beta-Hexachlorocyclohexane (alias of Beta-Hexachlorocyclohexane)

CAS RN:319-85-7

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Adequate decontamination of dermal exposures and supportive care are the mainstays of treatment for mild to moderate exposures. Seizures, respiratory depression, and CNS depression indicate a more severe poisoning.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) Following adequate airway, respiratory, and circulatory support, treatment of seizures is standard anticonvulsant therapy with benzodiazepines as first line therapy followed by phenobarbital. Propofol infusions and/or neuromuscular blockade may be necessary in refractory cases. Phenytoin should not be used as it likely to be of minimal effectiveness. Severe metabolic acidosis can be treated with sodium bicarbonate. After stabilization remove contaminated clothing and decontaminate the skin with soap and water if there has been dermal exposure.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: Prehospital oral decontamination should be avoided because of the risk of rapid onset CNS depression and seizures and subsequent aspiration.
    • 2) HOSPITAL: Generally, gastrointestinal decontamination should be avoided because of the potential for rapid onset CNS depression and seizures with subsequent aspiration.
  • D) AIRWAY MANAGEMENT
    • 1) Patients who are comatose, seizing or with altered mental status may need tracheal intubation and mechanical respiratory support.
  • E) ANTIDOTE
    • 1) None
  • F) SEIZURES
    • 1) IV benzodiazepines, barbiturates.
  • G) ENHANCED ELIMINATION
    • 1) Dialysis is likely to be of minimal benefit because of the large volume of distribution.
  • H) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Adults who intentionally ingest lindane or any child with an ingestion should be referred to a health care facility. Patients with prolonged or repeated dermal applications should be referred to a health care facility if they become symptomatic.
    • 2) OBSERVATION CRITERIA: After ingestion, patients who are asymptomatic after 6 hours can be discharged home.
    • 3) ADMISSION CRITERIA: Patients with persistently altered mental status, abnormal vital signs, or recurrent seizures should be admitted.
    • 4) CONSULT CRITERIA: Consult a poison center or medical toxicologist for assistance in managing severe poisonings.
  • I) PITFALLS
    • 1) Phenytoin is likely to be of minimal effectiveness for seizure control.
  • J) PHARMACOKINETICS
    • 1) Lindane can be absorbed via inhalation, ingestion, or by dermal exposure. Following ingestion, the half-life is several days, and after dermal application half life is 18 to 21 hours. The volume of distribution is not completely known but is considered to be large.
  • K) TOXICOKINETICS
    • 1) Prolonged application, repeated applications, occlusive dressings, broken skin or chronic skin conditions will all increase absorption. Children absorb more after dermal application because of increased body surface area relative to mass and greater skin permeability. CNS toxicity generally develops within 15 to 120 minutes of ingestion.
  • L) DIFFERENTIAL DIAGNOSIS
    • 1) The differential diagnosis is any condition that presents with seizures and hence is quite broad.
0.4.3 INHALATION EXPOSURE
  • A) INHALATION: Move patient to fresh air. Monitor for respiratory distress. If cough or difficulty breathing develops, evaluate for respiratory tract irritation, bronchitis, or pneumonitis. Administer oxygen and assist ventilation as required. Treat bronchospasm with an inhaled beta2-adrenergic agonist. Consider systemic corticosteroids in patients with significant bronchospasm.
  • B) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
  • C) First responders should wear protective clothing to prevent secondary contamination. Be prepared to collect any vomitus or excreta in a manner to prevent further contamination; bag and treat as hazardous waste.
  • D) Do not administer adrenergic amines, which may further increase myocardial irritability and produce refractory ventricular arrhythmias.
  • E) Dialysis, exchange transfusion, and hemoperfusion are probably ineffective.
0.4.4 EYE EXPOSURE
  • A) DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.
  • B) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
  • C) Carefully observe patient for development of clinical signs and symptoms, and administer treatment as described in DERMAL EXPOSURE where appropriate.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 1) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
    • 2) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
    • 3) First responders should wear protective clothing to prevent secondary contamination. Be prepared to collect any vomitus or excreta in a manner to prevent further contamination; bag and treat as hazardous waste.
    • 4) ACUTE LUNG INJURY: Maintain ventilation and oxygenation and evaluate with frequent arterial blood gases and/or pulse oximetry monitoring. Early use of PEEP and mechanical ventilation may be needed.
    • 5) Do not give oils by mouth.
    • 6) Do not administer adrenergic amines, which may further increase myocardial irritability and produce refractory ventricular arrhythmias.
    • 7) CHOLESTYRAMINE - Oral administration may enhance the excretion of kepone and chlordane which are trapped in the enterohepatic circulation.
    • 8) Dialysis, exchange transfusion, and hemoperfusion are probably ineffective.
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