MECHLORETHAMINE
HAZARDTEXT ®
Information to help in the initial response for evaluating chemical incidents
-IDENTIFICATION
SYNONYMS
2,2'-Dichloro-n-methyldiethylamine 2,2'-Dichlorodiethyl-methylamine beta,beta'-Dichlorodiethyl-n-methylamine bis(beta-Chloroethyl)methylamine bis(2-Chloroethyl)methylamine Caryolysin Chlormethine Cloramin di(2-Chloroethyl)methylamine Dichlor amine Dichloren Diethylamine, 2,2'-dichloro-n-methyl- Embichin HN2 HN-2 MBA Mecloretamina Methylbis(beta-chloroethyl)amine Methyldi(2-chloroethyl)amine Mustargen Mustine N-Methyl-bis(2-chloroethyl)amine N-Methyl-lost N-Methyl-2,2'-dichlorodiethylamine n,n-bis(2-Chloroethyl)methylamine T-1024 TL 146 ENT 25294 Molecular Formula: C5-H11-Cl2-N NIOSH/RTECS IA 1750000 NSC 762 CAS 51-75-2 CAS 55-86-7 (Hydrochloride) References: RTECS, 1988 CHLORAMIN CHLORAMINE (CAS 51-75-2)
IDENTIFIERS
C5-H11-Cl2-N C5H11Cl2N HCl
SYNONYM REFERENCE
- (Budavari, 2000; epa, 1985; HSDB , 2001; Lewis, 2000; RTECS , 2001)
USES/FORMS/SOURCES
Mechlorethamine gel is indicated for the topical treatment of stage IA and IB mycosis fungoides-type cutaneous T-cell lymphoma in patients who have received prior skin-directed therapy (Prod Info VALCHLOR(TM) topical gel, 2013). Mechlorethamine is indicated intrapleurally, intraperitoneally, or intrapericardially for the palliative treatment of metastatic carcinoma resulting in effusion. Intravenous mechlorethamine is indicated for the palliative treatment of mycosis fungoides, stages III and IV Hodgkin disease, bronchogenic carcinoma, chronic lymphocytic leukemia (CLL), chronic myelocytic leukemia (CML), lymphosarcoma, and polycythemia vera (Prod Info Mustargen(R) intravenous injection, 2009).
Mechlorethamine is available as powder vials containing 10 mg of mechlorethamine hydrochloride, provided in treatment sets of 4 vials (Prod Info Mustargen(R) intravenous injection, 2009). Mechlorethamine is available as mechlorethamine 0.016% w/w gel (equivalent to 0.02% mechlorethamine hydrochloride) in 60 g tubes (Prod Info VALCHLOR(TM) topical gel, 2013).
Mechlorethamine is a nitrogen mustard prepared by the action of thionyl chloride on 2,2'-(methylimino)diethanol in trichloroethylene. It was developed as a gas warfare agent (Budavari, 2000; HSDB , 2002; Sittig, 1991).
SYNONYM EXPLANATION
- Many of the synonyms listed are commonly used interchangeably to refer to both mechlorethamine, and its hydrochloride, mechlorethamine hydrochloride (CAS 55-86-7). However, unless noted otherwise, the data listed in this document are specific to mechlorethamine (CAS 51-75-2).
-CLINICAL EFFECTS
GENERAL CLINICAL EFFECTS
- USES: Intravenous mechlorethamine is indicated for the palliative treatment of mycosis fungoides, stages III and IV Hodgkin disease, bronchogenic carcinoma, chronic lymphocytic leukemia (CLL), chronic myelocytic leukemia (CML), lymphosarcoma, and polycythemia vera. Mechlorethamine is also used intrapleurally, intraperitoneally, or intrapericardially for the palliative treatment of metastatic carcinoma resulting in effusion. Mechlorethamine gel is used for the topical treatment of stage IA and IB mycosis fungoides-type cutaneous T-cell lymphoma in patients who have received prior skin-directed therapy.
