1. Health Hazards of Solvents Case Study #3 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.

2. Case 3 n Mr. Z works in a chemical barn for a chemical company. n He was working next to a 2000 gallon chemical storage tank containing lasso-atrazine (triazine herbicide), which was recirculating and a high pressure hose broke and sprayed chemical into his face.

3. Case 3 n First aid and eye wash was provided n Complaints initially: eye irritation and visual difficulties, headaches. Eye exam by ophthalmologist: corneal stain + on L eye. Acuity 20/70 L eye, 20/70 R eye. n Chief complaint in follow- up: Severe headaches every time he goes to work at the same job.

4. Case 3 - MSDS n Lasso-Atrazine: –Contains alachlor (2-chloro 2, 6 diethyl N methoxy methyl). Mild skin irritant. Hepatotoxic, kidney toxicity. Eye irritation. Skin sensitizer. Possible carcinogen. –Contains atrazine (2 chloro 4 ethyl amino 6 isopropyl amino S-triazine). Herbicide. Slight skin irritation. Renal effects. Carcinogen in animals. –Mixed with solvent: benzene chloride. Strong narcotic effects, with CNS intoxication.

5. Case 3 n Headaches start predictably after he begins work at the plant in the same area, resolve on weekends, several hours after going home from work. n One type of headache was bitemporal, constant and mild in character (3/10). The second type was much more intense (9/10), pulsating, associated with nausea and vomiting, and required him to stop whatever he was doing at the time and rest.

6. Case 3 n He was evaluated at the University Clinic, and treated with amitriptyline and trilafon. n No prior history of headaches. No family history of headaches / migraine. n He reports sleep disturbance: early awakening. Intrusive thoughts. n ETOH: occasional wine with dinner. n Multiple prior mild acute intoxication episodes with dizziness.

7. Case 3 n Neuropsychological evaluation: Difficulty with verbal memory, complex visual memory especially memory storage of new information. Full scale IQ 78. Premorbid estimate 106. Mild loss of cognitive integrative functions. Personality: severe depression. n After six months, a CT Scan of Brain is performed and is normal. n Eye acuity gradually returned to 20/20 in both eyes.

8. Case 3 n What are your diagnoses? n What features of the headaches may be helpful in making the diagnosis? n Which chemical(s) are most likely responsible for ongoing symptoms? What other chemicals are common causes of these types of headaches? n What is his prognosis? n What additional treatment recommendations?