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Table 1. Exposure Limits, Common Organic Solvents and Metals

Compound	OSHA PEL TWA: ppm (mg/m³)	NIOSH REL TWA: ppm (mg/m³), IDLH	ACGIH ppm (mg/m³) TLV, STEL
Acrylamide	(0.3)	(0.03), 60 Ca
Arsenic, inorganic	(0.01)	C (0.002)	(0.01), -
Arsenic, organic	0.5 mg/m³
Carbon disulfide	20, 30, 100 for 30 min	1 (3), 10 STEL (30), 500	10 (31)
Ethylene oxide		1 < 0.1, < 0.18, 5 C, 800	1 (1.8)
n -hexane	500 (1800)	50 (180), 1100	50, (176)
Lead	0.05 mg/m³	0.100 mg/m³	(0.05), -
Mercury, inorganic	C 0.1 mg/m³	0.05 mg/m³, C 0.01 mg/m³, 10 mg/m³	0.025 mg/m³
Mercury, organic	0.01 mg/m³, C 0.04 mg/m³	0.01 mg/m³, ST 0.03 mg/m³, 2 mg/m³	0.01 mg/m³, 0.03 mg/m³
Methyl n -butyl ketone	100 (410)		5 (20)
Perchloroethylene	100, 200 C, 300 for 5 min in 3 h	150 Ca	25 (170), 100 (685)
Styrene	100, 200 C, 600 for 5 min in 3 h	50 (215), 100 ST (425), 700	50 (213), 100 (428)
Thallium	0.1 mg/m³ skin	0.1 mg/m³, 15 mg/m³	0.1 mg/m³
Toluene	200, 300, 500 for 10 min	100 (375), 150 ST (560), 500	50 (188)
1,1,1 Trichloroethane (methyl chloroform)	350 (1900)	C 350(1900) for 15 min, 700	350 (1910), 450 (2460)
Trichloroethylene	100, 200 C, 300 for 5 min in 2 h	1000 Ca	50 (269), 100 (1070)
Vinyl chloride	1, 5 for 15 min	ND
Xylene	100 (435)	100 (435), 150 ST (655)	100 (434), 150 (651)
Abbreviations: OSHA - Occupational Safety and Health Association; NIOSH - National Institute of Occupational Safety and Health; ACGIH - American Congress of Governmental Industrial Hygienists; TWA - time-weighted average; TLV - threshold limit value; PEL - permissible exposure limit; REL - recommended exposure limit; ppm - parts per million; STEL - short-term exposure limit; Ca - level for carcinogenicity; C - ceiling, should never be exceeded; ND - not determined

Table 2. Agency for Toxic Substances and Disease Registry Biological Exposure Indices

Compound	Urine	Blood	Expired Air	Other
Acrylamide
Arsenic	Inorganic arsenic: end of work week, 50 µg/g monomethyl-arsonic acid, cacodylic acid (days)			Hair (ingestion chronic)
Carbon disulfide	2-TTCA* 5 mg/g	Carbon disulfide	Carbon disulfide
Ethylene oxide
n -hexane	2-5 hexanediol: end of shift, 5 mg/g 2 hexanol, total metabolites	n -hexane	n -hexane
Lead	Lead	Lead 30 μg/100 mL		Erythrocyte protopor-phyrin
Mercury, inorganic	Mercury: start of shift, 35 µg/g	Mercury: end of shift at end of work week, 15 µg/L
Methyl n -butyl ketone		2,5 hexane dione
Perchloro-ethylene	Perchloro-ethylene, trichloroacetic acid	Perchloroethylene 1 mg/L	Perchloro-ethylene: before last shift of week, 10 ppm†
Styrene	Mandelic acid: start of shift, 300 mg/g; end of shift, 800 mg/g Phenylglyoxylic acid: start of shift, 100 mg/g; end of shift, 240 mg/g	Styrene: start of shift, 0.02 mg/L; end of shift, 0.55 mg/L
Thallium	Thallium
Toluene	Hippuric acid	Toluene	Toluene
1,1,1 Trichloroethane (methyl chloroform)	Trichloroacetic acid: end of work week, 10 mg/L total trichloroethanol: end of shift at end of work week, 30 mg/L	Total trichloroethanol 1 mg/L	Methyl chloroform: prior to last shift of work week, 40 ppm†
Trichloro-ethylene	Trichloroethylene, trichloroacetic acid: end of work week, 100 mg/g or trichloroacetic acid plus trichloroethanol, 300 mg/g	Trichloroethylene: end of work week, 4 mg/L	Trichloro- ethylene
Vinyl chloride
Xylene	Methylhippuric acid: end of shift, 1.5 mg/g	Xylene	Xylene
*2-TTCA - 2-thiothiazolidine-4-carboxylic acid † ppm - parts per million

