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A 38 year-old laborer experienced solvent intoxication during each of two spray paintings of a dump truck and other heavy equipment in an enclosed, unventilated garage. The paint base consisted primarily of toluene and methyl ethyl ketone. Nausea, headaches, dizziness, respiratory difficulty and other symptoms began after exposures. Over the next several days he developed impaired concentration, memory loss and cerebellar signs including an intention tremor, gait ataxia and dysarthria. MRI of the brain and EGG early in the work-up were normal, although later MRIs demonstrated fluid collection over the left parietal area. Examination by a toxicologist and neurologist revealed likely toxic encephalopathy with dementia and cerebellar ataxia. Three formal neuropsychological assessments over 2 1/2 years quantified cognitive, motor and behavioral changes. Despite similar findings in chronic exposure to these solvents, lasting sequelae following acute exposure have not been widely reported.
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PMID:Chronic neuropsychological and neurological impairment following acute exposure to a solvent mixture of toluene and methyl ethyl ketone (MEK). 174 49

The purpose of this review has been to discuss human and environmental factors which may influence the acute irritative and neurotoxic effects of organic solvents. The review is based on a field study and on four human experimental studies. Several studies have shown that printers and other workers exposed to mixtures of solvents experience an increased frequency of work related irritative and neurological symptoms although the exposure has been far below the occupational exposure limits. A series of controlled human exposure studies was carried out. Different groups of persons were exposed to the most frequent solvent, toluene. Toluene in alveolar air and the urinary excretion of the metabolites were measured and the acute effects of toluene were assessed by the performance in a series of test of the perceptual and psychomotor functions as well as a standardized registration of annoyance and symptoms. The pharmacokinetics of toluene is complex and there is a large individual variation in the excretion of the metabolites. This variation can only to a limited extend be related to known variables. Intake of alcohol during exposure inhibits the metabolism of toluene and increases the internal dose. Normal therapeutic doses of cimetidine or propranolol have no measurable effect on toluene metabolism. Exposure to 100 ppm during 7 h causes irritation in the eyes and airways as well as feeling of intoxication, dizziness, and headache. There are signs of impairment in the performance in test concerning visual perception, colour vision, vigilance as well as the psychomotor functions. However, the influence on the performance tests was not seen in all studies. Variations in the air concentration of toluene with peaks op to 300 ppm causes fluctuation in the alveolar concentrations, but no acute effect of these peaks or of increased physical activity during exposure could be detected. However, the importance of peek concentrations and of workload for the development of chronic solvent encephalopathy is still unknown. The influence of a 9-25 years occupational exposure to solvents was investigated. A group of printers occupationally exposed to mixtures of solvents were compared with a matched unexposed control group. There was no difference between printers and controls in the performance in the psychological test, but in two of the tests there were tendencies to increased sensitivity to toluene in the group of printers. It is concluded that exposure to toluene corresponding to the occupational limit in several countries cause irritative and prenarcotic symptoms and possibly a lowered performance.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Human solvent exposure. Factors influencing the pharmacokinetics and acute toxicity. 203 Oct 44

Thirty two males and 39 females aged 31-50 were exposed for 7 h to one of the three following conditions: (1) Clean air, (2) constant exposure to 100 ppm toluene, or (3) a varying exposure with the same time-weighted average, but with peaks of 300 ppm every 30 min. During exposure the subjects exercised in three 15-min periods with a load of 50 to 100 W. Exposure to toluene caused significant (P less than 0.05) complaints about poor air quality, altered temperature and noise perception, increased irritation in the nose and the lower airways, feeling of intoxication, and there were tendencies (P less than 0.1) towards irritation in the throat, headache and dizziness. In the four performance tests there was a tendency towards a lower score in a vigilance test while no effect of toluene exposure was seen in a peg board test, a five choice serial reaction test, or a colour test, indicating only minimal if any effect on the psychomotor or visual performance. There was no difference in the acute effects caused by the exposure containing peak concentrations and by the constant exposure.
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PMID:Human response to varying concentrations of toluene. 229 24

1. The acute toxicity of many volatile compounds is similar, being more related to physical properties than to chemical structure. 2. Volatile substance abusers experiences euphoria and disinhibition but this may be followed by nausea and vomiting, dizziness, coughing and increased salivation; cardiac arrhythmias, convulsions, coma and death occur in severe cases. 3. Laboratory analysis of blood and urine samples collected up to 24 h post-exposure may be helpful if the diagnosis of volatile substance abuse is in doubt. 4. There is only a weak correlation between blood toluene and 1,1,1-trichloroethane concentrations and the clinical features of toxicity, possibly because of rapid initial tissue distribution and elimination. 5. Recovery normally occurs quickly once exposure has ceased but support for respiratory, renal or hepatic failure may be needed as well as treatment for cardiac arrhythmias. Therapy with intravenous acetylcysteine should be considered in cases of acute carbon tetrachloride poisoning.
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PMID:Diagnosis and treatment of acute poisoning with volatile substances. 277 67

The impact of industrial toluene exposure was assessed in 262 male employees of two Danish photographic printing plants. The study involved assessment of acute and chronic exposure based on a scoring system, standardised questions, measurement of blood pressure, pulmonary functions, and the plasma concentrations of urate, creatinine, creatine kinase, alanine-aminotransferase, FSH, LH, testosterone, sexual hormone binding globulin, thyroxine, triiodothyronine, and cortisole (following synacthen). The potentially confounding factors: age, weight, height, alcohol consumption and tobacco smoking were included in statistical analysis which showed that systolic blood pressure (p less than 0.01), P-P-FSH (p less than 0.001), dizziness (p less than 0.0001), decreased ability to concentrate (p less than 0.001), and dizziness during the past year (p less than 0.01) were correlated with the exposure score. Following six weeks without exposure, systolic blood pressure and P-ALAT decreased, the latter being correlated with the exposure score.
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PMID:Health effects of toluene exposure. 335 18

