Chloroform

CAS RN: 67-66-3

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Treatment is symptomatic and supportive.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) Treatment is symptomatic and supportive. Treat ventricular dysrhythmias using standard ACLS protocols. Chloroform may sensitize the myocardium to catecholamines. Epinephrine and other sympathomimetics should be used with caution as ventricular dysrhythmias may be precipitated. Renal failure may require renal replacement therapy. Hepatic injury may be treated with N-acetylcysteine with a similar protocol to that used for acetaminophen toxicity. Rarely, hemolysis may require treatment with packed red blood cell transfusions.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: Gastrointestinal decontamination for chloroform ingestion is not recommended due to the potential for GI irritation, abrupt onset of CNS depression, and the risk for aspiration.
    • 2) HOSPITAL: GI decontamination for a chloroform ingestion is not routinely recommended due to the potential for GI irritation, abrupt onset of CNS depression, and the risk for aspiration. For patients with evidence of a large life-threatening ingestion (eg, large volume of radiopaque chloroform seen in stomach on abdominal x-ray), NG tube aspiration may be considered only after the airway has been protected.
  • D) AIRWAY MANAGEMENT
    • 1) Patients with significant CNS depression or respiratory depression may require intubation; consider using lung-protective ventilator settings given the risk for ARDS.
  • E) ANTIDOTE
    • 1) There is no specific antidote for chloroform toxicity. Some sources have suggested the use of N-acetylcysteine to prevent or treat hepatotoxicity. No data on clinical efficacy exist; however, in cases at risk for increased morbidity and mortality, it is generally considered to be a rational approach to therapy as there is minimal risk with administration and possible benefit.
  • F) DYSRHYTHMIAS
    • 1) Initiate ACLS protocols. Chloroform may sensitize the myocardium to catecholamines. Epinephrine and other sympathomimetics should be used with caution as ventricular dysrhythmias may be precipitated.
  • G) ENHANCED ELIMINATION
    • 1) Hemodialysis has not been shown to enhance chloroform elimination; however, it may be necessary to treat renal failure in severe cases.
  • H) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Asymptomatic patients with only a minimal exposure may be monitored at home.
    • 2) OBSERVATION CRITERIA: Any patient with ingestion of more than a minimal amount of chloroform or symptoms after inhalational exposure should be referred to a healthcare facility for evaluation and monitoring.
    • 3) ADMISSION CRITERIA: Patients with a significant exposure should be admitted for cardiovascular monitoring and monitored for delayed pulmonary, hepatic, and renal toxicity.
    • 4) CONSULT CRITERIA: Consult a toxicologist for any patient with symptomatic toxicity. Consult a nephrologist for patients with evidence of renal failure. Consult an ophthalmologist for patients with a significant ocular exposure.
  • I) PITFALLS
    • 1) Failure to anticipate delayed hepatic, renal, and pulmonary toxicity.
  • J) TOXICOKINETICS
    • 1) Chloroform is readily absorbed through both inhalation and ingestion. It is highly soluble in adipose tissue, and has a volume of distribution of 2.6 L/kg. Metabolites include chlormethanol, hydrochloric acid, phosgene, chloride, carbon dioxide, and diglutathionyl dithiocarbonate. It is excreted primarily by the lungs with 43% exhaled unchanged and 4% to 5% exhaled as carbon dioxide. A small proportion of metabolites are excreted renally. The average elimination half-life of orally ingested chloroform is approximately 1.5 hours.
0.4.3 INHALATION EXPOSURE
  • A) Patients with an inhalational exposure should be removed to fresh air.
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.
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) Treatment is symptomatic and supportive; there is no specific antidote. In substantial exposure, patients should be admitted and observed for several days for possible delayed toxicity. Monitor liver and kidney function. Monitor fluid and electrolyte status.
    • 3) Chloroform may be absorbed through the skin. Observe patient for delayed toxicity.
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