What is Quaternary Ammonium Compound Toxicity?
Quaternary ammonium compounds, or QACs, are a type of chemical that’s often found in disinfectants, preservatives, and products that reduce surface tension (surfactants). You can find QACs in many different settings and products, including working environments, commercial applications, and home supplies. For example, they’re used in disinfectant sprays and wipes in hospitals, sterilizing tools used in surgery, laundry detergents, and treatments for standing water. QACs have been used and researched for over 50 years and they were generally believed to be safe for humans.
QACs are made of a positively charged ammonium group attached to at least one hydrophobic hydrocarbon (hydrophobic means it doesn’t mix with water). The most often used QACs are alkyldimethylbenzyl ammonium chloride (ADBAC or BAC), cetylpyridinium chloride (CPC), dodecyl-dimethyl ammonium chloride (DDAC), and cocobenzyldimethyl ammonium chloride (BAC).
During the COVID-19 pandemic, there has been a massive increase in the use of QACs as disinfectants. Studies conducted before, during, and after the pandemic have reported increased levels of QACs. They can kill many different kinds of microbes and have been assumed to be safe for humans to use and be exposed to. That said, there are increasing worries about the potential negative impacts of QACs on human health and the environment.
QACs are very common in the environment and can be found in a variety of water sources. This includes wastewater treatment plants, surface water (like rivers and lakes), groundwater, and soil and sediment. The reason QACs stick around in the environment is because they are stable and hard to breakdown (biodegrade). This could become a threat to human health. Potential risks could include skin irritation, effects on the respiratory system, allergic reactions, and reproductive toxicity (damage to the reproductive system). Long-term exposure to QACs in animals other than humans has resulted in hormonal disruption, problems with the immune system, and reproductive toxicity.
What Causes Quaternary Ammonium Compound Toxicity?
The harmful effects of QACs, or Quaternary Ammonium Compounds, are determined by their chemical makeup, how they enter the body, the amount taken in, and how long the person is exposed to them. Despite having been used by humans for a long time, there isn’t a lot of information or study done on how QACs can be toxic to the human body.
Usually, disinfectants that are ready to use and contain QACs are seen as a low risk to people because they contain small amounts of QACs. However, there is a higher risk of harmful effects with QACs that are very concentrated, or if they’re breathed in or swallowed.
QACs can cause something called oxidative stress, which happens when there are too many harmful molecules, known as reactive oxygen species (ROS), produced in your body, disrupting the normal function of cells. Having a positive charge, QACs can connect with the negatively charged cell membranes, which can lead to the disruption of these membranes and cell death.
Risk Factors and Frequency for Quaternary Ammonium Compound Toxicity
There isn’t much detailed research on how harmful Quaternary Ammonium Compounds (QACs) are to humans. However, a recent study found QACs in 80% of the blood samples taken from people across the U.S., with the concentration levels varying from 0.01 to 1.58 ng/mL. There have been some isolated instances of harmful or even fatal side effects from exposure to QACs in both humans and animals, but it’s still unclear exactly what amounts constitute toxic or lethal doses in humans.
A significant amount of the QACs used annually – about 75% – ends up in our water supply through systems that treat wastewater, while the remaining 25% is released directly into our environment. As the COVID-19 pandemic has increased the use of QAC-containing products, there’s been a rise in their environmental impact and potential health risks, including the detection of QACs in breast milk and blood samples.
- A recent study discovered QACs in 80% of human blood samples from the U.S., with varying concentration levels.
- There have been reported cases of harmful or fatal effects from QAC exposure in humans and animals.
- The toxic and lethal doses of QACs for humans aren’t yet determined.
- Approximately 75% of the QACs used annually enter the water supply through wastewater treatment systems.
- The remaining 25% of annual QAC usage directly impacts the environment.
- Due to the COVID-19 pandemic, the use of QAC-containing products has increased, leading to greater environmental effects and potential health risks.
- Hazardous QACs have been found in breast milk and blood samples.
Signs and Symptoms of Quaternary Ammonium Compound Toxicity
Quaternary ammonium compound (QAC) toxicity may occur if people are exposed to certain industrial or household products, such as disinfectants, fabric softeners, and personal care items. QACs are usually safe when the products containing them are used correctly. However, if they are swallowed, breathed in, or absorbed in large quantities, they can cause harm.
