroethylene is a colorless, volatile, nonflammable liquid with a sharp, sweet odor. The vapor is heavier than air and can collect in toxic levels in poorly ventilated spaces. While the odor threshold is low, tetrachloroethylene quickly desensitizes olfactory responses; therefore, odor may not be an adequate warning of toxic levels.
- Tetrachloroethylene is readily absorbed if inhaled or ingested. Dermal exposure to the liquid can cause burns and irritation, but absorption across intact skin is slow. Exposure by any route can cause systemic effects.
General Information
Description
At room temperature, tetrachloroethylene is a colorless, nonviscous, nonflammable liquid. It evaporates easily and has a sweet odor. The vapors are heavier than air. Tetrachloroethylene is slightly soluble in water, and is miscible with most organic solvents and oils. Although it is considered to be quite stable, at temperatures greater than 600°F (316°C), it breaks down to form the poisonous gas, phosgene, and hydrogen chloride, which are potent pulmonary irritants. Tetrachloroethylene is stored in mild steel tanks equipped with breathing vents and chemical driers in cool, dry, well-ventilated locations, away from any area where fire hazard may be acute, or in glass containers.
Routes of Exposure
Inhalation
Inhalation is the most important route
of exposure, and tetrachloroethylene is absorbed readily through the lungs. Most people can smell tetrachloroethylene in the air at levels of 5 to 50 ppm (OSHA PEL is 100 ppm). Odor is an adequate warning for high-dose acute exposures, but might not be adequate for prolonged exposures because olfactory fatigue can occur. The vapors are heavier than air and can collect to toxic levels in poorly ventilated or low-lying areas and cause asphyxiation. Levels of 75 to 100 ppm can cause mild ocular irritation and levels of 216 ppm or more produce respiratory tract irritation. Central nervous system (CNS) effects, including sleepiness, headache, and loss of coordination, have been observed at exposures of 100 to 300 ppm. During exposures of 1,000 to 1,500 ppm for less than 2 hours, people have experienced mood changes, slight ataxia, faintness, and dizziness. Exposure to higher concentrations or for longer periods of time can lead to collapse, coma, or death.
Children exposed to the same levels of
tetrachloroethylene 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 tetrachloroethylene
vapor found nearer to the ground.
Skin/Eye Contact
Exposure to high levels of tetrachloroethylene
vapor causes ocular irritation. Direct contact with the liquid
can cause skin and eye irritation and burns. Absorption across
intact skin is slow. Thus, systemic toxicity is unlikely unless
liquid on the skin is prevented from evaporating by heavy
clothing or other impermeable covering.
Children are more vulnerable to toxicants
absorbed through the skin because of their relatively larger
surface:body weight ratio.
Ingestion
Ingested tetrachloroethylene is rapidly
absorbed and can cause systemic effects similar to those seen
with inhalation exposure.
Sources/Uses
Tetrachloroethylene is made by direct
chlorination or oxychlorination of certain hydrocarbons. Tetrachloroethylene
is used as a chemical intermediate, as solvent for metal cleaning
and vapor degreasing, and for dry-cleaning and textile processing.
It is found in many household products, including paint removers,
water repellents, silicone lubricants, spot removers, adhesives,
wood cleaners, and many products used by hobbyists. Tetrachloroethylene
may still be employed as grain fumigant. It was formerly used
as a deworming medicine in humans. It has been intentionally
abused for its CNS-intoxicating effect. With improved recovery
and recycling efforts, production has declined from about
500 million pounds in the 1980s to about 250 million pounds
in the 1990s.
Standards and Guidelines
OSHA PEL (permissible exposure limit)
= 100 ppm (averaged over an 8-hour workshift)
OSHA Ceiling for 15-minute exposure =
200 ppm; 5-minute maximum peak in any 3 hours = 300 ppm
NIOSH IDLH (immediately dangerous to
life or health) = 150 ppm; potential occupational carcinogen
AIHA ERPG-2 (maximum airborne concentration
below which it is believed that nearly all persons could be
exposed for up to 1 hour without experiencing or developing
irreversible or other serious health effects or symptoms that
could impair their abilities to take protective action) =
200 ppm.