- PHARMACOLOGY: Mechlorethamine hydrochloride, also known as HN2 hydrochloride, is an antineoplastic agent that is nitrogen analog of sulfur mustard. As a biologic alkylating agent, it exerts its cytotoxic effects by inhibiting the rapid proliferation of cancer cells.
- TOXICOLOGY: Overdose effects are seen primarily in rapidly dividing cells (eg, bone marrow, gastrointestinal tract).
- EPIDEMIOLOGY: Overdose is rare.
Overdose data are limited. Overdose effects are anticipated to be an extension of adverse effects following therapeutic doses. Severe leukopenia, anemia, thrombocytopenia, and a hemorrhagic diathesis with subsequent delayed bleeding may develop following total doses higher than 0.4 mg/kg of body weight for a single course. Exposure of the eyes to mechlorethamine results in inflammation, pain, burning, photophobia, and blurred vision. Irreversible anterior eye injury and blindness may occur.
INTRAVENOUS: Nausea and vomiting (onset: 1 to 3 hours; duration: 8 to 24 hours), anorexia, thrombosis, thrombophlebitis, maculopapular skin eruption, erythema multiforme, extravasation injury, jaundice, alopecia, vertigo, hearing loss, tinnitus, weakness, headache, drowsiness, vertigo, lightheadedness, seizures, progressive muscle paralysis, paresthesia, cerebral degeneration, coma, and hypersensitivity reactions, including anaphylaxis. HEMATOLOGIC EFFECTS: Severe myelosuppression has occasionally occurred and may be observed for up to 50 days or more after initiating mechlorethamine therapy. Lymphocytopenia (onset within 24 hours), granulocytopenia (onset within 6 to 8 days and lasts for 10 days to 3 weeks), thrombocytopenia (onset and duration, similar to granulocyte levels), persistent pancytopenia, and hemorrhagic complications have been reported. DERMAL: COMMON (5% or greater): Dermatitis, pruritus, bacterial skin infection, skin ulceration or blistering, and hyperpigmentation.
- POTENTIAL HEALTH HAZARDS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 153 (ERG, 2004)
TOXIC; inhalation, ingestion or skin contact with material may cause severe injury or death. Contact with molten substance may cause severe burns to skin and eyes. Avoid any skin contact. Effects of contact or inhalation may be delayed. Fire may produce irritating, corrosive and/or toxic gases. Runoff from fire control or dilution water may be corrosive and/or toxic and cause pollution.
-FIRST AID
FIRST AID AND PREHOSPITAL TREATMENT
INGESTION: Exposure of the oral mucosa to mechlorethamine gel may result in pain, redness, and ulceration which may be severe. Patients may already have severe vomiting and gastrointestinal irritation. Administer activated charcoal if the ingestion is recent, the patient is not vomiting, and is able to maintain their airway. GI decontamination is not indicated after parenteral mechlorethamine exposure. DERMAL: Wash skin thoroughly with soap and water. OCULAR: Irrigate exposed eyes for at least 15 minutes.
DILUTION: If no respiratory compromise is present, administer milk or water as soon as possible after ingestion. Dilution may only be helpful if performed in the first seconds to minutes after ingestion. The ideal amount is unknown; no more than 8 ounces (240 mL) in adults and 4 ounces (120 mL) in children is recommended to minimize the risk of vomiting (Caravati, 2004).
-MEDICAL TREATMENT
LIFE SUPPORT
- Support respiratory and cardiovascular function.
SUMMARY
- FIRST AID - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 153 (ERG, 2004)
Move victim to fresh air. Call 911 or emergency medical service. Give artificial respiration if victim is not breathing. Do not use mouth-to-mouth method if victim ingested or inhaled the substance; give artificial respiration with the aid of a pocket mask equipped with a one-way valve or other proper respiratory medical device. Administer oxygen if breathing is difficult. Remove and isolate contaminated clothing and shoes. In case of contact with substance, immediately flush skin or eyes with running water for at least 20 minutes. For minor skin contact, avoid spreading material on unaffected skin. Keep victim warm and quiet. Effects of exposure (inhalation, ingestion or skin contact) to substance may be delayed. Ensure that medical personnel are aware of the material(s) involved and take precautions to protect themselves.
