Medical Management Guidelines for Methyl Bromide (Bromomethane)
(CH
3Br)
CAS# 74-83-9
UN# 1062
PDF Versionpdf icon[225 KB]
Synonyms include bromomethane, monobromomethane, isobrome, and methyl fume.
- Persons exposed only to methyl bromide gas do not pose substantial risks of secondary contamination; however, some methyl bromide may permeate clothing. Persons whose clothing or skin is contaminated with liquid methyl bromide (temperatures less than 38.5°F) can secondarily contaminate others by direct contact or through off-gassing vapor.
- A gas at room temperature, methyl bromide readily penetrates
skin, cloth, and other protective materials such as rubber
and leather. It is nonflammable and toxic at low concentrations.
- Methyl bromide is odorless and odor provides no warning
of hazardous concentrations. However, because methyl bromide
is odorless and nonirritating, a lacrimator (an agent that
irritates the eyes and causes tearing), most commonly chloropicrin,
is often added as a warning agent.
- Methyl bromide is absorbed well by the lungs and to some
degree through intact skin. Oral exposure is rare because
methyl bromide is a gas at room temperature, but it may
be absorbed by the gastrointestinal tract. Exposure by any
route can cause systemic effects.
General Information
Description
Methyl bromide is a colorless gas at
room temperature and a liquid below 38.5°F (3.6°C)
or when compressed. It is usually shipped as a liquefied,
compressed gas. It is odorless and nonirritating at low concentrations
and has a musty or fruity odor at high concentrations (greater
than 1,000 ppm). Because methyl bromide lacks adequate physiologic
warning properties, up to 2% chloropicrin, a lacrimator, is
often added to prevent significant exposure.
Routes of Exposure
Inhalation
Most exposures occur by inhalation and
by absorption through the skin. Odor is not an adequate
indicator of the presence of pure methyl bromide and does
not provide reliable warning of hazardous concentrations.
Because pure methyl bromide lacks adequate warning properties,
significant exposure can occur before symptoms are evident.
Methyl bromide is 3 times heavier than
air and can accumulate in poorly ventilated or low-lying areas.
Under adverse conditions, it can remain in the air for days
after application as a fumigant. Fatalities have occurred
among pesticide appliers and building occupants who were exposed
during the application process or who prematurely reentered
fumigated buildings.
Children exposed to the same levels
of methyl bromide as adults may receive larger doses because
they have greater lung surface area:body weight ratios and
increased minute volumes:weight ratios. In addition, they
may be exposed to higher levels than adults in the same location
because of their short stature and the higher levels of methyl
bromide found nearer to the ground.
Skin/Eye Contact
Methyl bromide gas easily penetrates
most protective clothing (e.g., cloth, rubber, and leather)
and skin. Prolonged retention in clothing and rubber boots
may lead to chemical dermatitis and severe burns. Skin absorption
may contribute to systemic toxicity.
Children are more vulnerable to toxicants
absorbed through the skin because of their relatively larger
surface area:body weight ratio.
Ingestion
Ingestion of methyl bromide is unlikely
because it is a gas at room temperature.
Sources/Uses
Methyl bromide is produced by adding
sulfuric acid to a mixture of sodium bromide and methyl alcohol.
Methyl bromide is used primarily as a pesticide to fumigate
soil, spaces, structures, and commodities. It is also used
as a methylating agent, low-boiling solvent, and oil extractant
in chemical syntheses. Less toxic chemicals have replaced
it as a refrigerant and fire-extinguisher constituent.
Standards and Guidelines
OSHA ceiling limit = 20 ppm (skin)
NIOSH IDLH (immediately dangerous to
life or health) = 250 ppm
AIHA ERPG-2 (the 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)
= 50 ppm
Physical Properties
Description: Colorless; gas at
room temperature and liquid below 38.5°F (3.6°C)
Warning properties: Inadequate;
musty or fruity odor at greater than 1,000 ppm; eye and throat
irritation at greater than 500 ppm.
Molecular weight: 95.0 daltons
Boiling point (760 mm Hg): 38.5°F
(3.6°C)
Freezing point: -137°F (-94°C)
Vapor pressure: 1420 mm Hg at
68°F (20°C)
Gas density: 3.4 (air = 1)
Water solubility: Water soluble
(0.09% at 68°F) (20°C)
Flammability: Flammable, but only
in the presence of a high-energy ignition source.