Physical Properties - Calcium Hypochlorite
Description: colorless, nonviscous,
nonflammable liquid
Warning properties: sweet, chloroform-like
odor detectable at 5 to 50ppm; adequate for acute exposures,
but might be inadequate for chronic exposure because olfactory
fatigue can occur.
Molecular weight: 165.83 daltons
Boiling point (760 mm Hg): 250.16°F
(121.20°C)
Freezing point: -8.14°F (-22.3°C)
Specific gravity: 1.623 at 68°F
(20°C) (water = 1.000)
Vapor pressure: 15.8 mm Hg at
71.6°F (22°C)
Vapor density: 5.83 (air = 1.00)
Water solubility: negligible (0.015%
at 68°F [20°C])
Flammability: nonflammable liquid;
vapors do not readily ignite; attemperatures >600°F
(>316°C), tetrachloroethylene oxidizes to form hydrogen
chloride, phosgene, and carbon monoxide.
Incompatibilities
Tetrachloroethylene reacts with strong
oxidizers such as nitric acid or nitrogen tetroxide and strong
alkali such as sodium hydroxide or potassium carbonate, but
only at elevated temperatures. Tetrachloroethylene reacts
with metals very slowly at 25°C, but will react explosively
with molten potassium and possibly with other reactive metals
such as barium or lithium at elevated temperatures. Tetrachloroethylene
does not react with water at ordinary temperatures, but with
strong aqueous alkali at higher temperatures, tetrachloroethylene
will form dichloroacetic acid and hydrochloric acid.
Health Effects
- Inhalation or ingestion of tetrachloroethylene can cause
CNS depression and cardiovascular effects. At high concentrations,
the vapor is irritating to the eyes, mucous membranes, and
respiratory tract. The liquid is irritating to the skin
and can cause chemical burns.
- Tetrachloroethylene effects on the CNS are thought to
be caused by interaction of the parent compound with neural
membranes; other effects as well as liver cancer in animals
are thought to be caused by tetrachloroethylene metabolites,
but the exact mechanisms are not known.
Acute Exposure
Tetrachloroethylene probably depresses
the CNS through a solvent effect on lipids and protein components
of neural membranes. It defats the skin, causing redness,
blistering, and scaling. Organ damage, primarily liver and
kidney, may occasionally be seen. CNS effects appear immediately
during and following exposure, while organ damage may be delayed
for hours to days. Most inhaled or ingested tetrachloroethylene
leaves the body unchanged in exhaled air. Only 1% to 3% is
metabolized (though there is considerable individual variation),
and residual organ damage is not commonly observed.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
CNS
Tetrachloroethylene causes dose-related
CNS and respiratory depression, but transient initial CNS
excitation can also occur. Symptoms can include irritability,
impaired coordination, lightheadedness, headache, slurred
speech, malaise, nausea, ataxia, sedation, coma, and death.
Peripheral neuropathies and optic neuritis have been reported (POSINDEX, 2014). Sublethal CNS effects generally resolve quickly when the victim
is removed from further exposure, but may be delayed due to
fat uptake. CNS effects can also be prolonged following ingestion
exposure.
Cardiovascular
Tetrachloroethylene can lower the myocardial
threshold to the dysrhythmogenic effects of catecholamines
and can predispose exposed people to dysrhythmias, although
this appears to be much less likely with this chemical than
with other related chemicals.
Respiratory
Upper respiratory tract irritation can
occur following inhalation of high concentrations of tetrachloroethylene.
Exposure to certain chemicals can lead
to Reactive Airway Dysfunction Syndrome (RADS), a chemically-
or irritant-induced type of asthma.
Children may be more vulnerable because
of relatively increased minute ventilation per kg and failure
to evacuate an area promptly when exposed.
