Reactive Airway Dysfunction Syndrome (RADS) in a Chemistry Teacher Induced by Fumes of Mixed Iodine Compounds

Hannu, Timo; Riihimäki, Vesa; Piirilä, Päivi

doi:10.2486/indhealth.47.681

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…The response to treatment is variable and the complete resolution of the condition may take months or years to happen. [5] Complete improvement in our patient’s respiratory function took 1 year to happen.…”

Section: Discussionmentioning

confidence: 95%

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Inhalational exposure to dimethyl sulfate vapor followed by reactive airway dysfunction syndrome

Aghabiklooei

Zamani

Shiva

et al. 2010

Indian J Occup Environ Med

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Dimethyl sulfate (DMS) is an oily liquid used as a solvent, stabilizer, sulfonation agent, and catalyst. Exposure to DMS primarily happens in the workplace via inhalational contact and damages the upper and lower airways. Our manuscript reports a case of DMS-related reactive airway dysfunction syndrome (RADS). The patient was a healthy 29-year-old man who was referred to our ER after accidental exposure to the vapor of DMS with the complaint of dyspnea, dry cough, photophobia, and hoarseness. His vital signs were normal except for a low-grade fever. Redness of the pharynx, conjunctivitis, and cholinergic signs and symptoms were present. Conservative management with O2 and fluid therapy was initiated. Twenty hours later, the patient became drowsy and his respiratory symptoms exacerbated; chest X-ray revealed haziness in the base of the right lung and prominence of the vessels of the lung hillum. After 1 week, the liver transaminases rose and C-reactive protein elevated (2+). The patient got better with conservative treatment and was discharged after 9 days; however, exertional dyspnea, wheezing, and thick white sputum persisted and therefore, reactive airway dysfunction syndrome (RADS) related to DMS vapor was confirmed which was treated by prednisolone. Exertional dyspnea continued up to 10 months. Hoarseness lasted for 6 months. This case shows that DMS vapor inhalation can cause RADS especially in the chemical workers who continue working in the contaminated place despite the relatively good air conditioning.

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Section: Discussionmentioning

confidence: 95%

“…Treatment with corticosteroids is advocated in these patients. [5] Our case received prednisolone for 6 months to regain his acceptable pulmonary function. Serial monitoring of bronchial hyper-reactivity is often advocated.…”

Section: Discussionmentioning

confidence: 99%

Inhalational exposure to dimethyl sulfate vapor followed by reactive airway dysfunction syndrome

Aghabiklooei

Zamani

Shiva

et al. 2010

Indian J Occup Environ Med

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Occupational exposure to aluminum and its biomonitoring in perspective

Riihimäki

Aitio

2012

Critical Reviews in Toxicology

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Exposure to aluminum at work is widespread, and people are exposed to several species of aluminum, which differ markedly as to the kinetics and toxicity. Especially welding of aluminum is widely applied and continuously expanding. Inhalation of fine particles of sparsely soluble aluminum results in the retention of deposited particles in the lungs. From the lungs, aluminum is released to the blood and distributed to bones and the brain, and excreted to urine. Soluble aluminum compounds are not accumulated in the lungs. Neurotoxicity is the critical effect of exposure to sparsely soluble aluminum compounds. Studies on workers exposed to aluminum welding fumes have revealed disturbances of cognitive processes, memory and concentration, and changes in mood and EEG. Early pulmonary effects have been observed among aluminum powder-production workers using high-resolution computed tomography. The primary objective of aluminum biomonitoring (BM) is to help prevent the formation of aluminum burden in the lungs and thereby to prevent harmful accumulation of aluminum in target organs. BM of aluminum can be effectively used for this purpose in the production/use of aluminum powders, aluminum welding, as well as plasma cutting, grinding, polishing and thermal spraying of aluminum. BM of aluminum may also be similarly useful in the smelting of aluminum and probably in the production of corundum. BM can help identify exposed individuals and roughly quantitate transient exposure but cannot predict health effects in the production/use of soluble aluminum salts. For urinary aluminum (U-Al) we propose an action limit of 3 µmol/L, corrected to a relative density of 1.021, in a sample collected preshift after two days without occupational exposure, and without use of aluminum-containing drugs. This value corresponds roughly to 2.3 µmol/g creatinine. Compliance with this limit is expected to protect the worker against the critical effect of aluminum in exposure to sparsely soluble aluminum dusts, the cognitive function of the central nervous system. For serum aluminum (S-Al), we do not propose an action limit because S-Al is less sensitive as an indicator of aluminum load.

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