Flammable range: 13.5% to 14.5%
(concentration in air)
Incompatibilities
Methyl bromide reacts with strong oxidizers,
magnesium, aluminum, tin, zinc, and alloys. It attacks aluminum
to form aluminum trimethyl, which is spontaneously flammable.
Health Effects
- Methyl bromide is a neurotoxic gas that can cause convulsions,
coma, and long-term neuromuscular and cognitive deficits.
- Exposure to high concentrations of pure methyl bromide
may cause inflammation of the bronchi or lungs, an accumulation
of fluid in the lung, and irritation of the eyes and nose.
Tearing agents added to methyl bromide to provide warning
of its presence can also cause these symptoms, even at very
low concentrations.
- Skin contact with high vapor concentrations or with liquid
methyl bromide can cause systemic toxicity and may cause
stinging pain and blisters.
Acute Exposure
Methyl bromide methylates the sulfhydryl
groups of enzymes, causing cellular disruption and reduced
glutathione levels. Cellular disruption, primarily in the
CNS, results in progressive dysfunction. In sublethal poisoning,
a latency period of 2 to 48 hours can occur between exposure
and onset of symptoms. Methanol, a metabolite of methyl bromide,
may also contribute to the neurologic and visual effects,
but this is only likely to be significant at high levels of
exposure.
Children do not always respond to chemicals
in the same way that adults do. Different protocols for managing
their care may be needed.
CNS
The most serious effects of acute inhalation
exposure involve the CNS. Depending on the concentration and
duration of exposure, initial neurologic effects may be delayed
for 2 or more hours after exposure and may include headache,
nausea, vomiting, dizziness, malaise, and visual disturbances.
Examination may reveal involuntary movements of the eyes,
dilated pupils, slurred speech, trembling of the extremities
during movement, impaired gait, impaired sensation of touch,
brain damage (i.e., cerebellar abnormalities), motor deficits,
and decreased reflexes.
Neuropsychiatric abnormalities often
occur after acute exposure, although onset may be delayed
for days to weeks. In some cases, mental disturbances may
predominate with only mild neurologic signs and no seizures;
in others, severe and prolonged seizures may occur. Motor
and cognitive deficits may persist indefinitely.
Peripheral Neurologic Peripheral neuropathy
may develop after acute exposure to methyl bromide and may
persist indefinitely.
Respiratory
Respiratory symptoms are the most likely
nonneurologic effects of acute methyl bromide inhalation.
Throat irritation, chest pain, and shortness of breath are
common. Severe exposures may cause inflammation of the bronchi
or lungs and an accumulation of fluid in the lungs, which
may be delayed 24 hours or longer after exposure. Death may
result from respiratory or cardiovascular failure.
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.
Cardiovascular
Acute inhalation of high concentrations
can cause rapid, ineffective beating of the heart.
Renal
Protein and blood in the urine, scant
urine production, absence of urine production, and accumulation
of urea and other nitrogen wastes in the blood due to death
of kidney cells have been described. Complete recovery is
usual.
Hepatic
Elevated liver enzymes in serum and jaundice
occur occasionally after acute exposure.
Ocular
Eye exposure to liquid methyl bromide
or to high concentrations of vapor may cause corneal irritation
and burns.
Dermal
Contact with either liquid or high vapor
concentrations can cause stinging pain, redness of the skin,
and blisters characteristic of second-degree burns.
Because of their relatively larger surface
area:body weight ratio, children are more vulnerable to toxicants
absorbed through the skin.
Potential Sequelae
Peripheral nerve damage, speech difficulty,
and neuropsychiatric sequelae such as impaired gait, involuntary
movements of the eyes, tremors, involuntary muscle jerks,
seizures, decline in mental abilities, and severe mental disorders
(i.e., psychoses) may develop weeks after exposure.
Chronic Exposure
Repeated exposures have been associated
with peripheral neuropathies, especially sensory neuropathy,
impaired gait, behavioral changes, and mild liver and kidney
dysfunction. Visual impairment secondary to atrophy of the
optic nerve has been reported. Chronic exposure may be more
serious for children because of their potential longer latency
period.
Carcinogenicity
The International Agency for Research
on Cancer has determined that methyl bromide is not classifiable
as to its carcinogenicity to humans.
Reproductive and Developmental Effects
Methyl bromide is not considered a reproductive
or developmental toxicant. No human data are available; one
study of experimental animals (rats and rabbits) did not find
teratogenic effects at levels below those causing maternal
death. Methyl bromide 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.