INHALATION EXPOSURE INHALATION: Move patient to fresh air. Monitor for respiratory distress. If cough or difficulty breathing develops, evaluate for respiratory tract irritation, bronchitis, or pneumonitis. Administer oxygen and assist ventilation as required. Treat bronchospasm with an inhaled beta2-adrenergic agonist. Consider systemic corticosteroids in patients with significant bronchospasm. If bronchospasm and wheezing occur, consider treatment with inhaled sympathomimetic agents.
DERMAL EXPOSURE DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999). Treat dermal irritation or burns with standard topical therapy. Patients developing dermal hypersensitivity reactions may require treatment with systemic or topical corticosteroids or antihistamines.
EYE EXPOSURE DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.
ORAL EXPOSURE Exposure of the oral mucosa to mechlorethamine gel may result in pain, redness, and ulceration which may be severe. Patients may already have severe vomiting and gastrointestinal irritation. Administer activated charcoal if the ingestion is recent, the patient is not vomiting, and is able to maintain their airway. GI decontamination is not indicated after parenteral mechlorethamine exposure. DILUTION: If no respiratory compromise is present, administer milk or water as soon as possible after ingestion. Dilution may only be helpful if performed in the first seconds to minutes after ingestion. The ideal amount is unknown; no more than 8 ounces (240 mL) in adults and 4 ounces (120 mL) in children is recommended to minimize the risk of vomiting.
-RANGE OF TOXICITY
MINIMUM LETHAL EXPOSURE
- LCt50 (INHL) HUMAN - 3000 mg-min/m(3) (pp 3-10)
MAXIMUM TOLERATED EXPOSURE
- Severe leukopenia, anemia, thrombocytopenia, and a hemorrhagic diathesis with subsequent delayed bleeding may develop following total doses higher than 0.4 mg/kg of body weight for a single course (Prod Info Mustargen(R) intravenous injection, 2009).
- In one study, the maximum tolerated dose in humans was 0.2 mg/kg on a daily 1 to 5 day schedule (Freireich et al, 1966).
- Median Incapacitating Dosage (ICt50) HUMAN (pp 3-10):
- A dose of 10 mg/m(3) was reported lethal in humans. However, the chemical was reported only as "Nitrogen Mustard" and no indication was given if it was mechlorethamine (CAS 51-75-2) or its hydrochloride salt (CAS 55-86-7) (ITI, 1995).
- Carcinogenicity Ratings for CAS51-75-2 :
ACGIH (American Conference of Governmental Industrial Hygienists, 2010): Not Listed EPA (U.S. Environmental Protection Agency, 2011): Not Listed IARC (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004): 2A ; Listed as: Nitrogen mustard 2A : The agent (mixture) is probably carcinogenic to humans. The exposure circumstance entails exposures that are probably carcinogenic to humans. This category is used when there is limited evidence of carcinogenicity in humans and sufficient evidence of carcinogenicity in experimental animals. In some cases, an agent (mixture) may be classified in this category when there is inadequate evidence of carcinogenicity in humans and sufficient evidence of carcinogenicity in experimental animals and strong evidence that the carcinogenesis is mediated by a mechanism that also operates in humans. Exceptionally, an agent, mixture or exposure circumstance may be classified in this category solely on the basis of limited evidence of carcinogenicity in humans.
