Acute, nonfatal intoxication with trichloroethylene.

Area of Science:

• Occupational Medicine
• Toxicology
• Nephrology

Background:

• Trichloroethylene (TRI) is a common industrial solvent with potential health risks.
• Acute inhalation exposure can lead to systemic toxicity, affecting organs like the kidneys.
• Monitoring biomarkers is crucial for assessing exposure levels and organ damage.

Observation:

• A 54-year-old male experienced acute TRI inhalation from a metal-degreasing machine, requiring intensive care.
• Blood and urine samples were analyzed for TRI, its metabolites (trichloroethanol, trichloroacetic acid), and kidney injury markers (total urinary proteins, urinary glutamine synthetase, urinary N-acetyl-beta-D-glucosaminidase).
• Elevated TRI levels were detected in blood, with peak metabolite concentrations occurring hours after exposure, and acute renal involvement indicated by urinary protein and enzyme elevations.

Findings:

• TRI blood levels decreased significantly within 38 hours post-exposure.
• Urinary enzymes, particularly glutamine synthetase (GS), showed distinct peaks 7 and 74 hours after exposure, indicating transient kidney effects.
• The estimated exposure level of 150 ppm TRI exceeded the ACGIH TLV of 50 ppm, with the kidney identified as the primary affected organ.

Implications:

• This case demonstrates the potential for significant kidney effects from acute TRI inhalation, even in nonfatal exposures.
• Urinary glutamine synthetase (GS) serves as a sensitive and valuable biomarker for detecting and monitoring TRI-induced nephrotoxicity.
• Occupational safety measures and biomonitoring are essential for preventing and managing TRI exposure in industrial settings.