What is Chloroform Toxicity?
Chloroform is a clear liquid that easily turns into gas. In the past, it was commonly used to put people to sleep for surgery. Nowadays, it’s mainly used in labs and for making different industrial products. Chloroform can be harmful to your health and is considered a dangerous substance. Because of this, there are strict rules about how it should be handled and disposed to ensure safety.
Chloroform poisoning doesn’t happen very often, but it can occur if a person accidentally breathes in its fumes at work. In rare cases, it may happen if someone consumes it or purposely inhales it as part of a suicide attempt. There are cases that suggest both one-time and long-term exposure to chloroform can increase the risk of liver and kidney diseases, as well as other health problems.
What Causes Chloroform Toxicity?
Chloroform is a clear, sweet-smelling, liquid that can’t catch fire and doesn’t dissolve very well in water. It was first made in the 1830s and has been used for a variety of things, including as an anesthetic (a substance that causes loss of sensation or consciousness) and for cleaning water.
In the late 1800s, people used chloroform to put patients to sleep during surgery, but this stopped when it was found to cause serious side effects, including death. Instead, nitric oxide began to be used. Chloroform was also used to clean drinking water, but the US Environmental Protection Agency (EPA) started to regulate this use in 1979. Scientists had found links between chloroform in drinking water and a higher risk of cancer and other health problems in rats. While some places still use chloroform to clean their water, not all do.
Recent studies have found only a slight link between chloroform and human cancers, possibly due to the decrease in chloroform used to purify water.
These days, chloroform is mainly used for specific purposes in manufacturing and research. For instance, it’s used as a solvent (a substance in which other substances can dissolve) in industries producing things like medicine, cars, plastic, cleaning chemicals and cooling gases. In scientific research, particularly chemistry, it’s used both as a solvent and a reagent (a substance used to cause a chemical reaction).
Because chloroform can be harmful and presents health risks, there are strict rules around its use. As such, cases of poisoning from chloroform are rare today, and usually happen by accident at workplaces that use the chemical. In the past, there have been cases where chloroform was used deliberately to harm others, including in suicide, murder, and other crimes.
Risk Factors and Frequency for Chloroform Toxicity
People can come into contact with chloroform in different ways. It’s often encountered in places like workplaces, factories, and labs. Sometimes, individuals might ingest or inhale it on purpose, either for recreation or to harm themselves. If someone swallows a large amount, as little as 10 mL to 30 mL could be enough to be deadly.
Signs and Symptoms of Chloroform Toxicity
There are no specific tests for diagnosing chloroform toxicity, so identifying it relies on a detailed review of the patient’s medical history. This includes asking about the patient’s job, particularly if they work in an industry that uses chloroform, and checking for a history of mental health problems, which could indicate intentional poisoning.
Chloroform toxicity can be caused by ingesting or inhaling it, and the symptoms can be different depending on whether exposure was sudden (acute) or over a long period (chronic). In acute cases, a patient might experience symptoms such as:
- Seizures
- Headache
- Dizziness
- Changes in mental state or delirium
- Sedation
- Chest pain
- Fast heart rate
- Stomach pain
- Nausea and vomiting
Initial vital signs might seem normal in acute cases, but they can later show a fast heart rate, rapid breathing, stopped breathing (apnea), and low blood pressure, along with lower oxygen saturation. Signs visible during a physical examination can include sweating, apnea, bluish skin or lips (cyanosis), and dilated pupils that respond slowly to light. The person may also have an unusual smell. The skin can show irritation, redness, blisters, or even chemical burns if it has been in contact with chloroform.
Chronic chloroform exposure affects various body systems and causes different symptoms. Long-term exposure to chloroform can lead to symptoms like:
- Headaches
- Dizziness
- Confusion
- Focus problems
- Memory issues
- Irritability
- Coughing
- Shortness of breath
- Wheezing and chest discomfort
- Stomach pain, nausea, and vomiting
- Abdominal pain and yellowing of the skin or eyes (jaundice) from liver damage
- Liver enlargement and abnormal liver function test results
- Change in urine output (increase or decrease)
- Blood or protein in the urine and impaired kidney function
These symptoms are caused by changes in the central nervous system, irritation of the respiratory tract, digestive system problems, damage to the liver, and kidney problems that occur with continuous exposure to chloroform.
Testing for Chloroform Toxicity
When someone is exposed to chloroform, an initial test of their bodily fluids might not show any signs of harm at first. However, usually between 12 and 48 hours after the exposure, lab results can start indicating damage. These abnormal results can continue to increase over the next few days.
For instance, liver function tests could show increased levels of aspartate transaminase, alanine transaminase, and glutamate dehydrogenase – enzymes that are usually found inside liver cells. Their presence in larger than normal amount in your blood indicates that the cells of your liver are being damaged.