NIOSH (National Institute for Occupational Safety and Health, 2007): Not Listed MAK (DFG, 2002): Category 1 ; Listed as: N-Methyl-bis(2-chloroethyl)amine (nitrogen mustard) NTP (U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project ): Not Listed
TOXICITY AND RISK ASSESSMENT VALUES
- EPA Risk Assessment Values for CAS51-75-2 (U.S. Environmental Protection Agency, 2011):
References: ITI, 1995 Lewis, 2000 RTECS, 2002 US Army, 1975 LC50- (INHALATION)DOG: LC50- (INHALATION)MOUSE: LC50- (INHALATION)RABBIT: LC50- (INHALATION)RAT: LCLo- (INHALATION)CAT: LCLo- (INHALATION)HUMAN: LCt50- (INHALATION)HUMAN: LD50- (INTRAVENOUS)CHICKEN: LD50- (SKIN)GOAT: LD50- (ORAL)GUINEA_PIG: LD50- (SUBCUTANEOUS)GUINEA_PIG: LD50- (INTRAPERITONEAL)MOUSE: LD50- (INTRAVENOUS)MOUSE: LD50- (ORAL)MOUSE: LD50- (SKIN)MOUSE: LD50- (SUBCUTANEOUS)MOUSE: LD50- (INTRAVENOUS)RABBIT: LD50- (ORAL)RABBIT: LD50- (SKIN)RABBIT: LD50- (SUBCUTANEOUS)RABBIT: LD50- (INTRACEREBRAL)RAT: LD50- (INTRAPERITONEAL)RAT: LD50- (INTRAVENOUS)RAT: 100 mg/kg (ITI, 1995) 1100 mcg/kg
LD50- (ORAL)RAT: LD50- (SKIN)RAT: LD50- (SUBCUTANEOUS)RAT: LD50- (SKIN)SHEEP: LDLo- (ORAL)GOAT: LDLo- (SKIN)PRIMATE: LDLo- (SKIN)RABBIT: TD- (SKIN)HUMAN: TD- (SKIN)MOUSE: TDLo- (SKIN)HUMAN: 153 mg/kg for 3Y -- carcinogenic, tumors of the skin and appendages 5840 mg/kg for 8Y - Intermittent -- carcinogenic, tumors of the skin and appendages
TDLo- (INTRAPERITONEAL)MOUSE: Male, 800 mcg/kg at 1D prior to mating -- affected spermatogenesis, including genetic material, sperm morphology, motility and count Female, 4 mg/kg at 6-7D of pregnancy -- neonatal effects Female, 500 mcg/kg at 12D of pregnancy -- cytological changes, including somatic cell genetic material 69 mg/kg for 39W - Intermittent -- tumorigenic, tumors of the respiratory system
TDLo- (INTRAVENOUS)MOUSE: Male, 800 mcg/kg at 1D prior to mating -- affected spermatogenesis, including genetic material, sperm morphology, motility and count Female, 1 mg/kg at 11D of pregnancy -- fetotoxicity, stunted fetus size, post-implantation mortality, musculoskeletal developmental abnormalities in the fetus 10 mg/kg for 42D - Intermittent -- neoplastic, leukemia, lymphomas including Hodgkin's disease
TDLo- (SKIN)MOUSE: TDLo- (INTRAPERITONEAL)RAT: Female, 800 mcg/kg at 4D of pregnancy -- post-implantation mortality, developmental abnormalities in the fetus Female, 300 mcg/kg at 11D of pregnancy -- post-implantation mortality Female, 300 mcg/kg at 12D of pregnancy -- musculoskeletal system changes in the fetus
TDLo- (INTRAVENOUS)RAT: Female, 200 mcg/kg at 10D of pregnancy -- post-implantation mortality, developmental abnormalities in the fetus 5720 mcg/kg for 1Y - Intermittent -- carcinogenic, gastrointestinal tumors, leukemia
TDLo- (SUBCUTANEOUS)RAT:
-STANDARDS AND LABELS
WORKPLACE STANDARDS
- ACGIH TLV Values for CAS51-75-2 (American Conference of Governmental Industrial Hygienists, 2010):
- AIHA WEEL Values for CAS51-75-2 (AIHA, 2006):
- NIOSH REL and IDLH Values for CAS51-75-2 (National Institute for Occupational Safety and Health, 2007):
- OSHA PEL Values for CAS51-75-2 (U.S. Occupational Safety, and Health Administration (OSHA), 2010):
- OSHA List of Highly Hazardous Chemicals, Toxics, and Reactives for CAS51-75-2 (U.S. Occupational Safety and Health Administration, 2010):
ENVIRONMENTAL STANDARDS
