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CASE STUDY

CASE STUDY

A 6-year-old girl is brought to the emergency department by her parents*. She is comatose, tachypneic (25 breaths per minute), and tachycardic (150 bpm), but she appears flushed, and fingertip pulse oximetry is normal (97%) breathing room air. Questioning of her parents reveals that they are homeless and have been living in their car (a small van). The nights have been cold, and they have used a small charcoal burner to keep warm inside the vehicle. What is the most likely diagnosis? What treatment should be instituted immediately? If her mother is pregnant, what additional measures should be taken?

Humans live in a chemical world. They inhale, ingest, and absorb through the skin many of these chemicals. The occupational-environmental toxicologist is primarily concerned with the recognition, prevention, and treatment of adverse effects in humans that may result from exposure to chemicals encountered at work or in the general environment. In clinical practice, the occupational-environmental toxicologist must identify and treat the adverse health effects of these exposures. In addition, the trained occupational-environmental toxicologist will be called upon to assess and identify hazards associated with chemicals used in the workplace or introduced into the human environment, and to develop strategies and procedures to prevent the ill effects of the identified chemical hazards.

Occupational and environmental (OE) toxicology cases present complex problems. Exposure is rarely limited to a single type of molecule. Most workplace or environmental materials are compounds or mixtures. The ingredients are often poorly described in the documentation available for review. Moreover, although regulatory agencies in many countries have requirements for disclosure of hazardous materials and their health impacts, proprietary information exclusions often make it difficult for those who treat OE-poisoned patients to understand the nature and scope of the presenting illness. Because many of these illnesses have long latency periods before they become manifest, it is often a matter of detective work to uncover and characterize the original processes and causal materials. Monitoring of exposure concentrations both in the workplace and in the general environment has become more common. However, the records of monitoring are often difficult to locate and to relate to an individual or small group of exposed individuals. The records that are available often are inadequate to establish the extent of the person or group’s exposure, its duration, and its dose rate. This information may be critical to the clinical and forensic identification of the toxic disorder and its management.

Occupational Toxicology

Occupational toxicology deals with the effects of chemicals found in the workplace. The major emphasis of occupational toxicology is to identify the agents of concern, identify the acute and chronic diseases that they cause, define the conditions under which they may be used safely, and prevent absorption of harmful amounts of these chemicals. The occupational toxicologist will also be called upon to treat the diseases caused by these chemicals ...

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