Additionally, increasing levels of substances like blood urea nitrogen and creatinine could suggest the kidneys are becoming injured. Unusual blood clotting could also point to your liver not doing its job properly.
Increases in lactate dehydrogenase (LDH) and creatine phosphokinase (CPK) levels can also be seen. An abdominal X-ray could detect a certain kind of material that shows up clearly on the imaging, suggesting that a person might have swallowed a compound made with chlorine, such as chloroform.
If chloroform exposure continues over a long period, the levels of the enzymes in your blood are often much higher than in cases of one-off exposure. Other signs of long-term exposure that can show up in tests include higher ammonia and LDH levels, and oddities in blood clotting profiles. Tests can also help rule out inflammation of the liver caused by a viral infection.
At the same time, doing an ultrasound on your liver can show whether it’s increased in size, become filled with fat, or shows signs of inflammation – all of these are indicators of possible damage from chloroform over a long period.
Treatment Options for Chloroform Toxicity
When a patient needs to be assessed for possible poisoning, doctors perform an in-depth check of their breathing and heart function. This is done using devices that can continuously monitor the heartbeat and the levels of oxygen in the blood, known as pulse oximetry. Sometimes, a breathing tube is inserted into the patient’s windpipe based on their mental state and oxygen needs.
After the breathing tube is placed, certain medicines like activated charcoal and sorbitol are given via a tube that goes through the nose into the stomach. These medicines help to remove the poison from the body. Another medicine, N-acetylcysteine, might be used to restore certain proteins in the body and limit the damage caused by harmful substances. However, a procedure known as gastric lavage, which involves washing out of the stomach, is not usually recommended.
If the patient has low blood pressure, they will be given intravenous fluids and medicines to raise it. In the case of poisoning with chloroform, a substance that is a weak acid, doctors may ask for advice from kidney specialists whether to make the patient’s urine more alkaline. Making the urine more alkaline can speed up the removal of chloroform and change it into a less harmful form. If the patient has kidney failure and too much acid in their body, they might need to undergo dialysis, a treatment that removes waste and excess water from the blood.
All patients suffering from poisoning should be monitored closely in an intensive care unit. In cases where the poison was taken in deliberately, the patient may benefit from talking to a mental health professional once they’re medically stable.
In long-term or ‘chronic’ poisoning cases, the treatment generally involves keeping the patient hydrated and providing supportive care. Gastroenterology experts, who specialize in diseases of the digestive system, can be asked to evaluate if the liver has been harmed. It’s also important to remove the patient from the source of the chloroform to ensure effective treatment.
What else can Chloroform Toxicity be?
Acute toxicity from chloroform can appear like other conditions that cause sudden changes in mental state and difficulty breathing. These can include:
- Carbon monoxide poisoning
- Alcohol intoxication
- Heroin intoxication
- Inhalant abuse
- Mushroom poisoning
- Opioid toxicity
Long-term, or chronic, toxicity from chloroform can present symptoms similar to other conditions. These may include:
- Viral hepatitis
- Wilson’s disease
- Autoimmune liver diseases
What to expect with Chloroform Toxicity
Generally, patients fully recover from chloroform toxicity. In cases of acute toxicity, typically seen when there’s a sudden high-level of exposure to chloroform, the liver’s irregular functions or problematic blood test results are usually resolved within 2 weeks after treatment begins. This would include the recovery of abnormal liver enzymes, serum chemistry (the liquid part of the blood), coagulation profiles (checks how well your blood is clotting), LDH (an enzyme your tissues use to generate energy), and CPK (an enzyme found mainly in the heart, brain, and skeletal muscle). Follow-ups with the patient confirm the complete resolution of all these laboratory values.
Similarly, chronic toxicity, which refers to long-term exposure to chloroform, will entirely resolve within a month after the patient is no longer exposed to the substance that caused the toxicity, as demonstrated by laboratory results.
Possible Complications When Diagnosed with Chloroform Toxicity
If someone has been exposed to chloroform and is experiencing toxicity, there are several complications they may encounter including:
- Sudden Liver Failure
- Sudden Kidney Failure
- Distributed Blood Clotting Inside the Blood Vessels
- Respiratory Failure
- Irregular Heartbeat
Preventing Chloroform Toxicity
People who work in industries that use chloroform should receive training on safety practices at work to protect their health. To prevent or lessen the health risks, measures such as minimizing exposure to chloroform can be taken. This can be done by improving ventilation in the workplace, wearing personal protective safety gear, and enforcing strong safety rules at work. Regular health check-ups might be required for those who have a higher chance of experiencing health issues due to long-term exposure to chloroform.
