Acute Health Effects After the Elk River Chemical Spill, West Virginia, January 2014.

OBJECTIVES: On January 9, 2014, approximately 10 000 gallons of a mixture of 4-methylcyclohexanemethanol and propylene glycol phenyl ether spilled into West Virginia's Elk River, contaminating the potable water supply of about 300 000 West Virginia residents. This study sought to describe acute health effects after the chemical spill. METHODS: We conducted a descriptive analysis using 3 complementary data sources: (1) medical records of patients who visited an emergency department during January 9-23, 2014, with illness potentially related to the spill; (2) West Virginia Poison Center caller records coded as "contaminated water" during January 9-23, 2014; and (3) answers to household surveys about health effects from a Community Assessment for Public Health Emergency Response (CASPER) questionnaire administered 3 months after the spill. RESULTS: In the 2 weeks after the spill, 2000 people called the poison center reporting exposure to contaminated water, and 369 people visited emergency departments in the affected area with reports of exposure and symptoms potentially related to the spill. According to CASPER weighted cluster analyses, an estimated 25 623 households (21.7%; 95% confidence interval [CI], 14.4%-28.9%) had ≥1 person with symptoms who felt that they were related to the spill in the 3 months after it. Reported health effects across all 3 data sources included mild skin, respiratory, and gastrointestinal symptoms that resolved with no or minimal treatment. CONCLUSIONS: Medical records, poison center data, and CASPER household surveys were inexact but useful data sources to describe overall community health effects after a large-scale chemical spill. Analyzing multiple data sources could inform epidemiologic investigations of similar events.

A study on the relative breakthrough time (RBT) of a respirator cartridge for forty-six kinds of organic solvent vapors.

The breakthrough time of a commercially available respirator cartridge was measured for 46 kinds of organic solvents. The condition of the test air flow was set according to the Japanese government standard for the National Approval Test: at 300 ppm of an organic solvent vapor concentration, a temperature of 20 degrees C, a relative humidity of 50 percent, and a flow rate of 30 L/min. The interval between the start of passing the test flow through a cartridge and the time when the concentration of organic solvent vapors at the downstream of the cartridge reached 5 ppm was measured. The ratios of breakthrough times of organic solvents to that of cyclohexane which is designated as the standard test vapor in Japan, were calculated to obtain the relative breakthrough times (RBTs). Nine of the 46 organic solvents had breakthrough times shorter than that of cyclohexane, and these organic solvents with shorter RBTs were characterized by low boiling points and small molecular weights. The RBTs of 34 organic solvents were compared with the breakthrough times reported by Nelson et al. The relationship between the RBTs of this experiment and those reported by Nelson correlated well (correlation coefficient: 0.861).

Disposition of acetone, methyl ethyl ketone and cyclohexanone in acute poisoning.

A case of coma due to the drinking of a liquid cement for polyvinyl chloride resin, containing acetone, methyl ethyl ketone, cyclohexanone and polyvinyl chloride is described. The patient also simultaneously ingested the alcoholic beverage, sake. After gastric lavage, plasma exchanges and direct hemoperfusions, the patient recovered. The concentrations of these chemicals in plasma and urine were analyzed at various time intervals to estimate the clearance. The elimination half lives for acetone and methyl ethyl ketone were 18 hours and 10 hours, respectively. Although cyclohexanone made up the largest component in the solvents, the blood level was extremely low and a large amount of cyclohexanol, a metabolite of cyclohexanone was detected in the blood and urine. The glucuronide metabolite of cyclohexanol was also estimated after the hydrolysis with beta-glucuronidase. Since the conversion of cyclohexanone to cyclohexanol is known to be catalyzed by alcohol dehydrogenase, possible interactions between sake ingestion and cyclohexanone metabolism is proposed.

Blood-brain barrier permeability to horseradish peroxidase in twitcher and cuprizone-intoxicated mice.

The status of blood-brain barrier (BBB) permeability was investigated in the twitcher, an authentic murine model of globoid cell leukodystrophy (GLD, Krabbe disease) and cuprizone-intoxicated mice. Although extensive demyelination was noted in the CNS of both mice and additionally, macrophage infiltration was pronounced in the twitcher, BBB remained intact to horseradish peroxidase. Thus, the change of microenvironment caused by demyelination is not necessarily a responsible factor for increased BBB permeability in the inflammatory demyelinating conditions.

Fatal overdose from Bendectin.

A three-year old male ingested approximately 100 tablets of Bendectin. He developed tonic-clonic seizures followed by cardiac arrest. Toxicologic analysis yielded high levels of doxylamine, dicyclomine, and pyridoxine in blood, peritoneal fluid, and tissue homogenates. The antihistamine, doxylamine succinate appears to be the toxic constituent. Analytical methods used to document the case are herein described.