Chloroform Toxicity - Symptoms, Health Hazards, and Treatment

Introduction

Chloroform is a colorless liquid used as an anesthetic agent in surgical procedures. However, its use has become obsolete with advancements in modern medicines and is actively used in solvent, refrigerant, and pharmaceutical productions. Maximum exposure to chloroform occurs through inhalation than oral exposure in humans, and it gets metabolized rapidly in the kidneys and liver. As a result, the chemical can cause severe toxicity in humans, leading to hepatotoxicity, central nervous system depression, renal failure, and cardiac arrhythmias.

What Are the Symptoms of Chloroform Toxicity?

The symptoms caused by chloroform toxicity include:

• Burning sensation in the nose and mouth.

• Nausea.

• Vomiting.

• Dizziness.

• Ataxia.

• Convulsions.

• Excitement.

• Coma.

What Are the Sources of Exposure to Chloroform?

• Chloroform toxicity can occur through several resources where it is manufactured and used. Chloroform is formed in the chlorination of wastewater, swimming pools, and drinking water.

• Also, paper and pulp mills, sanitary landfills, and hazardous waste sites are potential sources of chloroform emissions.

• Chloroform can also be present in various beverages and food items, mainly due to running tap water during the production and processing of these products.

• Humans can easily get exposed to chloroform from naturally occurring organic material present in water resources.

What Are the Health Hazards Associated With Chloroform?

Acute Health Effects:

• Acute inhalation of chloroform can cause central nervous system depression in humans, causing headaches, dizziness, and other side effects at lower concentrations.

• Chloroform used as anesthesia affects gastrointestinal, respiratory, and cardiac systems. In addition, it also affects the kidney and liver due to inhalation exposure. Therefore, for this reason, chloroform is not used as an anesthetic agent nowadays.

• Chloroform can also cause cardiac and respiratory arrest at fatal doses in humans.

Chronic Health Effects:

• Chronic oral exposure to chloroform affects humans' liver, kidneys, and blood.

• Inhalation of chloroform affects the liver and causes jaundice and hepatitis. It also depresses the central nervous system and causes irritability. Human kidneys are also affected by the inhalation of chloroform.

• Moreover, exposure to chloroform through all the routes can cause carcinogenic effects in humans.

What Are the Primary Target Organs of Occupational Chloroform Exposure?

Inhalation Exposure:

• Gastrointestinal Tract - Chloroform exposure produces symptoms such as loss of appetite, eructation, and nausea.

• Liver - Inhalation exposure to chloroform causes liver necrosis, increased liver weight, hepatitis, and fatty liver degeneration, primarily due to occupational exposure and in various animals exposed to chloroform.

• Central Nervous System - Workers in chloroform industries usually have symptoms such as irritability, depression, headaches, and lassitude.

• Kidney - Inhalation of chloroform has been found to cause cloudy swelling of renal tubules and increased kidney weight. The symptoms were mainly based on animal studies.

Oral Exposure:

• Kidney - Oral exposure-related symptoms were observed in rats, including interstitial fibrosis, whereas symptoms like tubular degeneration, necrosis, hyperplasia, and fibrosis were seen in mice. In addition, humans were found to have nephrosis due to oral exposure to chloroform in cough syrups.

• Testis - Testicular atrophy was observed due to oral exposure to chloroform in rats.

• Liver - Increased enzyme activity, increased liver weight, and necrosis and degeneration of fatty liver were various symptoms found in animal studies. In addition, chloroform-related hepatotoxicity was observed in humans through cough remedies.

Other Target Organs:

• Vascular System - Pancreatic, polyarteritis of mesenteric and other arteries was found due to chloroform exposure in rats.

• Thyroid - Colloid density and reduction of follicular size were observed in rats.

• Occupational exposure to chloroform was found to cause spleen enlargement in humans.

How Is Chloroform Absorbed and Distributed in the Body?

Absorption:

Chloroform absorption occurs rapidly through the skin, gastrointestinal tract, and lungs. In humans, chloroform absorption via the gastrointestinal tract is 100 %, and absorption through the respiratory system or lungs is approximately 47 % to 77 %, reaching maximum blood levels within one hour. Oral absorption of chloroform is more active in animals such as mice, rats, and monkeys.

Distribution:

Chloroform is well absorbed into all body parts. Hence it gets distributed to all organ systems. Inhalation exposure to chloroform leads to a decrease in all three blood components (platelets, red blood cells, and white blood cells) levels, with a half-life of approximately 14 minutes in the rapid phase, a half-life of 90 minutes in the slow step, and an undetermined time for prolonged phase. Chloroform exposure has been found to accumulate in the body fat of animals and humans as it is lipid soluble, passes through the cell membrane, and reaches high concentration levels in nervous tissues. Chloroform concentration is dose-related in body tissues and usually occurs in this pattern: adipose > brain > liver > Kidney > blood. The presence of chloroform was also found in fetal blood through the placenta, with levels much higher than in maternal blood.

How Is Chloroform Toxicity Diagnosed?

Chloroform toxicity is diagnosed in the body by identifying its presence in a person's expired breath. This is done with serial breath analysis to evaluate the amount of chloroform absorbed by the person. The diagnosis is based on clinical symptoms and systemic effects of chloroform poisoning. In addition to these, blood levels and abdominal radiographs also help the doctor in the diagnosis of chloroform toxicity.

How Is Chloroform Toxicity Treated?

The treatment of chloroform toxicity is done in the following ways:

• First, doctors use antidote therapy with hydrocyanic acid to treat chloroform toxicity.

• In addition to this, activated charcoal therapy is used for the decontamination of the gastrointestinal system.

• The doctor rescues airway obstruction with endotracheal intubation and mechanical ventilator support.

• Hypotension is treated with vasopressor drugs, and intravenous fluids are given to the patient post-exposure.

• Intravenous NAC (N-acetylcysteine) is also used to treat hepatic (liver) injury due to chloroform exposure.

• Renal (kidney) failure is often treated with hemoperfusion and hemodialysis in some cases of toxicity.

• The doctor also manages other clinical symptoms with conventional treatment methods.

Conclusion

Chloroform toxicity and its outcomes depend on the amount of exposure, duration, and source of direction. The chemical produces severe health hazards in animals and humans, causing fatal consequences if not treated timely. Though treatment options are available for chloroform poisoning, proper preventive measures must be taken to prevent occupational hazards.