- EPA CERCLA, Hazardous Substances and Reportable Quantities for CAS51-75-2 (U.S. Environmental Protection Agency, 2010):
- EPA CERCLA, Hazardous Substances and Reportable Quantities, Radionuclides for CAS51-75-2 (U.S. Environmental Protection Agency, 2010):
- EPA RCRA Hazardous Waste Number for CAS51-75-2 (U.S. Environmental Protection Agency, 2010b):
- EPA SARA Title III, Extremely Hazardous Substance List for CAS51-75-2 (U.S. Environmental Protection Agency, 2010):
Listed as: Mechlorethaminec Reportable Quantity, in pounds: 10 Threshold Planning Quantity, in pounds: Note(s): b
- EPA SARA Title III, Community Right-to-Know for CAS51-75-2 (40 CFR 372.65, 2006; 40 CFR 372.28, 2006):
Listed as: Nitrogen mustard [2-Chloro-N-(2-chloroethyl)-N-methylethanamine] Effective Date for Reporting Under 40 CFR 372.30: 1/1/87 Lower Thresholds for Chemicals of Special Concern under 40 CFR 372.28:
- DOT List of Marine Pollutants for CAS51-75-2 (49 CFR 172.101 - App. B, 2005):
- EPA TSCA Inventory for CAS51-75-2 (EPA, 2005):
SHIPPING REGULATIONS
- DOT -- Table of Hazardous Materials and Special Provisions for UN/NA Number 2810 (49 CFR 172.101, 2005):
Hazardous materials descriptions and proper shipping name: Compounds, tree killing, liquid or Compounds, weed killing, liquid Symbol(s): D, G D: identifies proper shipping names which are appropriate for describing materials for domestic transportation but may be inappropriate for international transportation under the provisions of international regulations (e.g., IMO, ICAO). An alternate proper shipping name may be selected when either domestic or international transportation is involved. G: identifies proper shipping names for which one or more technical names of the hazardous material must be entered in parentheses, in association with the basic description. (See 40 CFR 172.203(k).)
Hazard class or Division: 6.1 Identification Number: NA2810 Packing Group: I Label(s) required (if not excepted): 6.1 Special Provisions: T14, TP2, TP13, TP27 T14: Minimum test pressure (bar): 6; Minimum shell thickness (in mm-reference steel) (See sxn.178.274(d)): 6 mm; Pressure-relief requirements (See sxn.178.275(g)): section 178.275(g)(3); Bottom opening requirements (See sxn.178.275(d)): Prohibited. TP2: a. The maximum degree of filling must not exceed the degree of filling determined by the following: [Degree of filling = 95/1+alpha(tr - tf)], where tr is the maximum mean bulk temperature during transport, tf is the temperature in degrees celsius of the liquid during filling, and alpha is the mean coefficient of cubical expansion of the liquid between the mean temperature of the liquid during filling (tf) and the maximum mean bulk temperature during transportation (tr) both in degrees celsius; and b. For liquids transported under ambient conditions a may be calculated using the formula: [alpha = (d15-d50)/(35 x d50)], where d15 and d50 are the densities (in units of mass per unit volume) of the liquid at 15 degrees C (59 degrees F) and 50 degrees C (122 degrees F), respectively. TP13: Self-contained breathing apparatus must be provided when this hazardous material is transported by sea. TP27: A portable tank having a minimum test pressure of 4 bar (400 kPa) may be used provided the calculated test pressure is 4 bar or less based on the MAWP of the hazardous material, as defined in sxn. 178.275 of this subchapter, where the test pressure is 1.5 times the MAWP.
