Sticky situations: cyanoacrylate exposures reported to a poison control system.

INTRODUCTION: Cyanoacrylate (Super Glue®) exposures are commonly reported to poison control centers, but little has been published in the medical literature regarding these exposures. We sought to characterize cyanoacrylate exposures reported to a poison control system. METHODS: We performed a retrospective review of a poison system's database for all cases of single-substance human exposure to cyanoacrylate-containing products from 2005 to 2015. Data collected included age, gender, route of exposure, clinical effects, treatments recommended and medical outcome. RESULTS: There were a total of 893 patients, 505 (56.6%) of which were female. Patient ages ranged from 6 months to 88 years with a median of 11 years. The vast majority of exposures (n = 871, 97.5%) were unintentional, but a small number of exposures (n = 22, 2.5%) were due to intentional misuse (such as trying to stop a bleeding cut) or malicious intent (such as purposefully gluing a person's eyes shut as a prank). Routes of exposure included: ingestion, n = 337 (37.7%); ocular, n = 322 (36.1%); dermatologic, n = 285 (31.9%); inhalation, n = 16 (1.8%); nasal, n = 1 (0.1%); and otic, n = 1 (0.1%); some patients had multiple routes of exposure. Treatments recommended by the poison center included irrigation (n = 411), petroleum jelly (n = 143), mineral oil (n = 131), topical antibiotic ointment (n = 82), peanut butter (n = 6), acetone (n = 4) and WD-40® (n = 2). A total of 657 patients (73.6%) were managed on-site, while 236 (26.4%) were seen in a health care facility. Among all exposures, effects were classified as none (n = 287), minor (n = 529) and moderate (n = 77). No major effects or deaths were reported. CONCLUSIONS: In this case series, the majority of cases occurred in children and most exposures did not result in significant morbidity. Notably, there was wide variation in terms of recommended treatments; further study is needed to determine the optimal treatment method and to standardize poison center recommendations for treating patients with cyanoacrylate exposures.

Polyurethane adhesive ingestion.

Polyurethane adhesives are found in a large number of household products in the United States and are used for a variety of purposes. Several brands of these expanding wood glues (those containing diphenylmethane diisocyanate [MDI]) have the potential to form gastrointestinal (GI) foreign bodies if ingested. The ingested adhesive forms an expanding ball of glue in the esophagus and gastric lumen. This expansion is caused by a polymerization reaction using the heat, water, and gastric acids of the stomach. A firm mass is created that can be 4-8 times its original volume. As little as 2 oz of glue have been reported to develop gastric foreign bodies. The obstructive mass is reported to form within minutes of ingestion of the adhesive. The foreign body can lead to esophageal impaction and obstruction, airway obstruction, gastric outflow obstruction, mucosal hemorrhage, ulceration, laceration, perforation of the esophageal and gastric linings, and death. Clinical signs following ingestion include anorexia, lethargy, vomiting, tachypnea, and abdominal distention and pain, and typically develop within 12 hours. Clinical signs may depend upon the size of the mass. If left untreated, perforation and rupture of the esophagus or stomach can occur. The glue mass does not stick to the GI mucosa and is not always detectable on abdominal palpation. Radiographs are recommended to confirm the presence of the "glue-ball" foreign body, and radiographic evidence of the obstruction may be seen as early as 4-6 hours following ingestion. Emesis is contraindicated owing to the risk of aspiration of the glue into the respiratory tree or the subsequent lodging of the expanding glue mass in the esophagus. Likewise, efforts to dilute the glue and prevent the formation of the foreign body through administration of liquids, activated charcoal, or bulk-forming products to push the foreign body through the GI tract have proven ineffective. Even endoscopy performed to remove the foreign body has been shown to be unreliable. The safest, most effective, and successful therapy is surgical intervention to remove the GI foreign body. If performed early enough, complete recovery of the animal can be expected. Differential diagnoses for polyurethane adhesive ingestion include any potential cause of GI obstruction. The public is largely unaware of the hazards that ingestion of this product may produce. Public education efforts are needed to inform pet owners about the hazards of these glues and the overall importance of providing our companion animals with safe, poison-free environments.