Prehospital Management
- Victims exposed only to methyl bromide gas do not pose
substantial risks of secondary contamination to personnel
outside the Hot Zone; however, some methyl bromide may permeate
clothing. Victims whose clothing or skin is contaminated
with liquid methyl bromide (i.e., ambient temperature less
than 38.5°F) can secondarily contaminate response personnel
by direct contact or through off-gassing vapor.
- Methyl bromide is a neurotoxic gas that may cause headaches,
dizziness, visual disturbances, ventricular fibrillation,
pulmonary edema, ataxia, convulsions, coma, and death.
- Exposures to high concentrations of methyl bromide can
cause eye, skin, and respiratory tract irritation, as well
as chemical pneumonitis. Dermal absorption may contribute
to systemic toxicity.
- There is no antidote for methyl bromide. 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
Methyl bromide 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) with a full facepiece
is recommended in response situations that involve exposure
to potentially unsafe levels of methyl bromide vapor.
Skin Protection: Chemical-protective
clothing (including boots and gloves) is recommended because
methyl bromide vapor or liquid can be absorbed through the
skin and may contribute to systemic toxicity. Contact with
liquid methyl bromide can cause skin irritation and 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.
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
Remove clothing, including footwear,
from all victims because methyl bromide gas persists in cloth,
leather, and rubber. After clothing has been removed, patients
exposed only to the gas who have no skin or eye irritation
may be transferred immediately to the Support Zone. All others
require decontamination (see Basic Decontamination
below).
Rescuer Protection
If exposure levels are determined to
be safe, decontamination may be conducted by personnel wearing
a lower level of protection than that worn in the Hot Zone
(see Rescuer Protection, above).
ABC Reminders
Quickly access for a patent airway, ensure
adequate respiration and pulse. Stabilize the cervical spine
with a collar and a backboard if trauma is suspected. Administer
supplemental oxygen as required. Assist ventilation with a
bag-valve-mask device if necessary.
Basic Decontamination
Victims who are able may assist with
their own decontamination. Remove all contaminated clothing
including footwear. Methyl bromide can persist in cloth, leather,
and rubber, and these materials may contribute to severe chemical
burns after prolonged skin contact. Double-bag contaminated
clothing and personal belongings. Leave these items in
the Hot Zone.
Flush exposed skin and hair with water
for at least 15 minutes, then wash twice with mild soap. Rinse
thoroughly with water. Use caution to avoid hypothermia when
decontaminating children or the elderly. Use blankets or warmers
when appropriate.
Irrigate exposed or irritated eyes with
plain water or saline for 15 to 20 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.
Oral exposure to methyl bromide is rare
(it is a gas at temperatures above 38.5°F); however,
if ingestion occurs, do not induce emesis. If the victim
is alert and able to swallow, administer a slurry of activated
charcoal at 1 gm/kg (usual adult dose 60-90 g, child dose
25-50 g). A soda can and straw may be of assistance when offering
charcoal to a child.
Consider appropriate management of chemically
contaminated children at the exposure site. Also, provide
reassurance to the child during decontamination, especially
if separation from a parent occurs. If possible, seek assistance
from a child separation expert.
Transfer to Support Zone
As soon as basic decontamination is complete,
move the victim to the Support Zone.
Support Zone
Be certain that victims have been decontaminated
properly (see Decontamination Zone above). Persons
who have undergone decontamination pose no serious risks of
secondary contamination. 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 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.
Advanced Treatment
In cases of respiratory compromise secure
airway and respiration via endotracheal intubation. If not
possible, perform cricothyroidotomy if equipped and trained
to do so.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly).
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or are having seizures or cardiac arrhythmias should be treated
according to advanced life support (ALS) protocols.
If evidence of shock or hypotension
is observed begin fluid administration. For adults, bolus
1,000 mL/hour intravenous saline or lactated Ringer's solution
if blood pressure is under 80 mm Hg; if systolic pressure
is over 90 mm Hg, an infusion rate of 150 to 200 mL/hour is
sufficient. For children with compromised perfusion administer
a 20 mL/kg bolus of normal saline over 10 to 20 minutes, then
infuse at 2 to 3 mL/kg/hour.
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 the patient has ingested methyl bromide,
prepare the ambulance in case the patient vomits toxic material
or has diarrhea. 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. Because systemic symptoms may
be delayed for several hours after exposure, all exposed patients
should be transported to a medical facility for evaluation.
Symptomatic patients should receive priority in transport.