Packaging Authorizations (refer to 49 CFR 173.***): Exceptions: None Non-bulk packaging: 201 Bulk packaging: 243
Quantity Limitations: Vessel Stowage Requirements:
Hazardous materials descriptions and proper shipping name: Compounds, tree killing, liquid or Compounds, weed killing, liquid Symbol(s): Not Listed Hazard class or Division: 6.1 Identification Number: NA2810 Packing Group: II Label(s) required (if not excepted): 6.1 Special Provisions: IB2, T11, TP2, TP27 IB2: Authorized IBCs: Metal (31A, 31B and 31N); Rigid plastics (31H1 and 31H2); Composite (31HZ1). Additional Requirement: Only liquids with a vapor pressure less than or equal to 110 kPa at 50 °C (1.1 bar at 122 °F), or 130kPa at 55 °C (1.3 bar at 131 °F) are authorized. T11: Minimum test pressure (bar): 6; Minimum shell thickness (in mm-reference steel) (See sxn.178.274(d)): sxn.178.274(d)(2); Pressure-relief requirements (See sxn.178.275(g)): Normal; Bottom opening requirements (See sxn.178.275(d)): sxn.178.275(d)(3). TP2: a. The maximum degree of filling must not exceed the degree of filling determined by the following: [Degree of filling = 95/1+alpha(tr - tf)], where tr is the maximum mean bulk temperature during transport, tf is the temperature in degrees celsius of the liquid during filling, and alpha is the mean coefficient of cubical expansion of the liquid between the mean temperature of the liquid during filling (tf) and the maximum mean bulk temperature during transportation (tr) both in degrees celsius; and b. For liquids transported under ambient conditions a may be calculated using the formula: [alpha = (d15-d50)/(35 x d50)], where d15 and d50 are the densities (in units of mass per unit volume) of the liquid at 15 degrees C (59 degrees F) and 50 degrees C (122 degrees F), respectively. TP27: A portable tank having a minimum test pressure of 4 bar (400 kPa) may be used provided the calculated test pressure is 4 bar or less based on the MAWP of the hazardous material, as defined in sxn. 178.275 of this subchapter, where the test pressure is 1.5 times the MAWP.
Packaging Authorizations (refer to 49 CFR 173.***): Exceptions: 153 Non-bulk packaging: 202 Bulk packaging: 243
Quantity Limitations: Vessel Stowage Requirements:
Hazardous materials descriptions and proper shipping name: Compounds, tree killing, liquid or Compounds, weed killing, liquid Symbol(s): Not Listed Hazard class or Division: 6.1 Identification Number: NA2810 Packing Group: III Label(s) required (if not excepted): 6.1 Special Provisions: IB3, T7, TP1, TP28 IB3: Authorized IBCs: Metal (31A, 31B and 31N); Rigid plastics (31H1 and 31H2); Composite (31HZ1 and 31HA2, 31HB2, 31HN2, 31HD2 and 31HH2). Additional Requirement: Only liquids with a vapor pressure less than or equal to 110 kPa at 50 °C (1.1 bar at 122 °F), or 130 kPa at 55 °C (1.3 bar at 131 °F) are authorized, except for UN2672 (also see Special Provision IP8 in Table 3 for UN2672). T7: Minimum test pressure (bar): 4; Minimum shell thickness (in mm-reference steel) (See sxn.178.274(d)): sxn.178.274(d)(2); Pressure-relief requirements (See sxn.178.275(g)): Normal; Bottom opening requirements (See sxn.178.275(d)): sxn.178.275(d)(3). TP1: The maximum degree of filling must not exceed the degree of filling determined by the following: [Degree of filling = 97/1+alpha(tr - tf)], where tr is the maximum mean bulk temperature during transport, and tf is the temperature in degrees celsius of the liquid during filling. TP28: A portable tank having a minimum test pressure of 2.65 bar (265 kPa) may be used provided the calculated test pressure is 2.65 bar or less based on the MAWP of the hazardous material, as defined in sxn. 178.275 of this subchapter, where the test pressure is 1.5 times the MAWP.
