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Organic Solvents Differential Diagnoses

  • Author: Jonathan S Rutchik, MD, MPH; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
 
Updated: May 02, 2014
 
 

Diagnostic Considerations

Acute CNS symptoms (rapid onset)

Cerebral anoxia

Cerebral ischemia

Drug overdose

Drug toxicity

Hyperglycemia or hypoglycemia

Metabolic derangements

Postictal

Thyroid storm

Wernicke encephalopathy

Meningitis

Encephalitis

Central pontine myelinolysis Chronic CNS symptoms (slow onset)

Pseudodementia (depression)

Dementia of Alzheimer type

Dementia of multiinfarct type

Dementia of normal pressure hydrocephalus (NPH) variant

Dementia pugilistica

Drug toxicity

Nutritional excess of deficit

Multiple sclerosis

Epilepsy

Brain tumor or metastasis

Carcinomatous meningitis

Encephalitis or meningitis

Chronic drug abuse

Multiple head trauma history

Hepatocerebral syndrome

Krabbe leukodystrophy

Adult adrenoleukodystrophy Chronic PNS symptoms

Diabetes

Thyroid disease

Uremia

Liver disease

HIV infection

Medication toxicity

Lymphoma or other neoplasm

Nutritional deficit or excess

Syphilis

Familial neuropathy

Myasthenia gravis

Amyotrophic lateral sclerosis

Mononeuritis multiplex Other diagnoses to consider

Occupational exposures from previous employment

Environmental exposures from residence (indoor) and neighborhood (ambient) air and household water

Other environmental exposures from commercial products routinely used

Exposures from food and food preservatives

Paraproteinemic neuropathy

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Jonathan S Rutchik, MD, MPH Associate Clinical Professor, Division of Occupational Medicine, Department of Medicine, University of California, San Francisco, School of Medicine; Neurology, Environmental and Occupational Medicine Associates (www.neoma.com)

Jonathan S Rutchik, MD, MPH is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, International Parkinson and Movement Disorder Society, Society of Toxicology, Western Occupational and Environmental Medical Association, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American College of International Physicians, American Heart Association, American Stroke Association, American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, National Association of Managed Care Physicians, American College of Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Roberta J Seidman, MD Associate Professor of Clinical Pathology, Stony Brook University; Director of Neuropathology, Department of Pathology, Stony Brook University Medical Center

Roberta J Seidman, MD is a member of the following medical societies: American Academy of Neurology, Suffolk County Society of Pathologists, New York Association of Neuropathologists (The Neuroplex), American Association of Neuropathologists

Disclosure: Nothing to disclose.

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Table 1. Organic Solvents and Their Common Industrial Uses
CompoundIndustrial Uses
AcetoneCleaning solvent
AcrylamideMining and tunneling, adhesives, waste treatment, ore processing
BenzeneFuel, detergents, paint removers, manufacture of other solvents
Carbon disulfideViscose rayon, explosives, paints, preservatives, textiles, rubber cement, varnishes, electroplating
Ethylene oxide (ETO)Instrument sterilization
N- hexaneGlues and vegetable extraction, components of naphtha, lacquers, metal cleaning compounds
Hydrogen sulfideSulfur chemical manufacturing, by-product of petroleum processing, decay of organic matter
MethaneIndustrial settings
Methyl mercaptanOdorant in natural gas and fuels
Methyl-N- butyl ketoneMany industrial uses
Methylene chloride (dichloromethane)Solvent, refrigerant, propellant
OrganochlorineInsecticides
OrganophosphatesInsecticides
PCEDry cleaning, degreaser, textile industry
StyreneFiberglass component, ship building
ToluenePaint, fuel oil, cleaning agents, lacquers, paints and paint thinners
1,1,1-Trichloroethane (methyl chloroform)Degreaser and propellant
TCECleaning agent, paint component, decaffeination, rubber solvents, varnish
Vinyl chlorideIntermediate for polyvinylchloride resins for plastics, floor coverings, upholstery, appliances, packaging
XylenePaint, lacquers, varnishes, inks, dyes, adhesives, cements, fixative for pathologic specimens
Table 2. Exposure levels Believed Safe for Workers
CompoundUrineBloodExpired Air
AcetoneAcetone, formic acid 100 mg/LAcetoneAcetone
BenzeneTotal phenol 50 mg/g at the end of the shift, trans-trans- muconic acidBenzeneBenzene before shift, 0.08 ppm; end exhaled, 0.12 ppm
Carbon disulfide2-TTCA 5 mg/g*Carbon disulfideCarbon disulfide
ETONoneNoneNone
N- hexane2,5-hexanediol 5 mg/g at the end of the shift, 2-hexanol, total metabolitesN- hexaneN- hexane
Hydrogen sulfideNoneNoneNone
MethaneNoneNoneNone
Methyl mercaptanNoneNoneNone
MethanolFormic acid 80 mg/g at the start of the work week, methanol 15 mg/g at the end of the shiftNoneMethanol
Methyl-N- butyl ketoneNone2,5-hexane dioneNone
Methylene chlorideNoneMeCl2MeCl2
OrganochlorineNoneNoneNone
OrganophosphatesNoneNoneNone
PCEPCE, trichloroacetic acidPCE 1 mg/LPCE 10 ppm before the last shift of the week
StyreneEnd of the shift: mandelic acid (MA) 800 mg, phenylglyoxylic acid (PGA) 240 mg/g)