Emergency Department Management
- Hospital personnel away from the scene are not at significant
risk of secondary contamination from patients exposed to
methyl bromide gas or to liquid methyl bromide at ambient
temperatures greater than 38.5°F; however, some methyl
bromide may have permeated clothing.
- Methyl bromide is a neurotoxic gas that may cause headaches,
dizziness, visual disturbances, ventricular fibrillation,
pulmonary edema, ataxia, convulsions, coma, and death.
- Exposures to high concentrations of methyl bromide can
cause eye, skin, and respiratory tract irritation, as well
as chemical pneumonitis. Dermal absorption can contribute
to systemic toxicity.
- There is no antidote for methyl bromide. Treatment consists
of support of respiratory and cardiovascular functions.
Decontamination Area
Patients who have been decontaminated
previously may be transferred immediately to the Critical
Care Area. Other patients 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 because of the frequency
of hand-to-mouth activity among children.
ABC Reminders
Evaluate and support airway, breathing,
and circulation. Intubate the trachea in cases of respiratory
compromise. In cases of respiratory compromise secure airway
and respiration via endotracheal intubation. If not possible,
surgically create an airway.
Treat patients who have bronchospasm
with aerosolized bronchodilators. The use of bronchial sensitizing
agents in situations of multiple chemical exposures may pose
additional risks. Consider the health of the myocardium before
choosing which type of bronchodilator should be administered.
Cardiac sensitizing agents may be appropriate; however, the
use of cardiac sensitizing agents after exposure to certain
chemicals may pose enhanced risk of cardiac arrhythmias (especially
in the elderly).
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive,
or have seizures or ventricular arrhythmias should be treated
in the conventional manner.
Basic Decontamination
Patients who are able may assist with
their own decontamination. Remove and double-bag all clothing,
including footwear, because methyl bromide penetrates many
materials and can remain trapped in them. If clothing is to
be reused, it must undergo thorough decontamination. Some
contaminated clothing may not be safe for reuse (e.g., leather
articles).
Flush exposed skin and hair with water
for at least 15 minutes, then wash twice with mild
soap. Rinse thoroughly with water. Use caution to avoid hypothermia
when decontaminating children or the elderly. Use blankets
or warmers when appropriate.
Irrigate exposed or irritated eyes with
plain water or saline for 15 to 20 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 Critical Care Area. An ophthalmic
anesthetic, such as 0.5% tetracaine, may be necessary to alleviate
blepharospasm, and lid retractors may be required to allow
adequate irrigation under the eyelids.
Oral exposure to methyl bromide is rare
(it is a gas at temperatures above 38.5°F); however,
if ingestion occurs, do not induce emesis. If the victim
is alert and able to swallow, and if not already done, 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.
Critical Care Area
Be certain that appropriate decontamination
has been carried out (see Decontamination Area, above).
ABC Reminders
Evaluate and support airway, breathing,
and circulation as in ABC Reminders above. Establish
intravenous access in seriously ill patients. Continuously
monitor cardiac rhythm.
Patients who are comatose, hypotensive,
or have seizures or cardiac arrhythmias should be treated
in the conventional manner.
Inhalation Exposure
Administer supplemental oxygen by mask
to patients who have respiratory complaints. Treat patients
who have bronchospasm with aerosolized bronchodilators. The
use of bronchial sensitizing agents in situations of multiple
chemical exposures may pose additional risks. Consider the
health of the myocardium before choosing which type of bronchodilator
should be administered. Cardiac sensitizing agents may be
appropriate; however, the use of cardiac sensitizing agents
after exposure to certain chemicals may pose enhanced risk
of cardiac arrhythmias (especially in the elderly).
Consider racemic epinephrine aerosol
for children who develop stridor. Dose 0.25-0.75 mL of 2.25%
racemic epinephrine solution in 2.5 cc water, repeat every
20 minutes as needed, cautioning for myocardial variability.
Observe these patients for 24 hours
using repeated chest examinations and other appropriate tests.
Follow-up as clinically indicated.
Skin Exposure
If the skin was in contact with concentrated
methyl bromide vapor or liquid, chemical burns may result;
treat as thermal burns. Burns may be delayed in onset.
Eye Exposure
Continue irrigation for at least 15 minutes.
Test visual acuity. Examine the eyes for corneal damage and
treat appropriately. Immediately consult an ophthalmologist
for patients who have corneal injuries.