Gastrointestinal
Ingestion or inhalation of tetrachloroethylene
can cause nausea and vomiting.
Hepatic
Exposure to high levels of tetrachloroethylene
can cause transient hepatocellular damage manifested as hepatomegaly,
icterus, and elevated serum levels of liver enzymes. Liver
injury might not develop until several days after exposure.
Renal
Proteinuria, hematuria, and oliguric
renal failure can occur following exposure to very high levels
of tetrachloroethylene.
Dermal
Direct skin exposure to liquid tetrachloroethylene
can cause irritation and blistering. Prolonged contact can
result in second- and third-degree chemical burns.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
that affect the skin.
Ocular
High concentrations of tetrachloroethylene
vapor or direct contact with the liquid can cause intense
conjunctival and scleral irritation, pain, swelling, lacrimation,
and photophobia.
Potential Sequelae
Survivors of severe acute exposures that
induced coma or respiratory arrest might suffer brain or heart
damage from decreased levels of oxygen to these organs. Dermal
exposure may result in dermal hypersensitivity.
Chronic Exposure
Prolonged exposure to tetrachloroethylene
can result in memory and concentration impairment, vision
disturbances, dizziness, irritability, ataxia, sleep disturbances,
and peripheral neuropathy. Chronic exposure can cause liver
and kidney abnormalities. Chronic skin exposure can cause
irritant contact dermatitis.
Carcinogenicity
The U.S. Department of Health and Human
Services (DHHS) has determined that tetrachloroethylene is
reasonably anticipated to be a human carcinogen based on adequate
evidence from experimental animals (hepatocellular adenomas
and carcinomas in male mice and hepatocellular carcinomas
in female mice and mononuclear cell leukemia in rats). The
International Agency for Research on Cancer (IARC) has classified
tetrachloroethylene as probably carcinogenic to humans (Group
2A) based on limited evidence in humans and adequate evidence
from experimental animals.
Reproductive and Developmental Effects
Tetrachloroethylene 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. There is no conclusive
evidence that tetrachloroethylene has adverse reproductive
or developmental effects in humans. In animal studies, high
level exposures of pregnant females caused behavioral and
neurochemical changes in the offspring.
Tetrachloroethylene has been detected
in human breast milk.
Prehospital Management
- Victims exposed only to tetrachloroethylene vapor pose
no risk of secondary contamination to rescuers. Victims
whose skin or clothing is contaminated with liquid tetrachloroethylene
can contaminate rescuers by direct contact or through off-gassing
of vapor. Vomitus from patients who have ingested tetrachloroethylene
might also off-gas the vapor.
- Inhalation or ingestion of tetrachloroethylene can cause
CNS depression, respiratory irritation, and cardiovascular
effects. At high concentrations, the vapor is irritating
to the eyes, mucous membranes, and respiratory tract. The
liquid is irritating to the skin and can cause chemical
burns.
- There is no antidote for tetrachloroethylene 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 the 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
Inhaled tetrachloroethylene vapor is
readily absorbed and can irritate the respiratory tract. The
liquid is a skin and eye irritant with slow skin absorption.
Respiratory Protection: Positive-pressure,
self-contained breathing apparatus (SCBA) is recommended in
response situations that involve exposure to any level of
tetrachloroethylene vapor.
Skin Protection: to prevent possible
skin irritation and dermal absorption (a slow process), chemical-protective
clothing is recommended when skin contact with the liquid
is expected.
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. Provide supplemental oxygen
if cardiopulmonary compromise is suspected. If trauma is suspected,
manually maintain cervical immobilization and apply a cervical
collar and a backboard when feasible. Apply direct pressure
to stop any heavy bleeding. Maintain adequate circulation.
Victim Removal
If victims can walk, lead them out of
the Hot Zone to the Decontamination Zone. Victims who are
unable to walk should be removed on backboards or gurneys.
If these are not available, carefully carry or drag victims
to safety.
Consider appropriate management of chemically contaminated
children, such as measures to reduce separation anxiety if
a child is separated from a parent or other adult.