Table 3. Industrial Uses of Common Organic Solvents and Metals

Compound	Industrial Uses
Acrylamide	Mining and tunneling, adhesives, waste treatment, ore processing, paper, pulp industry, photography, dyes
Arsenic	Pesticides, pigments, antifouling paint, electroplating, seafood, smelters, semiconductors, logging
Carbon disulfide	Viscose rayon, explosives, paints, preservatives, textiles, rubber cement, varnishes, electroplating
Ethylene oxide	Instrument sterilization, chemical precursor
n -hexane	Glues and vegetable extraction, components of naphtha, lacquers, metal-cleaning compounds
Lead	Solder, lead shot, illicit whiskey, insecticides, auto body shops, storage batteries, foundries, smelters, lead-based paint, lead stained glass, lead pipes
Mercury	Scientific instruments, electrical equipment, amalgams, electroplating, photography, felt making, taxidermy, textiles, pigments, chloroalkali industry
Methyl n -butyl ketone	Paints, varnishes, quick-drying inks, lacquers, metal-cleaning compounds, paint removers
Organochlorine	Insecticides
Organophosphates	Insecticides
Perchloroethylene	Dry cleaning, degreaser, textile industry
Styrene	Fiberglass component, ship building, polyester resin
Thallium	Rodenticides, fungicides, mercury and silver alloys, lens manufacturing, photoelectric cells, infrared optical instruments
Toluene	Paint, fuel oil, cleaning agents, lacquers, paints and paint thinners
1,1,1 Trichloroethane (methyl chloroform)	Degreaser and propellant
Trichloroethylene	Cleaning agent, paint component, decaffeination, rubber solvents, varnish
Vinyl chloride	Intermediate for polyvinyl chloride (PVC) resins for plastics, floor coverings, upholstery, appliances, packaging
Xylene	Fixative for pathologic specimens, paint, lacquers, varnishes, inks, dyes, adhesives, cements

Table 4. Differential Diagnosis of Peripheral Neuropathy With Selective Lab Testing (Recommended lab tests in bold.)

Inflam-matory	Metabolic and Nutritional	Infective and Granulo-matous	Vasculitic	Neoplastic and Para-proteinemic	Drug-Induced and Toxic	Hereditary
Acute idiopathic polyneuro-pathy (Anti-Gm1, anti-Gd1a, anti-GQ1b)	Diabetes ( Fasting blood glucose , 2-hour glucose tolerance test)	AIDS ( HIV)	Mixed CT disease (ESR)	Compression and infiltration ( chest radiograph)	Alcohol	HMSN
Chronic inflammatory demyelin-ating polyneuro-pathy	Endocrino-pathies: hypo-thyroidism, acromegaly ( TSH , Electrolytes, GH)	Leprosy, syphilis ( RPR , FTA , MHA-TP)	Poly-arteritis nodosa	Paraneo-plastic syndromes (anti-Hu, anti-RII, etc; CBC)	See Table	HSN
	Uremia ( BUN/CR)	Diphtheria, Lyme ( Serology)	Rheu-matoid arthritis ( RF)	Paraprotein-emias ( SPEP , immuno-fixation , anti-MAG, M protein)		Friedreich ataxia
	Liver disease ( LFTs)	Sarcoidosis ( ACE)	SLE ( ANA)	Amyloidosis (nerve biopsy)		Familial amyloid (nerve biopsy)
	Vitamin B-12 deficiency ( B12)	Sepsis and multi-organ failure ( ESR)				Porphyria (porphobil-inogen, amino-levulinic acid), meta-chromatic leukodys-trophy, Krabbe, abetalipo-proteinemia, Tangier disease, Refsum disease, Fabry disease

