Summary

Organic solvents are used in detergents, insecticides, and a number of industrial settings. Most of these substances are highly lipid-soluble and therefore capable of causing CNS disorders and polyneuropathy. Some organic solvents break down into metabolites that are carcinogenic. While the metabolites may be found in urine or blood, the diagnosis is usually established based on clinical features and a history of exposure. Most organic solvents do not have an antidote; therefore, treatment is generally supportive.

For an overview of other types of substance toxicity (e.g., with organophosphates), see the learning card on poisoning.

Overview

Overview of some organic solvents

	Effects
Aromatic amines	Transitional cell carcinoma of the bladder
Lindane	CNS: dizziness, vertigo, headache
Polyvinyl chloride	Hemangiosarcoma CNS: ataxia, coma Scleroderma-like skin changes
Hydrocarbons	Systemic toxicity (sensorimotor polyneuropathy, cardiac arrhythmias) If aspirated → aspiration pneumonia Benzene derivatives → methemoglobinemia

High lipid solubility

All organic solvents are highly lipid-soluble (i.e., lipophilic), which can lead to:
- Degreasing of the skin → eczema
- Mucosal irritation
- Permeation of the CNS, with symptoms based on the area affected (e.g, headache)
- Peripheral neuropathy (e.g., polyneuropathy )

References:^[1]^[1]^[1]^[1]^[2]

Aromatic amines

Examples: benzidine, 2-naphthylamine, aniline
Sources of exposure: occupational sources (dyes, oil refining, rubber production, perfumes, pesticides), pharmaceuticals (e.g., benzocaine), and tobacco smoke
Effects
- Carcinogenic → transitional cell carcinoma of the bladder
- Benzene derivatives (e.g., aniline and benzocaine) → methemoglobinemia

References:^[1]^[3]

Lindane

Sources of exposure: skin contact, ingestion, or inhalation of hexachlorocyclohexane found in insecticides or topical creams for scabies
Effects
- CNS: dizziness, vertigo, headache
- Carcinogenic effects are currently being investigated.

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Polyvinyl chloride

Sources of exposure: inhalation of or skin/eye contact with polyvinyl chloride, which is found in automotive parts, furniture, packaging materials, pipes, and wire coating
Effects
- Neurological changes (e.g., fatigue, dizziness, ataxia, visual disturbances, coma)
- Eye, mucous membrane, and respiratory tract irritation
- Chronic exposure: vinyl chloride disease
  - Abdominal pain
    - Liver, esophagus, and stomach injury
    - Splenomegaly
  - Malignant liver tumors (especially hemangiosarcoma)
  - Scleroderma-like skin changes

References:^[1]

Hydrocarbons

Classification and sources of exposure
- Aromatic hydrocarbon : benzene
  - Found in solvents, glues, nail polishes, cigarette smoke, car emissions, paints
- Aliphatic hydrocarbon ;: n-hexane, heptane, methane, ethane, propane, butane, octane
  - Found in gasoline or kerosene (solvents, paraffin wax, lighter fluid, furniture polishes, and lamp oil)
- Halogenated hydrocarbon ;: methylene chloride, chloroform, carbon tetrachloride, tetrachloroethylene
  - From biomass burning or natural production by fungi/bacteria
  - CCl4: formerly widely used in fire extinguishers, refrigerants, dry-cleaning fluids, and propellants
Effects
- Systemic toxicity
  - Neurotoxicity (e.g., sedation, headache, blurry vision, sensorimotor polyneuropathy; , chronic toxic encephalopathy, coma)
  - Cardiotoxicity (e.g., arrhythmias)
  - Nephrotoxicity (e.g., nephritis, nephrosis, and renal failure)
  - Carbon tetrachloride toxicity: free radical formation → centrilobular fatty change, congestion, and necrosis of the liver
  - Chronic benzene exposure: acute or chronic myeloid leukemia, non-Hodgkin lymphoma
- If aspirated → aspiration pneumonia
Diagnosis: clinical
Treatment
- Supportive (i.e., monitoring, fluid therapy, supplemental oxygen, intubation if in respiratory failure)
- Nasogastric lavage may be considered for patients who ingested a large amount of hydrocarbons with significant toxic potential and present within 1 hour of ingestion.

References:^[2]^[4]