Decontamination Zone
Victims exposed only to tetrachloroethylene
vapor who have no eye or skin irritation do not need decontamination.
They may be transferred immediately to the Support Zone. All
others 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 required in the Hot
Zone (described above).
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. If trauma is suspected, manually
maintain cervical immobilization and apply a cervical collar
and a backboard when feasible. Administer supplemental oxygen
as required. Assist ventilation with a bag-valve-mask device
if necessary. Apply direct pressure to control heavy bleeding.
Basic Decontamination
Victims who are able may assist with
their own decontamination. Remove and double-bag contaminated
clothing and all personal belongings.
Wash exposed skin and hair 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 eyes with copious amounts
of tepid water or saline for at least 15 minutes. Remove
contact lenses if present and 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, 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.
Consider appropriate management of chemically
contaminated children at the exposure site. Also, provide
reassurance to the child during decontamination, especially
if separation from a parent occurs. If possible, seek assistance
from a child separation expert.
Transfer to Support Zone
As soon as basic decontamination is complete,
move the victim to the Support Zone.
Support Zone
Be certain that victims have been decontaminated
properly (see Decontamination Zone above). Victims
who have undergone decontamination or have been exposed only
to tetrachloroethylene vapor pose no serious risk of secondary
contamination to rescuers. In such cases, Support Zone personnel
require no specialized protective gear.
ABC Reminders
Quickly access for a patent airway. If
trauma is suspected, maintain cervical immobilization manually
and apply a cervical collar and a backboard when feasible.
Ensure adequate respiration and pulse. Administer supplemental
oxygen as required and establish intravenous access if necessary.
Place on a cardiac monitor.
Additional Decontamination
Continue irrigating exposed skin and
eyes, as appropriate.
In cases of ingestion, do not induce
emesis. If the victim is alert, asymptomatic, and has
a gag reflex, administer a slurry of activated charcoal at
1 gm/kg (usual adult dose 60-90 g, child dose 25-50 g), if
not previously given. 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 via endotracheal intubation. If not
possible, perform cricothyroidotomy if equipped and trained
to do so.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Epinephrine or other beta-adrenergic agents
should be used only with caution and only when clearly indicated.
Careful EKG monitoring for the possible induction of arrhythmias
should be done, and resuscitation medications and equipment
should be readily available.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or seizing or have cardiac dysrhythmias should be treated
according to advanced life support (ALS) protocols, observing
the precautions for catecholamines described above.
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 the condition of the patient,
treatment given, and estimated time of arrival at the medical
facility to the base station and the receiving medical facility.
If tetrachloroethylene has been ingested,
prepare the ambulance in case the victim vomits toxic material.
Prepare several towels and open double-sealable plastic bags
to quickly clean up and isolate vomitus, if necessary.
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 evidence
suggesting significant exposure, such as incoordination, disorientation,
or difficulty breathing, and patients who have ingested tetrachloroethylene
should be transported to a medical facility for evaluation.
Patients who have mild or transient
symptoms may be discharged form the scene after their names,
addresses, and telephone numbers are recorded. They should
be advised to rest and to seek medical care promptly if symptoms
develop or recur (see Patient Information Sheet below).
Emergency Department Management
- Patients exposed only to tetrachloroethylene vapor pose
no risk of secondary contamination to rescuers. Patients
who skin or clothing is contaminated with liquid tetrachloroethylene
can contaminate rescuers by direct contact or through off-gassing
of vapor. Vomitus from patients who have ingested tetrachloroethylene
can also off-gas the vapor.
- Inhalation or ingestion of tetrachloroethylene can cause
CNS depression, respiratory irritation, and cardiovascular
effects. At high concentrations, the vapor is irritating
to the eyes, mucous membranes, and respiratory tract. The
liquid is irritating to the skin and can cause chemical
burns.
- There is no antidote for tetrachloroethylene poisoning.
Treatment consists of support of respiratory and cardiovascular
functions.
