Neurotoxic interactions of industrially used ketones

Occupationally workers are most often exposed to a mixture of solvents. Exposure limits are, however, usually set separately for single solvents. So we reviewed the present knowledge about possible neurotoxic interactions of the industrially most used ketones acetone (ACE), methyl ethyl ketone (MEK) and methyl isobutyl ketone (MIBK) with solvents in general. A literature search from the last 25 years (1974-1998) revealed 54 original publications describing neurotoxic monitoring after combined exposure (experimental and occupational) involving the mentioned ketones. Animal exposure was described in 27 reports, exposure involving human volunteers in 12 reports, and occupational surveys constituted 15 reports. Of the 54 papers, 25 dealt with potentiation by ACE, MEK or MIBK of n-hexane or 2,5-hexanedione (2,5-HD) induced neurotoxicity. Possible synergistic interactions of the ketones were reported in 12 of the 29 remaining works. Only two studies reported neurotoxic potentiation after acute short-term combined exposure to human volunteers. Possible neurotoxic potentiation by the ketones after occupational mixed exposure without the involvement of n-hexane or 2,5-HD, were reported in 8 papers. Some studies reported a different outcome of metabolic interactions based on animal or volunteer exposure, compared to more long-term occupational exposure. We conclude that the widespread use of the rule of additivity often underestimates the effect when dealing with combined exposure to industrially used ketones. We also conclude that the results of combined exposure obtained in animals or human volunteers cannot necessarily be extrapolated to occupational situations. More research is needed in particular concerning the most frequently occurring mixtures comprising ketones and aromatic solvents such as acetone (ACE) and styrene as well as methyl isobutyl ketone (MIBK) and toluene.