Symptoms of QAC toxicity can vary a lot and depend on how the person was exposed, how much was absorbed, for how long, and their metabolic factors. If someone ingests QACs, they can experience symptoms like nausea, vomiting, diarrhea, bloody stools, and stomach pain. If it comes into contact with skin, it can cause irritation, skin inflammation, and burns. Exposing the mouth and throat to QACs can cause swelling in the mouth’s soft tissues or irritation to the back part of the throat, potentially affecting breathing. Breathing QACs in can lead to respiratory irritation and muscle spasms in the bronchial tubes. Exposing the eyes to QACs can cause inflammation of the conjunctiva, corneal abrasions or ulcers, and inflammation of the corneas.
In severe cases, QAC toxicity can lead to acute liver, respiratory, or kidney failure, collapse of the cardiovascular system, seizures, coma, and death.
Testing for Quaternary Ammonium Compound Toxicity
If you might have been exposed to a compound called QAC (Quaternary Ammonium Compounds) and are experiencing symptoms from it, your doctor will focus on what you’re experiencing, your exposure history, and their own professional judgment to diagnose and treat you. While common lab tests such as blood tests and urine tests can provide some insight into the severity of the exposure and any damage it might have caused to your organs, right now, there is no specific test that can measure QAC levels in your body.
If QAC exposure has affected your breathing, your doctor might do lung function tests or use imaging techniques, like X-rays, to take a closer look at your lungs. If you have skin symptoms like rashes or itchy spots, skin testing can confirm whether QAC is the allergen that caused these reactions.
In case your eyes have been affected, a special eye test using a tool known as a slit-lamp, combined with a dye called fluorescein and eye pressure measurement (tonometry), may be done. This helps to examine the surface of your eye and look for any damage caused by scratching or rubbing due to discomfort. During this test, they may also flip your upper eyelids inside out to check for scratches.
If you’ve swallowed QAC, your doctor may want to run tests to check your liver and kidney function to look for any damage to these organs. An imaging technique for your abdomen can detect signs of holes (perforations) in your gut. Also, in some cases, they might decide to perform an upper endoscopy, a procedure where a small camera is inserted down your throat to view your upper digestive system. This is often considered if you’re experiencing symptoms such as difficulty swallowing, painful swallowing, or noisy breathing (stridor).
Treatment Options for Quaternary Ammonium Compound Toxicity
If you’re exposed to QAC, or Quaternary Ammonium Compounds, it’s important to treat it like any other emergency. QACs are chemicals commonly found in disinfectants and antiseptics. If they get into your body in large amounts, they can be harmful. There’s no specific antidote to counteract QAC exposure, so the focus is on supportive care for the symptoms.
The first thing to do is make sure your airways are open and you’re able to breathe. If necessary, medical professionals will give you extra oxygen or help you breathe with a machine. They’ll also concentrate on supporting your circulation, which is the movement of blood throughout your body. To reduce further exposure to the chemical, they’ll remove any clothing that could have QAC on it.
Healthcare workers will likely reach out to a medical toxicologist or a local Poison Control Center for advice on how best to manage your case. A toxicologist specializes in the effects of chemicals on the body.
The mainstay of treatment for QAC exposure is supportive care, which helps your body while it heals itself. Depending on the severity of your exposure, this care can range from simple observation to more intensive treatments. For more severe cases, you may need intravenous fluids (fluids given through a needle into a vein), electrolyte supplements (minerals your body needs to function properly), or even treatments for seizures. In extreme cases, you might need to be hooked up to a machine that helps you breathe, or you may need a procedure called hemodialysis, which filters waste and extra fluid from your blood.
If you’ve swallowed QAC, doctors might consider treatments like gastric lavage (rinsing out your stomach) or activated charcoal (a special kind of charcoal that can help absorb the chemical) if you reach the hospital quickly and the amount you swallowed is significant. However, these treatments aren’t usually used if you’ve breathed in or touched QAC.
If you have other health issues like asthma or liver and kidney disease, your doctors will work to manage these as well. These conditions can make the effects of QAC exposure worse because they can interfere with your body’s ability to get rid of toxins.