Decontamination Area
Previously decontaminated patients and
those exposed only to tetrachloroethylene vapor and who have
no skin or eye irritation may be transferred immediately to
the Critical Care Area. All others require decontamination
as described below.
Be aware that use of protective equipment
by the provider may cause fear in children, resulting in decreased
compliance with further management efforts.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
absorbed through the skin. Also, emergency room personnel
should examine children's mouths for signs of irritation because
of the frequency of hand-to-mouth activity among children.
ABC Reminders
Evaluate and support the airways, breathing,
and circulation. Children may be more vulnerable to corrosive
agents than adults because of the relatively smaller diameter
of their airways. Provide supplemental oxygen if cardiopulmonary
compromise is suspected. In cases of respiratory compromise
secure airway and respiration via endotracheal intubation.
If not possible, surgically create an airway.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly). Epinephrine or other beta-adrenergic agents
should be used only with caution and only when clearly indicated.
Careful EKG monitoring for the possible induction of arrhythmias
should be done, and resuscitation medications and equipment
should be readily available.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or having seizures or have ventricular arrhythmias should
be treated in the conventional manner, observing the precautions
for catecholamines described above. Arrhythmias might respond
to beta-adrenergic blockers (e.g., propranolol, esmolol) if
lidocaine is ineffective.
Basic Decontamination
Patients who are able may assist with
their own decontamination. Remove and double-bag contaminated
clothing and all personal belongings.
Wash exposed skin and hair 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 or irritated eyes with
plain water or saline for at least 15 minutes. Remove contact
lenses if easily removable without additional trauma to the
eye. 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. Give activated charcoal at 1 gm/kg (usual adult
dose 60-90 g, child dose 25-50 g), if available and not previously
given. 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 the airways, breathing,
and circulation (as in ABC Reminders above. Children
may be more vulnerable to corrosive agents than adults because
of the relatively smaller diameter of their airways. Establish
intravenous access in seriously ill patients. Continuously
monitor cardiac rhythm.
Patients who are comatose, hypotensive,
or seizing or have ventricular arrhythmia should be treated
in the conventional manner, observing all precautions for
catecholamines described below. Arrhythmias might respond
to beta-adrenergic blockers (e.g., propranolol, esmolol) if
lidocaine is ineffective.
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory complaints. Treat patients
who have bronchospasm with aerosolized bronchodilators. Use
these and all other catecholamines only when clearly indicated
and when no alternatives are available. Administer the lowest
effective doses. Monitor for cardiac arrhythmia and be prepared
to treat as indicated. Also consider the health of the
myocardium before choosing which type of bronchodilator should
be administered.
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Skin Exposure
If the skin was in prolonged contact
with liquid tetrachloroethylene, chemical burns might be present;
treat these as thermal burns.
Eye Exposure
Ensure that adequate eye irrigation has
been completed. Test visual acuity. Examine the eyes for conjunctival
or corneal damage and treat appropriately. Immediately consult
an ophthalmologist for patients who have corneal injuries.
Ingestion Exposure
Do not induce emesis. If the patient
is alert and able to swallow and activated charcoal has not
been given previously, administer a slurry of activated charcoal
at 1 gm/kg (usual adult dose 60-90 g, child dose 25-50 g).
A soda can and straw may be of assistance when offering charcoal
to a child.
Consider endoscopy to evaluate the extent
of gastrointestinal-tract injury. Extreme throat swelling
may require endotracheal intubation or cricothyroidotomy.
Consider gastric lavage with a small nasogastric tube if:
(1) a large dose has been ingested; (2) the patient's condition
is evaluated within 30 minutes; (3) the patient has oral lesions
or persistent esophageal discomfort; and (4) the lavage can
be administered within 1 hour of ingestion. Care must be taken
when placing the gastric tube because blind gastric tube placement
may further injure the chemically damaged esophagus or stomach.