Table 5. Neuropathies With Unusual Features

Small Fiber Neuropathies	Facial Nerve Involvement	Autonomic Involvement	Sensory Ataxia	Pure Motor Involvement	Skin, Nail, or Hair Manifestation
Diabetes	Guillain-Barré	Paraneo-plastic	Polyganglio-nopathies	Motor neuron disease	Vasculitis: purpura, livedo reticularis
Amyloid	CIDP	GBS	Paraneo-plastic	Multifocal motor neuropathy	Cryoglo-binemia: purpura
HIV-associated	Lyme disease	Porphyria	Sjögren syndrome	GBs	Fabry disease: angiokera-tomas
Hereditary sensory and autonomic neuropathy	Sarcoidosis	Vincristine, vacor	Cisplatin analogs	Acute motor axonal neuropathy	Leprosy: skin hypopig-mentation
Fabry disease	HIV	Diabetes	Vitamin B-6 toxicity	Porphyria	Osteo-sclerotic myeloma: skin hyperpig-mentation
Tangier disease	Tangier	Amyloid	GBS (Miller-Fisher variant)	CIDP	Variegate porphyria: bullous lesions
Sjögren syndrome		HIV	IgM monoclonal gammopathy of undetermined significance	Osteosclerotic myeloma	Refsum disease: ichthyosis
		Hereditary sensory and autonomic neuropathy		Diabetic lumbar radiculoplex-opathy	Arsenic or thallium intoxication: Mees lines
				Hereditary motor sensory neuropathy (Charcot-Marie-Tooth)	Thallium intoxication: alopecia
				Lead	Giant axonal neuropathy: curled hair

Table 6. Industrial Agents and Pharmaceuticals Associated With Peripheral Neuropathy

Almitrine (s)	“Spanish toxic oil”
Arsenic (s)(d)	2-t-Butylazo- 2- hydroxyl- 5 methylhexane
Capsaicin	Acrylamide
Carbamate pesticides (nm)	Allyl chloride
Carbon disulfide (m)(d)	Amiodaron e (d)
Chloramphenicol (s)	Amitriptyline
Cimetidine (m)	Carbamates (nm)
Cisplatin (s)	Carbon monoxide
Cyanate	Chloroquine
Cycloleucine	Colchicine
Cytarabine	Dichloroacetic acid
Dapsone (m)	Disulfiram (m)
Dichloroacetylene (cr)	Ethionamide
Didoxynucleosides (s) (ddC, ddI, d4T)	Ethyl alcohol
Dimethylaminopropionitrile	Ethylene glycol (cr)
Doxorubicin (m)	Ethylene oxide
Ethambutol (s)	Germanium dioxide
Etoposide (s)	Gold
Glutethimide	Hexamethylmelamine
Hexachlorophene	Hydrazine
Hydralazine (s)	Indomethacin
Hyperinsulinemia/ hypoglycemia (m)	Isoniazid
Imipramine (m)	Lincomycin (nm)
Interferon alpha (nm)	Lithium
Lead (m)	L-Tryptophan
Lidocaine	Mercury, inorganic
Methyl n-butyl ketone (m)(d)	Mercury, organic
Metronidazole (s)	Methaqualone
Misonidazole (s)	Methyl bromide
Muzolimine	Methyl methacrylate
Nitrous Oxide (s)	N hexane (d)
Organophosphates (m)	Naproxen
Organophosphorus compounds (nm)	Nitrofurantoin (m)
Polychlorinated biphenyls (s)	Penicillamine (nm)
Polymyxin (nm)	Perhexiline (d)
Pyrethroids (ic)	Phenol
Pyridoxine (s)	Phenytoin
Sarin	Pyriminil
Succinylcholine (nm)	Quinine (nm)
Sulfonamides (m), sulfasalazine	Statins
Tacrolimus	Stilbamidine (cr)
Taxanes (paclitaxel, docetaxel) (s)	Suramin
Thalidomide (s)	Tetrachloroethane
Thallium (s)	Tetracyclines (nm)
Trimethaphan (nm)	Trithiozine
Vidarabine	Tubocurarine (nm)
Vincristine (m)	Vincristine (m), Vinca alkaloids
Zimeldine	Vinyl chloride
(s): Predominantly sensory (m): Predominantly motor (d): Possibly demyelination with conduction block (cr): Associated with cranial neuropathy (nm): Associated with neuromuscular transmission syndromes (ic): Associated with axon ion channel syndromes Bold: A rating for common or strong association Unbolded: B rating for less common or less than strong association

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Sections Toxic Neuropathy
Overview
Presentation
- History
- Physical
- Causes
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Toxic Neuropathy Questions & Answers

References

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