Case Study

A 34-year-old man who works as a certified pesticide applicator became profoundly vertiginous and collapsed while applying hydrogen cyanamide, a growth regulator applied to promote uniform budding in citrus. He was wearing a full protective ensemble, including overalls, boots, gloves, mask, goggles, and helmet. The patient was questioned extensively because hydrogen cyanamide can cause an Antabuse reaction when used by a person who has recently consumed alcohol or used alcohol-containing products. He denied using alcohol in any way, including after-shave and hair tonic.

In accordance with longstanding company protocols, coworkers removed the employee from the field, removed the protective ensemble, and decontaminated him with water. An ambulance was called and emergency medical technicians (EMTs) responded. They donned full protective gear, placed barriers around the patient, started intravenous fluids, and transported him to the hospital. The employee's blood pressure in the ambulance and on the way to the hospital was 90/40 mm Hg. At the emergency department, the patient was assessed by a triage nurse in the ambulance and sent through a decontamination shower. After decontamination, the patient was given intravenous fluids. Drug and alcohol blood tests were normal. The patient was hospitalized and his hypotension improved with intravenous fluids. He was still slightly hypotensive upon discharge.

Upon presentation at the consultant's office, the patient was still hypoten-sive and vertiginous. He denied using any alcohol or products containing alcohol for the 2 years he had been applying hydrogen cyanamide. Research confirmed that the chemical was a growth regulator and that concomitant use of it and alcohol would produce profound hypotension. A report was made to the health department, using a state form, and appropriate workers' compensation documents filed. Private investigators and government investigations failed to reveal any alcohol use by the patient. A review of the patient's complete medical records failed to reveal any other cause of the symptomatology and physical findings. Motion pictures of the patient taken by a private investigator failed to reveal any alcohol or drug use. The consultant arranged for a "hold" tube of blood from the emergency department to be analyzed. The only abnormal substance discovered was hydrogen cyanamide at levels just above the detection limit. The patient was followed by the consultant for 6 weeks until his blood pressure returned to the normal range and his vertigo resolved. Three months after the incident the patient was working without symptoms. A repeated blood level of the chemical had the same results as the first one, demonstrating that trace amounts in the patient's blood was not the cause of the acute symptoms and physical findings. The worker was discharged as cured.

0 0

Post a comment