Managing The Patient Poured Down Cellulosic Paint At Emergency Department

Abstract

Turkish Abstract

Introduction

Cellulosic paints are industrial materials widely used in a broad range of industries ¹. Cellulosic paints contain varying amounts of multiple chemical components such as acetone, cosolvent, butyl alcohol and toluene. Components of cellulosic paints have detrimental effects on human health ^2,3. Beside these possible consequences, clinical effect substantially depend on length of time, way and amount of chemical exposure. Unfortunately, in current literature, the management strategy of the exposures is not stated clearly. Our study represents a case of accidental cellulosic paint exposure by pouring down on head and our experiences about managing this patient and cleaning up the paint.

Case Report

A 20-year old man presented to our emergency department (ED) with a complaint of cellulosic paint exposure as an occupational accident. Exposure happened by pouring down on head 15 minutes before admission. At initial examination; his face, head, neck and upper extremities were covered by black cellulosic paint. The patient failed to see because the periorbital region and eyelids were covered by paint. His vital signs were blood pressure:131/71 mmHg, pulse rate: 111/per minute (regular), temperature: 36 °C, SaO2: 99 % and respiratory rate: 12/per minute. His state of conscious was assessed agitated (Glaskow Coma Scale:15). Electrocardiogram was sinus tachycardia. After initial examination, cellulosic paint was primarily removed by washing with water and soap and the patient's hair was cut (Figure).

Figure 1 Residual paint remnants on patient's scalp after haircut.

We had to wipe with thinner to remove residual paint remnants on patient's ears, eyebrows, eyelids and nails. Eyes were washed with saline solution (0.9% NaCl), and then eye drop including nonsteroid anti inflamatory drug was applied. Patient's whole blood count, blood urea, creatinine, sodium, potassium, aspartate aminotransferase, alanine aminotransferase, prothrombin time, international normalized ratio and arterial blood gases (pH:7.398) were all in normal ranges. Blood toxicological (headspace gas chromatography with flame ionization detection (HS-GC-FID))  analysis was studied from the sample taken at admission and detected 0.6 µl/ml (0,522 µg/L) toluene. At follow-up patient had insomnia and eye irritation for 7 and 3 days respectively, that  recovered problem-free.

Discussion

Toluene is an aromatic hydrocarbon (C7H8) found in household products including adhesives, paints and thinners. Widespread misuse of toluene makes toluene toxicity more common and risky condition especially for children and young people. Acute toluene toxicity causes neurologic, cardiovascular and metabolic manifestations. We observed that the neurologic problems have been more researched and focused compared to other body systems at literature. Neurologic problems develop due to neuronal changes and include impairments in motor function and cognitive abilities ⁴. Cardiovascular problems include fatal tachyarrhytmias and bradyarrhytmias ⁵.   Metabolic problems reported as bilateral adrenal hemorrhage result with metabolic acidosis, hypokalemia and hyperchloremia⁶.Current literature represents acute toluene intoxication cases by  inhalation of toluene containing paints and thinner fumes at indoor area ^4-7. However there are rarely encountered cases at literature occurred by orally intake  and intrathoracic injection ^7,8. Apart from these conditions, in our case toluene exposure occurred by transdermal absorption as a result of cellulosic paint contact. We didn?t observe severe intoxication signs and symptoms during follow-up. We believe this occurred due to limitedness of contact area, contact time and small amount of blood level (0,522 µg/L) compared with lethal cases (12,4 µg/mL (9), 30,2 µg/Ml ¹⁰.

In our case we considered the management of a cellulosic paint case at ED. Primarily at removal process of cellulosic paint from skin, we recommend washing with plenty of water. It isn?t possible to remove the residual paint remnants from scalp so we recommend to have patient?s haircut. In similar manner with the management of oil paint covered man, it?s difficult to remove remnants particularly at ears, face and nails ¹¹. Wiping with small amounts of thinner should be performed in the manner of preventing dermal irritation and over exposure of toluene. Eyes should be washed with saline solution. Ophtalmology consultation should be performed in order to control conjunctival and corneal contagion.

References

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Information Presentation

10. Ulusal Acil Tıp Kongresi, 1. Intercontinental Emergency Medicine Congress, Belek-Antalya / Türkiye, 15-18 Mayıs 2014 poster olarak sunulmuştur.