Because children do not ingest large
amounts of corrosive materials, and because of the risk of
perforation from NG intubation, lavage is discouraged in children
unless 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
There is no antidote for tetrachloroethylene
poisoning. Treatment is supportive. Controlled hyperventilation
to enhance respiratory elimination of tetrachloroethylene
has been reported, but is not a proven treatment method.
Laboratory Tests
Routine laboratory studies for all seriously
exposed patients include CBC, glucose, electrolytes, liver
enzymes, and kidney function tests. Chest radiography and
pulse oximetry (or ABG measurements) are recommended in cases
of severe inhalation exposure. Abdominal radiography may be
useful in evaluating the severity of ingestion exposure and
in assessing decontamination. Since hepatic and renal effects
following acute tetrachloroethylene exposure may be delayed,
serial testing over 1 to 3 days should be performed.
Tetrachloroethylene levels in blood or
expired air are not clinically useful but can be used to document
an exposure. Exposure to tetrachloroethylene is also suggested
by detection of trichloroacetic acid in blood or urine; however,
these tests are not specific for tetrachloroethylene.
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 tetrachloroethylene.
Delayed Effects
Skin injury can develop several hours
after exposure. Dermal hypersensitivity may also develop.
Hepatic or renal injury can develop a few days after exposure,
depending on the magnitude of the exposure.
Patient Release
Patients who have not experienced alterations
in mental status or respiratory difficulty may be discharged.
Patients who initially had mild symptoms, but who are asymptomatic
6 to 8 hours after exposure, may also be discharged. Discharged
patients should be advised to rest and to seek medical care
promptly if symptoms develop or recur (see the Tetrachloroethylene-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.
Follow-up laboratory evaluation of hepatic
and renal function should be arranged for severely exposed
patients. Neurologic examination for post-hypoxic injury is
recommended in cases of CNS or respiratory depression. Patients
who have skin burns or corneal lesions should be reexamined
within 24 hours.
Reporting
If a work-related incident has occurred,
you might be legally required to file a report; contact your
state or local health department.
Other persons might still be at risk
at the place where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
might 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 form the Occupational
Safety and Health Administration (OSHA) or the National Instituted
for Occupational Safety and Health (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
tetrachloroethylene.
Print this handout only.pdf icon[32.2 KB]
What is tetrachloroethylene?
tetrachloroethylene is a colorless to pale-yellow liquid with a
strong, pungent odor. It is used most extensively in the
manufacture of sorbic acid, but has also been used as a
warning agent in fuel gases, in the preparation of rubber
accelerators, in leather tanning, as an alcohol denaturant,
and as a stabilizer for tetraethyl-lead.
What immediate health effects can be caused by exposure to tetrachloroethylene?
Breathing or swallowing tetrachloroethylene
can cause lightheadedness, dizziness, clumsiness, nausea,
and vomiting. Very large amounts can cause sleepiness, coma,
and even death. It can damage the liver and kidneys. If the
liquid spills on the skin or eyes, it can cause irritation
or burns. Vapors in the air can cause burning eyes.
Can tetrachloroethylene poisoning be treated?
There is no antidote for tetrachloroethylene
poisoning, but its effects can be treated and most exposed
persons recover completely. People who have been exposed to
large amounts of tetrachloroethylene might need to be hospitalized.
Are any future health effects likely to occur?
A single small exposure form which a
person recovers quickly is not likely to cause delayed or
long-term effects. An exposure that occurs over many years
can affect the brain, skin, liver, and kidneys and can increase
the risk of certain types of cancer.
What tests can be done if a person has been exposed to tetrachloroethylene?
Specific tests for the presence of tetrachloroethylene
breakdown products in blood and urine are available, but they
are not generally useful to your doctor. If a severe exposure
has occurred, blood and other tests might show whether the
heart, lungs, liver, or kidneys have been affected. Testing
is not needed in every case.
Where can more information about tetrachloroethylene be found?
More information about tetrachloroethylene
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:
- dizziness or clumsiness
- nausea or vomiting
- loss of appetite
- difficulty breathing
[ ] 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.