The Pharmacotherapy of Blood Intoxication (Methmoglobinemia) Induce by Exposure to Ortho-Chlorobenzylidenemalononitrile (CS) in Public Protests

Background:Acquired Methemoglobinemia(MetHb)is a rare, but potentially serious and unfamiliarity with this complication may delay diagnosis and appropriate therapy. Presentation:A case ofmethemoglobinemiaoccurring in male teenage demonstrator as a complication of re-current exposure to ortho-chlorobenzylidenemalononitrile (CS) in public protests , the patient became cyanotic with a decrease in his level of consciousness, by the effect of hydrogen cyanide as by-product of (CS), resulting in a toxicmethemoglobinemia level in his blood.Methemoglobin is incapable of carrying oxygen and is formed when the ferrous iron in the heme molecule is oxidized to the ferric state. The diagnosis should be entertained when cyanosis, unresponsive to 100% oxygen therapy, appears suddenly, especially when exposure to an oxidant agent is established. Treatment:The patient received a 1 mg/kg dose of methylene blue intravenously. A cooximetry done 1 hour later showed a methemoglobin level of 43%. A second 1 mg/kg dose of methylene blue was given and another hour later the methemoglobin level had dropped to 13%. The patient also showed clinical improvement with resolution of the cyanosis and return of his mental status to baseline. Conclusion:Methylene blue is the specific antidote, but should be reserved for more severe cases or if co-morbid conditions make mild hypoxia un advisable

Usos y abusos de los gases lacrimógenos y la salud: prevención y manejo / Uses and abuses of teargas and health: prevention and management

Los gases lacrimógenos (GL) son métodos de control de manifestaciones públicas por los órganos represivos, muy utilizados y efectivos globalmente. El objetivo de esta revisión es actualizar información técnica sobre los gases lacrimógenos, añadiendo aspectos más recientes legales, éticos, médicos y preventivos del uso y abuso de estos agentes químicos durante las acciones de las fuerzas policiales y represivas. Las fuentes de información secundarias seleccionadas son portales generales con el buscador Google, académicos (Google académico), PubMed y de las organizaciones gubernamentales y no gubernamentales, también se incluyen hemerotecas de artículos periodísticos sobre su uso desde 2000 hasta 2014. La exposición aguda a (GL) se expresa con manifestaciones clínicas de afección respiratoria, irritación de los ojos y de la piel, requiriendo en la mayoría de los casos medidas generales de atención fuera del hospital. Sin embargo, en casos de personas con co-morbilidades respiratorias, alérgicas, glaucoma y del corazón, acarrean mayores consecuencias que requieren atención médica y hospitalaria. Se han reportado fatalidades relacionadas al uso y abuso de los agentes químicos. Desde el punto de vista de salud pública existe controversia sobre su uso, y definitivamente causan consternación en los afectados y los abusos de su utilización en manifestaciones pacíficas. Se hace un listado de recomendaciones ante exposiciones durante manifestaciones, como prevenir intoxicaciones severas y dar los primeros auxilios...

Tear gases (TG) are methods for public control used by police forces. The objective of this review is to update technical information about tear gas, adding more recent legal, ethical, medical and preventive aspects of the use and abuse of these chemicals during the actions of the police and repressive forces. Selected secondary sources of information are Google, Academic Google, PubMed and of governmental and non-governmental organizations, also included are newspaper archives about its use from 2000 to 2014. Acute exposure to (GL) is expressed with clinical manifestations of respiratory conditions, irritation of the eyes and skin, requiring in most cases general ambulatory measures of care. However, in persons with respiratory, allergic, glaucoma and heart comorbidities, they carry greater consequences requiring hospital care. Fatalities have been reported related to the use and abuse of chemical agents. From the viewpoint of public health there is a controversy about its use, and definitely cause consternation in the affected in peaceful demonstrations. A list of recommendations is made about how to prevent severe intoxications and give first aid...

A Study for Health Hazard Evaluation of Methylene Chloride Evaporated from the Tear Gas Mixture

This study explored the health hazard of those exposed to methylene chloride by assessing its atmospheric concentration when a tear gas mixture was aerially dispersed. The concentration of methylene chloride ranged from 311.1-980.3 ppm (geometric mean, 555.8 ppm), 30 seconds after the dispersion started. However, the concentration fell rapidly to below 10 ppm after dispersion was completed. The concentration during the dispersion did not surpass the National Institute for Occupational Safety and Health 'immediately dangerous to life or health' value of 2,300 ppm, but did exceed the American Conference of Governmental Industrial Hygienists excursion limit of 250 ppm. Since methylene chloride is highly volatile (vapor pressure, 349 mmHg at 20degrees C), the postdispersion atmospheric concentration can rise instantaneously. Moreover, the o-chlorobenzylidenemalononitrile formulation of tear gas (CS gas) is an acute upper respiratory tract irritant. Therefore, tear gas mixtures should be handled with delicate care.