After your treatment, you’ll need to have regular check-ups to make sure you’re recovering completely from the QAC exposure. These might include tests to check how well your liver and kidneys are working. With the right care and monitoring, most people can expect to recover fully without lasting effects from the exposure.
What else can Quaternary Ammonium Compound Toxicity be?
When it comes to identifying conditions caused by QAC (Quaternary Ammonium Compounds) toxicity, it can be quite tricky because the signs and symptoms are similar to several other diseases. These symptoms can either be quite apparent or hardly noticeable, and can change based on how a person was exposed to QACs.
For instance, if QACs come into contact with the skin, they can cause irritation or a condition called dermatitis. This could easily be confused with similar skin issues caused by metals, fabric softeners, or personal care items like lotion, shampoo, or fragrances.
If someone inhales QACs, it might trigger an asthma attack or other respiratory issues. Therefore, it is important for doctors to rule out such chronic diseases while diagnosing QAC toxicity.
Ingesting QACs could result in gastrointestinal problems, which might look a lot like food allergies, intolerances, side effects of certain medications or other stomach-related issues. Hence, while diagnosing QAC toxicity, all these possibilities must be considered.
Also, if QACs get into the eyes, they can cause irritation. This has to be differentiated from irritation due to other substances like smoke, dust, or chemicals.
Lastly, on the whole, symptoms of QAC toxicity may resemble allergic reactions. As such, doctors need to carefully differentiate between the two when making a diagnosis.
What to expect with Quaternary Ammonium Compound Toxicity
The outlook for QAC (Quaternary Ammonium Compounds) toxicity mainly depends on the seriousness, duration and amount of QAC exposure, as well as early care and support given. Generally speaking, QAC toxicity is uncommon, and most contact with QAC does not result in serious harm.
Most of the reported incidents of QAC toxicity are mild and fix themselves on their own. However, in severe cases of QAC toxicity, there can be dangerous complications, including failure of the respiratory system (breathing difficulties), seizures, and damage to vital organs.
Possible Complications When Diagnosed with Quaternary Ammonium Compound Toxicity
Exposure to Quaternary Ammonium Compounds (QACs) can cause serious complications as they irritate tissues. QACs are known for their harmful effects when in high concentrations; repeated exposure could lead to severe burns, long-term skin inflammation, and eye damage. They can also upset your stomach, causing vomiting and diarrhea that can result in severe dehydration.
Higher-risk patients with particular health conditions are more prone to the complications of QAC exposure. Such exposure can make certain health conditions worse. For instance, people with existing liver dysfunction may develop a sudden liver injury or cirrhosis. Equally, patients with reduced kidney function can face acute kidney injury potentially leading to final-stage kidney disease. Long-term exposure to QACs by breathing in can trigger acute asthma.
The Environmental Influences on Child Health Outcomes (ECHO) program has labeled QACs as high-priority for monitoring in children due to limited toxicity data on humans and lack of known testing for biomarkers.
Potential Risks:
- Severe burns
- Persistent skin inflammation
- Eye damage
- Stomach upset, with severe vomiting and diarrhea
- Increased health complications for individuals with liver and kidney dysfunction
- Acute asthma trigger in cases of chronic respiratory exposure
- Hazard to children, as identified by the ECHO program
Preventing Quaternary Ammonium Compound Toxicity
To prevent harm from toxic substances, it’s crucial to carefully follow the instructions provided by the manufacturer regarding how to store and handle these substances. When dealing with products containing QAC (a type of substance that can kill bacteria, viruses, and other germs), a few safety measures should be followed:
* Make sure you’re trained in how to use such products safely.
* Learn how to properly use personal protective gear.
* Depending on what the product calls for, you may need to wear gloves, safety goggles, or breathing masks.
* Be sure to only use the correct amount of the product and mix it with water (if needed) in the right proportions.
* Only use these substances in places that are well-ventilated to avoid breathing in any fumes.
* Store cleaning chemicals where they cannot be accessed by children and pets.
* Always keep these substances in their original containers.
* Avoid blending different cleaning substances together, since this can create harmful gases. In particular, never mix bleach with QAC-containing products.
If a person shows signs of being affected by such substances (either because they ingested it on purpose or by mistake), it’s essential to seek immediate emergency medical attention.
