Trichloroethylene Poisoning

Aka: Trichloroethylene Poisoning, Trichloroethylene, TCE Toxicity

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II. Background

  1. Trichloroethylene (TCE) is a synthetic solvent
  2. Volatile halocarbon used as an industrial solvent
    1. Used in refrigerant fluid (HFC-134a) and as a degreaser of metal parts
    2. Used in dry cleaning as a spotting agent
      1. Replaced with the less toxic tetrachloroethylene
  3. Originally used as inhalational Anesthetic and Analgesic in the 1800s
    1. Banned in U.S. for human use in 1977
  4. Exposures
    1. Contaminated soil
      1. Remains stable in original form for >25 years
    2. Contamined food
      1. Concentrates in processed foods (including meats)
    3. Contaminated water
      1. Groundwater levels normally<30 mcg/L
    4. Occupational inhalation exposure (esp. degreaser use)
      1. Levels normally <100 ppm
  5. Toxicity
    1. Releases toxic gases on combustion
      1. Neurologic toxicity
    2. Carcinogenic with occupational exposure
      1. Liver cancer
      2. Renal Cancer
      3. Non-Hodgkin Lymphoma

III. Mechanism

  1. Trichloroethylene (TCE) decomposes into other cytotoxins and carcinogens (esp. when exposed to heat or alkali)
    1. Dichloroacetylene (DCA)
    2. Phosgene
    3. Trichloroacetate (TCA)
    4. Dichlorovinyl Cysteine
  2. Neurologic Effects and Toxicity
    1. Acute Exposure
      1. Metabolizes to Chloral Hydrate
      2. Chloral Hydrate (as well as TCE) modulate GABA activity
    2. Chronic Exposure
      1. Cranial Nerve V (Trigeminal Nerve) selective demyelination
      2. Substantia NigraNeuron degeneration

IV. Pharmacokinetics

  1. Trichloroethylene (TCE) is rapidly absorbed
    1. Respiratory inhalation is greatest
    2. Gastrointestinal absorption
    3. Skin absorption
  2. Storage
    1. Adipose tissue
  3. Metabolism
    1. Hepatic metabolism via CYP2E1 to Trichloroacetate (TCA) or Trichloroethanol
    2. Renal excretion of some metabolites

V. Findings

  1. Neurologic
    1. Cranial Nerve VNeuropathy
    2. Dizziness
    3. Confusion
    4. Coma
  2. Cardiovascular
    1. Dysrhythmia
  3. Gastrointestinal
    1. Nausea or Vomiting
    2. Pneumatosis cystoides intestinalis (chronic exposure)
  4. Dermatologic
    1. Skin rashes or rashes
    2. Exfoliative Dermatitis
    3. Scleroderma
  5. Miscellaneous
    1. Rhabdomyolysis
    2. Hepatotoxicity
    3. Kidney Injury
    4. Eye irritation
    5. Disulfiram-like reaction with Alcohol ("degreaser's flush")

VI. Labs

  1. See Unknown Ingestion for full toxicologic testing
  2. Serum transaminases (AST, ALT)
  3. Drug Levels
    1. Urine Trichloroethylene and TCEth
    2. Blood TCEth

VII. Imaging

  1. Chest XRay
    1. Indicated with repiratory symptoms or suspected aspiration
    2. Trichloroethylene (TCE) is radiopaque

VIII. Management

  1. See Decontamination After Toxin Exposure
  2. Supportive Care
    1. Persistent Dysrhythmias may be treated with Beta Blockers or Lidocaine
  3. Disposition
    1. Accidental Inhalation exposures may be discharged when improved after symptomatic management
    2. Admit large ingestions (>20 ml)

IX. References

  1. Carroll and Yakey (2025) Crit Dec Emerg Med 39(3): 35
  2. Chiu (2013) Environ Health Perspect 121(3):303-11 +PMID: 23249866 [PubMed]

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