How Should Patients Exposed to Trichloroethylene Be Treated and Managed?
CE Original Date: November 8, 2007
CE Renewal Date: November 8, 2010
CE Expiration Date: November 8, 2012
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Upon completion of this section, you should be able to describe the principal treatment strategy for treating and managing TCE poisoning.
There is no antidote for TCE poisoning. Treatment consists of support of respiratory and cardiovascular functions.
In the case of dermal contact with liquid TCE, contaminated clothes should be removed and the affected areas washed with copious amounts of soap and water. Direct eye splashes require irrigation for at least 15 minutes. Corneal epithelium damage usually resolves spontaneously after irrigation.
Patients should be removed from the contaminated environment as soon as possible; begin artificial ventilation, if needed. Those with altered mental status or apparent respiratory insufficiency should receive supplemental oxygen. If the patient’s pulse is absent, cardiopulmonary resuscitation should be initiated.
Gut decontamination (emesis, lavage, or saline cathartic) is recommended if it can be initiated within two to three hours after the ingestion of more than a swallow of TCE. However, the effects of these measures have not been clinically evaluated. If emesis is considered, administer the emetic only to patients who are fully conscious and have an intact gag reflex. Activated charcoal has not been proven to absorb TCE, but, in general, it effectively decreases absorption of most ingested toxic agents.
- No data are available on the ability of hemodialysis or hemoperfusion to increase TCE elimination.
- No specific antidotes exist (Meditext 2004).
- Patients with serious TCE toxicity should be monitored for the possible development of arrhythmias.
- When diarrhea is present, monitor for the development of electrolyte abnormalities and screen for the possible development of hepatorenal dysfunction (Meditext 2004).
- Sequelae are unusual in acute exposures but reported (Lawrence and Partyka 1981; Feldman, White et al. 1985; Szlatenyi and Wang 1996).
No known treatment for chronic exposure to TCE exists. Potentially involved organ systems should be independently evaluated, and supportive measures should be initiated.
- Removal from the source and supportive care is the recommended treatment for acute TCE exposure.
- Symptomatic treatment is recommended for chronic TCE exposure.