Engineering case report. Toluene and methyl ethyl ketone exposure from a commercially available contact adhesive.

A maintenance worker became ill after working indoors over the course of 3 days with a commercially available contact adhesive containing toluene and methyl ethyl ketone. Respiratory protection or local exhaust ventilation was not used. The worker subsequently suffered from numerous medical symptoms including tremors and elevated blood pressure. Magnetic resonance imaging documented the occurrence of encephalopathy. The worker has alleged that the cause of these effects was exposure to the vapors from the contact adhesive. The objective of this study was to characterize/estimate the level of the worker's exposure by obtaining air samples in an exposure chamber while performing similar activities under similar conditions. We found that the worker may have been exposed to approximately 159 ppm toluene and 58 ppm methyl ethyl ketone 8-hr time-weighted averages for 8 hr of adhesive application. The maximum 15-min average exposures were 233 ppm toluene and 85 ppm methyl ethyl ketone.

Parental occupational exposure to exhausts, solvents, glues and paints, and risk of childhood leukemia.

PURPOSE: It is unknown whether parental occupational exposure to chemicals before during and after pregnancy increases the risk of acute lymphoblastic leukemia (ALL) in the offspring. Few studies on this topic have assessed maternal exposures. METHODS: In an Australian case-control study of ALL in children aged <15 years, parents were asked about tasks they undertook in each job using a set of job-specific modules (JSMs). An expert reviewed the likelihood of exposure to exhausts, solvents, glues, and paints. Exposure was examined in each job 2 years, 1 year and anytime before birth of the child, and up to 1 year after birth of child. RESULTS: Solvent exposure was similar for case and control mothers in all time periods. More case mothers had moderate/high exposure to exhausts than control mothers anytime before the birth of the child (p = 0.010). Exposure to moderate or substantial levels of exhausts by mothers (OR = 1.97 95% CI 0.99-3.90) or fathers (OR = 1.37 95% CI 1.01-1.86) before the birth increased the risk of ALL in their offspring. Exposure to paints, pigments, glues, and resins was similar in case and control parents. CONCLUSION: We found little evidence that parental occupational exposure to solvents, glues, and paints was associated with childhood ALL. There was some evidence ALL was associated with exhaust exposure.

Hyperzincemia from ingestion of denture adhesives.

The purpose of this article is to review the recent literature that documents the serious adverse systemic effects of prolonged, excessive zinc ingestion from the overuse of denture adhesives. This condition causes elevation of serum zinc levels that result in depression of serum copper. The low serum copper levels cause bone marrow depression and widespread sensory and motor neuropathies. Epidemiologic studies revealed the source of excessive zinc intake to be from overuse of denture adhesives. Denture patients must be advised of the risks of prolonged overuse of denture adhesives.

Effect of chronic and subchronic organic solvents exposure on balance control of workers in plant manufacturing adhesive materials.

High-level occupational exposure to volatile organic solvents may elicit neurotoxic effects, especially on central and peripheral structures involved in balance ability. Studies on balance control in relation with exposure levels close to the threshold limit values are scarce. This study aimed to assess the neurotoxic effects of chronic and subchronic exposure to organic solvents among workers in plant manufacturing adhesive materials. Balance control was evaluated in 18 subjects, mainly exposed to n-hexane and toluene, with current median exposure levels of 222 and 102 mg/m(3), respectively, and a median exposure duration of 21 years, and in 32 nonexposed controls, using posturography tests with and without sensory conflicting situations. Tests were undergone at the beginning of the work shift (chronic exposure) following a week end, and after 72 h (subchronic exposure). Balance control performance was lower in chronically exposed workers compared to controls, and got worse after subchronic exposure, particularly during situations, where vestibular information was important. Our study suggests that a low-level and prolonged exposure to volatile organic solvents, mainly n-hexane and toluene, in the workplace is associated with deleterious central effects involved in postural regulation. This neurotoxicity is characterized by difficulties to use the most relevant information to control balance, leading to altered management of sensory conflicting situations.

Tracheal and bronchial obstruction following cyanoacrylate aspiration in a toddler.

