Agency for Toxic Substances and Disease Registry
Polychlorinated Biphenyls (PCB) Toxicity
Treatment and Management
- No antidote exists for PCB exposure; therefore, treatment is symptomatic.
In the event of PCB splashes in the eyes, irrigate with tepid water immediately for at least 15 minutes, and follow with ophthalmic evaluation. Remove contaminated clothing and discard properly. Gently wash affected skin with soap and warm water for at least 15 minutes.
In the rare event that PCB-containing substances are ingested, immediately induce vomiting if the patient is conscious. Gastric lavage can be subsequently administered at a medical facility until the gastric washings are clear. Activated charcoal has not been proven beneficial, but is not contraindicated. Exposed persons should have periodic follow-up examinations with particular attention to hepatic function and dermal lesions.
- The goal of treatment in chronically exposed patients is to prevent any additional exposure to PCBs.
No specific treatment exists for chronic exposure to PCBs. Because no known methods exist for reducing the reserves of PCBs in adipose tissues, attempts to purge the body of PCBs should not be made. Cholestyramine therapy, sauna bathing, and fasting have all been attempted and have proven unsuccessful (AAP 1999). In fact, PCBs stored in fat can be mobilized by the patients crash dieting.
Initial treatment of chloracne is based on cessation of exposure, good skin hygiene, and dermatologic measures commonly used for acne vulgaris. If these measures are not effective, the patient should be referred to a dermatologist.
If chronic exposure has occurred as a result of consuming contaminated fish or game, the patient should be informed of the tendency for PCBs to accumulate in the body with continued exposure and counseled about the importance of minimizing further exposure. In areas with a known PCB problem, state and local public health or natural resources departments typically issue advisories specifying the bodies of water or hunting areas where fish and game are likely to be contaminated with PCBs and listing the species and size of fish or game that are of concern. Such advisories might completely ban consumption or might recommend limits on the frequency with which certain species are consumed. To minimize the risk for further exposure among sport and subsistence fishers, these persons should be encouraged to familiarize themselves with and observe advisory recommendations (ATSDR 2000a).
Because PCBs are hepatotoxins, history of exposure to other potentially hepatotoxic agents should be obtained. To minimize the risk of hepatic damage, patients should be encouraged to avoid exposure to other hepatotoxins, including medications with known hepatotoxicity, ethanol, and chlorinated solvents.
The offspring of mothers who ate large amounts of contaminated fish or wild game while pregnant. Fetuses and neonates are potentially more sensitive to PCBs than are adults because the hepatic microsomal enzyme systems that facilitate the metabolism and excretion of PCBs are not fully functional. In addition, infants and young children consume a greater amount of food per kilogram of body weight and therefore have a proportionately greater exposure to PCBs than do adults eating food with the same level of contamination (ATSDR 2000a).
The carcinogenic potential and other risks from exposure to PCBs should be carefully reviewed with the patient.
AAP encourages breastfeeding in all but the most unusual circumstances (AAP 1999).
| 7. |
What steps should be recommended to patients when PCB-related health effects are suspected? |
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