Accidental occupational exposure

A 36 year old boiler cleaner was working on the removal of sludge from a carbon tetrachloride tank. On the first day he acted as watchman for two other workers who were inside the tank, who were using full-face respirators. On the second day he entered the tank and washed it out several times with a high pressure hose. As the tank had been washed the previous day he did not anticipate any risk and did not wear a respirator. He worked in the tank for three hours, finishing at noon, and left to meet some friends. On the way he became nauseated and developed a severe headache, and decided, instead, to go home to bed. Over the next two days he became very drowsy, nauseated, vomited several times and passed very little urine. On the third day he was admitted to hospital where he complained of loin pain, nausea, vomiting and severe headache. On examination he was jaundiced, delirious and had extensive subconjunctival haemorrhages. He was anuric and laboratory investigations revealed high urea, AST and bilirubin. A week later urea and AST were even higher and he had thrombocytopenia. An electrocardiogram at this time showed evidence of myocarditis. The urinary output gradually improved, and three weeks after admission the blood urea and AST had fallen and platelet count was normal. At this stage, liver biopsy showed toxic hepatic injury, with a histology consistent with carbon tetrachloride toxicity. The patient failed to return for follow up liver function tests and biopsy but as far as was known, he was well (Barnes and Jones, 1967).

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