Management

Management of acute cases is supportive since no specific antidotes to VOCs are available. Indicated medications for altered mental status of unclear etiology and for suspected opioid co-ingestion include dextrose, thiamine, and naloxone and for bronchospasm selective beta-2-agonists (albuterol).

In cases of chronic exposure all reasonable means of reduction or complete removal of the toxic agent are warranted, and a consultation with poison control or an industrial hygienist may be helpful. The use of personal protective equipment and training in its use are often neglected, especially in the field and by temporary workers (see Chapters 5 and 6). In severe cases, the patient should be reevaluated with thorough neurophysiological and, if applicable, neuropsychological testing on a repeated basis with average frequency of one EMG and NCS study every 9 to 12 months until sufficient progress or stabilization is noted (39).

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