Epidemiologic Notes and Reports
Epistaxis and Liver-Function Abnormalities
Associated with Exposure to "Butyl" Caulk -- Kentucky
In a recent study the National Institute for Occupational
Safety
and Health (NIOSH) was asked to investigate a report of possible
toluene overexposure involving a person who lived in a log home in
Brodhead, Kentucky.
On February 27, 1981, a 45-year-old male resident of Brodhead
was
hospitalized for uncontrolled epistaxis. Three days earlier, while
the walls on the first floor of his log home were being caulked
with a
toluene- and petroleum distillate-based "butyl" caulk, he had noted
a
"strong solvent odor." However, he remained in the house almost
continuously. Over the next 3 days, he experienced increasingly
severe headache, nausea, dizziness, and feelings of disorientation.
On the fourth morning he had a nosebleed that became profuse in
early
evening, requiring that he be hospitalized. His wife and 2 sons,
who
slept upstairs, had similar symptoms, including nosebleeds, but to
a
milder degree. Neither he nor his family had a history of
nosebleeds
or bleeding diathesis. Results of blood tests done during his
hospitalization to determine coagulation parameters were
consistently
normal.
In the first 5 days of his hospitalization, the patient
continued
to have intermittent nasal hemorrhage despite packing. He received
8
units of blood in the same period and underwent surgery on March 4.
On March 6, a routine blood chemistry screen showed elevations of
total bilirubin, alkaline phosphatase, gamma glutamyl-transferase,
serum glutamic oxalacetic transaminase, and lactate dehydrogenase.
His liver function returned to normal within 2 weeks, except for a
persistently elevated alkaline phosphatase. Although he did not
and
does not consume alcohol, he has since developed moderate
hepatomegaly. A liver biopsy done on February 1, 1982, showed
fatty
infiltration and fibrosis. There was no history of hepatitis or
exposure to hepatitis; however, laboratory tests to rule out viral
hepatitis were not done.
Evaluation of the log home included air sampling and caulk
analysis by a private environmental consulting firm on April 5,
1981,
and a visit by NIOSH investigators on April 20 (1). Air sampling
on
April 5 showed toluene at a concentration of 2 parts per million
(ppm)
in the patient's bedroom (acceptable NIOSH limit is 100 ppm).
NIOSH
investigators noted that the house was heated to about 75 F (24 C)
without humidification. The patient's bedroom had bare log walls
with
caulk visibly extruding between the logs. NIOSH calculated the
surface area of exposed caulk in the bedroom to be 4.4 square feet.
Quantitative analysis of a bulk sample of fresh caulk yielded 6%
toluene, 0.5% xylene, and 15.5% "naphtha" or mixed petroleum
distillates.
Reported by the Hazard Evaluations and Technical Assistance Br, Div
of
Surveillance, Hazard Evaluations, and Field Studies, NIOSH, CDC.
Disclaimer
All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
