Health Hazards of Solvents

James E. Cone MD, MPH

and Karen Packard, RDH, MS
This presentation is made possible by a grant from the Association
of Occupational and Environmental Clinics and the National Institute
for Occupational Safety & Health.
Module Goals
 To provide an overview of occupational solvent
exposure
 To review potential health outcomes and public
health prevention options.
 To provide step by step approach to diagnostic
testing and treatment of solvent-related diseases
 To provide background information on specific
solvents
 To illustrate the diverse effects of solvents
through cases involving solvent toxicity
What is a solvent?
A solvent is a
liquid at room
temperature
used to dissolve
other substances

Classes of Common Organic Solvents:

 aliphatic hydrocarbons  amines
 cyclic hydrocarbons  esters
 aromatic hydrocarbons  alcohols
 halogenated hydrocarbons  ketones
 aldehydes  ethers
Permission to use photo requested from AIHA Lab Safety Committee
Scope of the Problem
 Over 49 million
tons of solvent
chemicals are
produced and
used each year in
the US alone.
 Often exposure
involves a mixture
of solvents.
Permission requested from US Navy
Occupational Disease due to Solvents?
 390,000 new cases of all types of
occupational disease appear annually
in the US.

 It is unknown how many of these cases

may be related to solvent exposure.
 Similar to other occupational diseases,
95% of all occupational solvent-related
disease cases are never reported,
 most are never recognized as being
occupationally-related.
OccupationalEnvironmental
 Workplace solvents may also result in
exposures to neighborhood
residents if
discharged from
workplaces without
adequate controls.
 Other hazards:
– Fire or explosion
– Improper storage or disposal

Used with Permission of

OccupationalEnvironmental
 Residual
perchloroethylene
solvent may be present
in freshly dry cleaned
clothes
 Properties of Solvents
 Solubility

 Non-flammability/
Flammability/
Explosivity

 Volatility

 Metabolism

 Complex mixtures
Used with permission of Advanced Chemistry Development Co. Graphic
 Routes of Solvent Exposure
 Inhalation

 Absorption
-skin
-mucous
membranes

 Ingestion

 Injection Jane Norling

Graphic
Organ System Effects

Corel Graphic
Biological Monitoring
For Example:
 Urine testing for:

– Benzene  Phenol
– Toluene  Hippuric Acid, o-Cresol
– Xylene Methyl Hippuric Acid
– n-Hexane 2,5 hexanedione*

-References:
• ACGIH Biological Exposure Indices
* Not commercially available at this time
Corel Graphic
Occupations Exposed to Solvents
 Painters
 Construction workers
 Semiconductor workers
 Machinists / auto mechanics
 Manufacturing workers
– Glue, Paint, Chemical, Plastics
– Rotogravure Printers, Metal Degreasers
 Graffiti removers
 Refinery workers
 Manicurists
 Drycleaners
 Many others
 Solvent Related Diseases
 Acute Intoxication
 Chemical Headache
 Chemical Hepatitis
 Chronic Toxic
Encephalopathy
 Hematological
Effects
 Renal Effects
 Reproductive Health
Effects Bill Bowerman developed
 Toxic Peripheral n-Hexane related peripheral
neuropathy from glues used for
Neuropathy running shoes
Dx of Solvent-Related Disease
 10 Step Process

 Certain conditions should

trigger the thought that it
might be solvent-related:
– Chemical hepatitis, peripheral
neuropathy, chronic headache,
chronic cognitive impairment,
miscarriage, and asthma.
Corel Graphic
Dx: Step 1 - Medical & Exposure
Records
 Prior medical records
 Industrial Hygiene data
 Labels, Material Safety
Data Sheets (MSDS),
Chemical Inventory Lists
 OSHA reports
Dx: Step 2 - Exposure History
 Symptoms &
Exposure History
 Complete History &
Physical
Examination
 Specific job duties,
solvent exposures
 Exposure monitoring
 Frequency of acute
solvent intoxication
episodes
Acute Solvent Intoxication -Stages
 Narcosis
impaired psychomotor
function as measured by
reaction time, manual
dexterity, coordination, or
body balance

 Anesthesia
 Central nervous
system depression
 Respiratory arrest
 Unconsciousness
 Dx: Step 3 - Medical History
 Asthma

 History of Blood
Dyscrasias

 Hearing loss

 History of Psychological
Problems
– Prior to exposure
– After exposure
Dx: Step 4 - Physical Examination

Focus on:
 Skin

 Eyes

 Gastro -

intestinal
 Neurologic

system
 Mental Status
Dx: Step 5 - Laboratory Tests
 Screening
 Biological Indices
 Pathologic
Indices

NIOSH Database of Medical Tests for OSHA

Regulated Substances:
http://www.cdc.gov/niosh/nmed/medstart.html
Corel Graphic
Dx: Step 6 - Other Testing
 Nerve Conduction
Studies
 Color Vision
 Hearing
 Pontogram (blink
reflex – facial and
trigeminal nerve
evaluation)
 Peak flow
Dx: Step 7 - Site Visit
“Walk Through” of Patient’s Workplace

 Assess workplace
and potential exposures
– Personal or area
industrial hygiene
sampling
– Ventilation of worksite
– Potential skin exposure

 Obtain prior environmental test results, if

available
Dx: Step 8 - Relationship?
 Decide whether the the
patient’s diagnosis is
more likely than not
work-related.
 Is the latency period
adequate?

 Exposure data
consistent?
Dx: Step 9 - Make the Diagnosis

 Was the dose of the solvent exposure

adequate, in your opinion, to cause the
problem? (e.g., is there a history of
acute intoxication episodes?)
 OR Is patient particularly sensitive to
the effects of solvents (e.g. increased
individual susceptibility or acquired
intolerance)?
Dx: Step 9 - Diagnosis
 Rule out other diseases with similar
outcomes:
– e.g., Alcoholic Hepatitis/ Hepatitis B

 Decide if a pre-existing condition exists

that has been exacerbated.

 File Clinician’s First Report, if required

by State Law.
Dx: Step 10 - Disposition
 Return to work
 Modified duty / preclusions
 Factors of disability
– Objective/ Subjective
 Vocational rehabilitation
 Apportionment
 Future medical care
Prevention of Solvent Exposures
 Elimination
 Substitution
 Engineering
Controls
 Administrative
Controls
– Isolation
 Personal Protective
Equipment
Used with permission from

 Education
 Personal Protective Equipment
 Protective Clothing-Impermeable aprons

 Gloves – Breakthrough
time depends on type of
glove, solvent exposure
and activity.

 Chemically resistant gloves: natural rubber,

butyl rubber, chloroprene, nitrile, and
fluorocarbon; or various plastics: polyvinyl
chloride, polyvinyl alcohol, polyethylene

Permission requested from

Personal Protective Equipment-
Respirators
Respirator Program must
include:
 Training
 Cleaning
 Fit testing
 Medical Clearance
 Change of filters –schedule
depends on exposure type and
amount
Environmental pressures are
often the primary cause of
solvent substitution.

Montreal Protocol
Clean Air Act

Pollution Prevention (P2)

Additional Resources
 Handouts
 Bibliography
 Web Sites
– Jonathan S Rutchik, MD, MPH Organic Solvents
http://www.emedicine.com/neuro/topic285.htm

 Acknowledgements:
– Photos by Janet Delaney
– Elizabeth Katz, MPH, CIH
– Rosemarie Bowler, PhD
– Public Health Institute, AOEC and NIOSH staff