The influence on the kinetics of toluene from long-term occupational exposure, cigarette smoking, and ethanol consumption was studied in 26 male spray painters. A group of spray painters with reported subjective symptoms such as concentration deficits, fatigue, and dizziness due to the solvent exposure did not differ in the uptake and disposition of toluene from a group of spray painters with no symptoms. In occupationally exposed workers, a tendency for an enhanced clearance of toluene from the blood was observed in relation to personal habits such as smoking and/or moderate chronic ethanol intake. Long-term occupational exposure to a mixture of organic solvents does not exert any effect on the metabolic rate of toluene as compared with that of an unexposed group.
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PMID:Toxicokinetics of toluene in occupationally exposed volunteers. 382 7

The nasal mucus flow, lung function, subjective response, and psychometric performance of 16 young healthy subjects was studied during 6-h exposures to clean air and to 10, 40 or 100 ppm of toluene under controlled conditions. The toluene exposures did not affect nasal mucus flow or lung function. At 100 ppm irritation was experienced in the eyes and in the nose. There was a significant deterioration in the perceived air quality and a significant increased odor level during all exposures to toluene. The test battery investigated visual perception, vigilance, psychomotor functions, and higher cortical functions and comprised five-choice, rotary pursuit, screw-plate, Landolt's rings, Bourdon Wiersma, multiplication, sentence comprehension, and word memory tests. In these eight tests measuring 20 parameters, no statistically significant effects of the toluene exposure occurred. For three tests (multiplication errors, Landolt's rings, and the screw plate test) there was a borderline significance (0.05% less than p less than 0.10%). The subjects felt that the tests were more difficult and strenuous during the 100-ppm exposure, for which headache, dizziness, and feeling of intoxication were significantly more often reported. The exposures to 10 and 40 ppm did not result in any adverse effects.
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PMID:Human response to controlled levels of toluene in six-hour exposures. 667 99

Toluene appears to produce reversible effects upon liver, renal and nervous systems. Its usual route of intake is via respiration. The nervous system appears to be the most sensitive to the effects of toluene. Although there are few studies of toluene's neurotoxicity, some tenuous results can be cited. High level toluene exposures produced incoordination, ataxia, unconsciousness and eventually, death. Lower level acute exposures in man produce dizziness, exhilaration and confusion. Activity level has been inadequately studied. Schedule controlled behaviors have been reported to produce inverted U-shaped concentration-effect curves on response rate measures. Alterations at levels as low as 150 ppm have been reported when appetitive contingencies are used. Very few studies of the nervous system have been performed at levels below 1000 ppm and most of the results were inconclusive. The TLV (threshold limit value) of toluene has been set at 100 ppm for 8 hrs. No exposures on possible groups at special risk, such as perinatal, aged or impaired subjects have been made. Few studies of reversibility of effects in the nervous system have been reported. Much more work is needed before strong conclusions can be drawn.
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PMID:Neurobehavioral effects of toluene: a review. 703 26

To investigate the relationship between chronic exposure to organic solvents and changes in central nervous system function, industrial painters were compared with an age- and education-matched referent group of nonexposed workers. Eighty-one male painters completed a symptom questionnaire. Twenty painters underwent both questionnaire and neuropsychological examinations. From the results of pairwise comparisons of the symptoms, dry and scaly skin, being easily depressed without reason, coldness of hands and legs, being easily irritated without reason, loss of appetite, dizziness, and unsteadiness occurred statistically significantly more often among the exposed subjects than among the referents. Performances on the Digit symbol test and vocabulary test scores (synonyms) in exposed subjects were significantly lower than those of controls. In multiple regression models, controlling for age, education, and alcohol intake, a significant relation was found between the duration of the solvent exposure and poor performance in both the Block design and Digit span tests. The relation between toluene exposure and poor performance in both the Santa Ana coordination test and the Benton visual retention test was also significant. The results suggest that a symptom inquiry and some behavioral tests are helpful for detecting the possible effects of exposure to low levels of organic solvents. However, no consistent pattern was observed in regard to the effects of organic solvent exposure on neurobehavioral function, which is coincident with the type I toxic central nervous system disorder as classified by the World Health Organization.
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PMID:Neurobehavioral effects of chronic occupational exposure to organic solvents among Japanese industrial painters. 834 37

A factory survey on dose-response relationship in toluene toxicity was conducted in 1985-1989 in four cities in China. The examination items consisted of personal diffusive sampling for TWA exposure measurement, questionnaires on subjective symptoms, hematology and serum biochemistry, and clinical examination including simple neurology tests. Hippuric acid was also determined in urine samples collected at the end of the shift. With selection criteria that (1) complete results were available on all study items and (2) valid toluene exposure data (i.e., toluene shared 90% or more of the exposure) were obtained for the exposed, 452 toluene-exposed workers (206 men and 246 women; toluene exposure at 24.7 ppm as GM) and 517 nonexposed controls (246 men and 271 women) were selected. The subjective symptoms increased in close association with the intensity of exposure to toluene; the threshold concentration appeared to exist at 100 ppm in the case of symptoms during work, and it might be at 50-100 ppm when symptoms off work were evaluated. During the work with exposure at higher concentrations, various symptoms possibly related to CNS or local effects (e.g., eyes, nose, and throat) were complained, and dizziness and floating sensations were identified as typical symptoms with significant dose-response relationship. Several symptoms persisted off work, most of which were apparently related but not necessarily limited to CNS effects. Hematology and serum biochemistry were essentially negative.
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PMID:Dose-dependent increase in subjective symptoms among toluene-exposed workers. 847 58


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