INTRODUCTION: Cyanoacrylates are a common class of household substances used as adhesives and are commonly sold under brand names such as Super Glue, Krazy Glue, and others. We are reporting a case of accidental cyanoacrylate adhesive aspiration by a toddler complicated by tracheal and bronchial obstruction. CASE REPORT: A toddler ingested a low-viscosity cyanoacrylate product and developed a severe, persistent cough. Initial vital signs, oxygen saturation, lung sounds, and chest radiograph were unremarkable. Rigid bronchoscopy was performed and several pieces of glue were removed from both main stem bronchi. The child made a full recovery after a 10-day hospital stay. DISCUSSION: Cyanoacrylate ester polymers are hard, glassy resins that exhibit excellent adhesion to a variety of materials. Aspiration of these products is a poorly described clinical entity. CONCLUSION: The low viscosity of cyanoacrylate adhesive formulations makes aspiration of these products a rare but potentially life-threatening exposure. Management centers upon supportive care and consideration of rigid bronchoscopy for removal of adherent glue.

An uncommon cause of corrosive esophageal injury.

We present an unusual case of corrosive esophageal injury following liquid glue ingestion. The endoscopic findings were tissue sloughing and blackened appearance of the esophagogastric junction, due to caustic esophageal injuries following ingestion of glue containing toluene.

Activation of soluble guanylate cyclase by nitric oxide is increased in lymphocytes from both rats chronically exposed to 2,5-hexanedione and workers chronically exposed to n-hexane.

Although occupational exposure to n-hexane induces neurotoxic effects in the central and peripheral nervous systems, the mechanisms of its neurotoxicity remain unclear. n-Hexane is metabolized to 2,5-hexanedione (2,5-HD), which is the neurotoxic agent and the indicator chosen for the biological monitoring of exposed workers. It has been previously reported that chronic exposure to 2,5-HD impairs the glutamate-nitric oxide-cyclic GMP pathway at the level of activation of soluble guanylate cyclase (sGC) enzyme by nitric oxide (NO), both in cultured neurons and in the cerebellum of rats in vivo. The aim of this study was to assess whether the activation of sGC by NO is also altered in lymphocytes from rats treated with 2,5-HD and/or workers chronically exposed to n-hexane. Lymphocytes were isolated from male Wistar rats treated with 2,5-HD in drinking water, and from blood samples from shoe-factory workers environmentally and chronically exposed to n-hexane. Urine samples were also collected from workers at the end of the shift in order to measure the urinary levels of 2,5-HD. Activation of sGC by NO was significantly higher (p<0.05) in lymphocytes from rats treated with 2,5-HD than in control rats. In isolated lymphocytes from exposed workers the activation of sGC by NO also increases (p<0.05) in contrast to the controls. The results presented here indicate that the activation of lymphocytes could be an indicator of the toxicity produced by being exposed to n-hexane, since the effects observed in workers chronically exposed to n-hexane are similar to those found in rats chronically treated with 2,5-HD in drinking water.

Comparison of genetic damage in Brazilian footwear-workers exposed to solvent-based or water-based adhesive.

Research has shown that workers employed in footwear manufacture are at increased risk of some cancers, the strongest evidence being for nasal cancer and leukemia. Footwear-workers are routinely exposed to complex mixtures of solvents in degreasers, cleaners, primers, and adhesives used in the production process as toluene, n-hexane, acetone, and possibly dust particles, additives in shoe materials and degradation products of materials. The recognition of the potential health-hazards of solvent-based adhesives (SBAs) has lead to the development of adhesives with no organic solvents, the water-based adhesives (WBA). We investigated footwear-workers (all males) exposed to SBA (n=29) (for 3.98+/-4.13 years), and WBA (n=16), which had spent the six months previous to the study employed in an experimental section which used only water-based adhesives, although they had previously worked in sections which used solvent-based adhesives (for 5.80+/-4.03 years); 25 healthy subjects were used as controls. The Comet assay and the micronucleus test were used as endpoints, while the traditional parameters for assessing exposure to toluene in organic mixtures by measuring the concentration of urinary hippuric acid were also assessed. Our results showed a significantly lower mean concentration of hippuric acid in the control group than found in the SBA (P<0.001) and WBA (P<0.05) groups. The Comet assay results showed that there was a significant increase in the mean damage index for the SBA (P<0.001) group in comparison to the WBA group and control (P<0.05). For the micronucleus test in binucleated lymphocytes and exfoliated buccal cell, the three groups were not statistically different. Our study demonstrated that water-based adhesives are clearly a better option for safeguarding the health of footwear-workers, even with possibility of isocyanate presence, while the positive results observed in SBA group might be explained by chloroprene presence in the adhesive.