Before shift: MA 300 mg/g or PGA 100 mg/g



Styrene 0.02 mg/L at the start of the shift, 0.55 mg/L at the end of the shiftNone
TolueneHippuric acidTolueneToluene
1,1,1-Trichlorethane (methyl chloroform)TCA 10 mg/L at the end of the work week; total trichloroethanol at the end of the shift and at the end of the work week, 30 mg/L Total trichloroethanol 1 mg/LMethyl chloroform 40 ppm before the last shift of the work week
TCETCE, TCA 100 mg/g at the end of the work week or TCA plus trichloroethanol 300 mg/gTCE at the end of the work week 4 mg/LTCE
Vinyl chlorideNoneNoneNone
XyleneMethylhippuric acid 1.5 g/g at the end of the shiftXyleneXylene
* TTCA - 2-thiothiazolidine 4-carboxylic acid.
Table 3. Recommended Exposure Limits, Organic Solvents
Compoundppm, mg/m,3
OSHA PEL as TWAsNIOSH REL as TWAs, IDLHACGIH TLV, STEL
Acetone1000 (2400)250 (590), 2500750 (1780) ceiling, 1000 (2380)
Acrylamide0.3(0.03), 60 level for carcinogenicityNone
Benzene10, 25 ceiling, 50 for 10 min0.1, STEL 1, 50010 (32)
Carbon disulfide20, 30, 100 for 30 min1 (3), 10 STEL (30), 50010 (31)
ETO < 0.1, < 0.18, 5 ceiling, 8001 (1.8)
N- hexane500 (1800)50 (180), 110050 (176)
Hydrogen sulfide20 ceiling, 50 for 10 min once only10 ceiling, (15) for 10 min, 100None
Methyl mercaptan10 ceiling (20)0.5 ceiling, (1) for 15 min, 150None
Methanol200 (260)200 (260), 250 STEL (325), 6000262 (200), 328 (250)
Methyl-n- butyl ketone100 (410)None5 (20)
Methylene chloride25, 15 STEL for 15 min2300 level for carcinogenicity50 (174) ceiling
Perchloroethylene100, 200 ceiling, 300 for 5 min in 3 h150 level for carcinogenicity25 (170), 100 (685)
Styrene100, 200 ceiling, 600 for 5 min in 3 h50 (215), 100 ST (425), 70050 (213), 100 (428)
Toluene200, 300, 500 for 10 min100 (375), 150 STEL (560), 50050 (188)
1,1,1-Trichlorethane (methyl chloroform)350 (1900)Ceiling 350 (1900) for 15 min, 700350 (1910), 450 (2460)
Trichloroethylene100, 200 ceiling, 300 for 5 min in 2 h1000 level for carcinogenicity50 (269), 100 (1070)
Vinyl chloride1, 5 for 15 minNot determinedNone
Xylene100 (435)100 (435), 150 STEL (655)100 (434),150 (651)
Abbreviations—ACGIH = American Congress of Governmental Industrial Hygienists, IDLH = Immediately dangerous to life or health; NIOSH = National Institute for Occupational Safety and Health, OSHA = Occupational Safety and Health Administration, PEL = permissible exposure limit, REL = recommended exposure limit; STEL = short-term exposure limit; TWA = time-weighted average.
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