Because liquid CCl4 can be absorbed through the skin, remove clothing from persons exposed through this route and clean the skin with copious amounts of soap (or mild detergent) and water. If liquid CCl4 is splashed in the eyes, irrigate the eyes for at least 15 minutes.
For patients who have ingested CCl4, the practical value of gastric lavage and administration of activated charcoal is doubtful as absorption from a gastro-intestinal exposure is likely to be nearly complete by the time the patient reaches appropriate medical care. Patients with significant exposure might be clinically unstable and gastric lavage and/or activated charcoal might place the patient at increased risk for complications such as aspiration and chemical pneumonitis.
Induced emesis is contraindicated because of the risk for pulmonary aspiration.
Human case reports from Europe, where antioxidants such as
- Methionine,
- Cysteine, and
- N-acetylcysteine (NAC, Mucomyst, or Acetadote)
were used, suggest that when these free-radical scavengers are given intravenously within 12 to 16 hours after a high-dose acute CCl4 exposure, they might prevent or decrease hepatic and renal damage [De Ferreyra et al. 1974; De Ferreyra et al. 1977; Prescott et al. 1977; Kearney 2007].
Elevated oxygen concentrations in vitro and in vivo reduce lipid peroxidation and hepatotoxicity. Hyperbaric oxygen (HBO) has been found to play a therapeutic role in human and animal CCl4 poisoning [Larcan et al. 1973; Truss et al. 1982; Burk et al. 1986; Burkhart et al. 1991]. HBO appears to inhibit the mixed function oxidase system responsible for conversion of CCl4 to hepatotoxic free radicals. Because there are no proven antidotes for CCl4 poisoning, HBO may be considered for potentially severe CCl4 exposures. However, there might be a delicate balance between oxidative processes that are therapeutic and those that mediate hepatotoxicity. Therefore, when HBO is being considered, it should be instituted before the onset of liver function abnormalities [Thom 2006].
Hemodialysis has been used to treat renal failure, but it has not been proven successful in reversing CCl4 pathology [Meredith 1989; Ruprah 1985].
Patients should be observed for onset of hepatic and renal effects for up to 2 weeks after exposure. To a large extent, survival depends on the patient's nutritional status and the underlying condition of the hepatorenal system. |