Beware of canine Gorilla Glue ingestions.

Household adhesive ingestions are considered relatively non-toxic. Gorilla Glue is a household glue containing a urethane polymer and a polymeric isocyanate liquid compound available in container sizes of 2 to 36 oz, and when applied will expand to 3-4 times its original volume. We report the ingestion of Gorilla Glue by 2 dogs that caused obstructive masses requiring surgical intervention. Dogs with a history of Gorilla Glue ingestion should be monitored closely by their owners and a veterinary referral made if signs of gastrointestinal distress develop.

Gastric outflow obstruction after ingestion of wood glue in a dog.

A 2-year-old, male, mixed-breed dog presented with a 12-day history of vomiting, depression, and weight loss after ingestion of industrial-strength wood glue containing diphenylmethane diisocyanate as its active ingredient. A diagnosis of gastric foreign body was made from survey abdominal radiographs. A large aggregate of solidified wood glue was surgically removed, and the dog recovered uneventfully. Fourteen other cases have been reported to the Animal Poison Control Center at the American Society for the Prevention of Cruelty to Animals (ASPCA). Eight of those 14 cases required surgical intervention. All cases recovered completely.

Drugs of abuse--an analysis based on cases from the Kraków Department of Clinical Toxicology of Jagiellonian University College of Medicine in 1997-2000.

The aim of the study was to present the frequency of acute drug overdosing by dependent patients in the years 1997, 1998, 1999 and 2000, and to compare the numbers of poisoned addicts suffering withdrawal syndrome and seeking detoxification. The analysis includes data for all drug addicts treated at the Kraków Department of Clinical Toxicology in years 1997, 1998, 1999 and 2000 because of drug overdosing and resultant acute intoxication, because of withdrawal syndrome and also the opiate dependent patients qualified to methadone maintenance programme. The patients dependent on ethanol were excluded. A progressive increase in number of poisonings with psychoactive substances was noted in analysed years, respectively 231, 298, 331 and 442 patients. Drugs of abuse, were the most frequent cause of admission. Also incidence rate of poisoning expressed per 10,000 of Kraków inhabitants was highest for the cases admitted because of overdosing or craving for narcotics. Opiate derivatives produced at home from poppy straw or from juice of poppy head (so called "kompot" or "Polish heroin") were the most common cause of admission in all the analysed years: increase in number of acutely poisoned, and also increase in number of opiate dependent patients who suffered withdrawal syndrome and sought detoxification was noted in 2000 as compared to years 1998 and 1999. Opiate derivatives followed by amphetamine, as the single toxic agent or in mixed combinations, were still the most common drugs of abuse detected in body fluids. The men were dominant in all the analysed years, but the increase in number of depended women was observed through the years under analysis.

Hypokalemic muscular paralysis causing acute respiratory failure due to rhabdomyolysis with renal tubular acidosis in a chronic glue sniffer.

CASE REPORT: A 34-year-old male was admitted to the emergency department with the development of quadriparesis and respiratory failure due to hypokalemia after prolonged glue sniffing. The patient was subsequently given mechanical ventilatory support for respiratory failure. He was weaned from the ventilator 4 days later after potassium replacement. Toluene is an aromatic hydrocarbon found in glues, cements, and solvents. It is known to be toxic to the nervous system, hematopoietic system, and causes acid-base and electrolyte disorders. Acute respiratory failure with hypokalemia and rhabdomyolysis with acute renal failure should be considered as potential events in a protracted glue sniffing.