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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.

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