Ingestion
Oral exposure to methyl bromide is rare
(it is a gas at temperatures above 38.5°F); however,
if ingestion occurs, do not induce emesis. If the victim
is alert and able to swallow, and if not already done, 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.
Antidotes and Other Treatments
There is no proven antidote for methyl
bromide poisoning. Dimercaprol (BAL) or acetylcysteine (Mucomyst)
have been suggested as antidotes based on the postulated mechanism
of methyl bromide's toxicity. However, no adequate studies
have tested the efficacy of these therapies, and they are
not recommended for routine use.
Laboratory Tests
Serum bromide levels can be used to document
that exposure did occur. However, bromide levels do not accurately
predict the clinical course. Routine laboratory studies include
CBC, glucose, and electrolyte determinations. Additional studies
for patients exposed to methyl bromide include liver-function
tests and renal-function tests. In cases of inhalation exposure,
chest radiography and pulse oximetry (or ABG measurements)
may be helpful.
Disposition and Follow-up
Decisions to admit or discharge a patient
should be based on exposure history, physical examination,
and test results. The probable delay in onset of serious effects
from methyl bromide exposure should be considered.
Delayed Effects
Because the onset of pulmonary edema
may be delayed for up to several days, patients who have severe
exposure should be monitored with serial examinations before
absence of toxic effects can be assured. If pulmonary edema
is suspected, admit patients to an intensive care unit. Neurological
symptoms also may not develop for several days or weeks.
Patient Release
Patients who have no evidence of neuropsychiatric
or pulmonary effects 24 hours after exposure may be discharged
with instructions to return to the ED if symptoms develop
or recur (see the Methyl Bromide-Patient Information
Sheet).
Follow-up
Obtain the name of the patient's primary
care physician so that the hospital can send a copy of the
ED visit to the patient's doctor.
Patients exposed to methyl bromide should
be monitored for late neuropsychiatric sequelae.
Patients who have corneal injuries should
be reexamined within 24 hours.
Reporting
Methyl bromide is a pesticide. If a pesticide
or work-related incident has occurred, you may be legally
required to file a report; contact your state or local health
department.
Other persons may still be at risk in
the setting where this incident occurred. If the incident
occurred in the workplace, discussing it with company personnel
may prevent future incidents. If a public health risk exists,
notify your state or local health department or other responsible
public agency. When appropriate, inform patients that they
may request an evaluation of their workplace from OSHA or
NIOSH. See Appendices III and IV for a list of agencies that
may be of assistance.
Patient Information Sheet
This handout provides information and
follow-up instructions for persons who have been exposed to
methyl bromide.
Print this handout only.pdf icon[44 KB]
What is methyl bromide?
Methyl bromide is a colorless gas or
liquid that is odorless at low concentrations. At very high
concentrations, it has a sweet, fruity odor. Tear gas is often
mixed with it so that a person exposed to methyl bromide will
be warned of its presence. Methyl bromide is used to kill
insects in the soil and to rid soils and buildings of termites.
Typically, the field or home is covered ("tented")
by a large tarp and the methyl bromide is pumped in. Methyl
bromide is also used in industry to make other chemicals.
What immediate health effects can result from methyl bromide exposure?
Breathing methyl bromide can cause injury
to the brain, nerves, lungs, and throat. High doses can also
injure the kidneys and liver. Contact with the skin and eyes
can lead to irritation and burns. Generally, the more serious
the exposure, the more severe the symptoms.
Can methyl bromide poisoning be treated?
There is no antidote for methyl bromide
poisoning, but its effects can be treated and most persons
recover. Persons who have experienced serious symptoms may
need to be hospitalized and may need follow-up examinations
or treatment later on.
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 that causes lung
or nervous system-related problems, permanent brain or nerve
damage can result.
What tests can be done if a person has been exposed to methyl bromide?
Specific tests for the presence of bromide
in blood may provide some useful information to the doctor.
If a severe exposure has occurred, blood and urine analyses
and other tests may show whether the lungs, brain, nerves,
liver, or kidneys have been damaged. Testing is not needed
in every case.
Where can more information about methyl bromide be found?
More information about methyl bromide
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[44 KB]
[ ] Call your doctor or the Emergency
Department if you develop any unusual signs or symptoms within
the next 24 hours, especially:
- coughing or wheezing
- difficulty in breathing, shortness of breath, or chest
pain
- difficulty in walking
- numbness of hands or feet
- confusion, dizziness, or fainting
- increased pain or a discharge from exposed 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.