Packaging Authorizations (refer to 49 CFR 173.***): Exceptions: 153 Non-bulk packaging: 203 Bulk packaging: 241
Quantity Limitations: Vessel Stowage Requirements:
Hazardous materials descriptions and proper shipping name: Toxic, liquids, organic, n.o.s Symbol(s): G Hazard class or Division: 6.1 Identification Number: UN2810 Packing Group: I Label(s) required (if not excepted): 6.1 Special Provisions: T14, TP2, TP13, TP27 T14: Minimum test pressure (bar): 6; Minimum shell thickness (in mm-reference steel) (See sxn.178.274(d)): 6 mm; Pressure-relief requirements (See sxn.178.275(g)): section 178.275(g)(3); Bottom opening requirements (See sxn.178.275(d)): Prohibited. TP2: a. The maximum degree of filling must not exceed the degree of filling determined by the following: [Degree of filling = 95/1+alpha(tr - tf)], where tr is the maximum mean bulk temperature during transport, tf is the temperature in degrees celsius of the liquid during filling, and alpha is the mean coefficient of cubical expansion of the liquid between the mean temperature of the liquid during filling (tf) and the maximum mean bulk temperature during transportation (tr) both in degrees celsius; and b. For liquids transported under ambient conditions a may be calculated using the formula: [alpha = (d15-d50)/(35 x d50)], where d15 and d50 are the densities (in units of mass per unit volume) of the liquid at 15 degrees C (59 degrees F) and 50 degrees C (122 degrees F), respectively. TP13: Self-contained breathing apparatus must be provided when this hazardous material is transported by sea. TP27: A portable tank having a minimum test pressure of 4 bar (400 kPa) may be used provided the calculated test pressure is 4 bar or less based on the MAWP of the hazardous material, as defined in sxn. 178.275 of this subchapter, where the test pressure is 1.5 times the MAWP.
Packaging Authorizations (refer to 49 CFR 173.***): Exceptions: None Non-bulk packaging: 201 Bulk packaging: 243
Quantity Limitations: Vessel Stowage Requirements:
Hazardous materials descriptions and proper shipping name: Toxic, liquids, organic, n.o.s Symbol(s): Not Listed Hazard class or Division: 6.1 Identification Number: UN2810 Packing Group: II Label(s) required (if not excepted): 6.1 Special Provisions: IB2, T11, TP2, TP13, TP27 IB2: Authorized IBCs: Metal (31A, 31B and 31N); Rigid plastics (31H1 and 31H2); Composite (31HZ1). Additional Requirement: Only liquids with a vapor pressure less than or equal to 110 kPa at 50 °C (1.1 bar at 122 °F), or 130kPa at 55 °C (1.3 bar at 131 °F) are authorized. T11: Minimum test pressure (bar): 6; Minimum shell thickness (in mm-reference steel) (See sxn.178.274(d)): sxn.178.274(d)(2); Pressure-relief requirements (See sxn.178.275(g)): Normal; Bottom opening requirements (See sxn.178.275(d)): sxn.178.275(d)(3). TP2: a. The maximum degree of filling must not exceed the degree of filling determined by the following: [Degree of filling = 95/1+alpha(tr - tf)], where tr is the maximum mean bulk temperature during transport, tf is the temperature in degrees celsius of the liquid during filling, and alpha is the mean coefficient of cubical expansion of the liquid between the mean temperature of the liquid during filling (tf) and the maximum mean bulk temperature during transportation (tr) both in degrees celsius; and b. For liquids transported under ambient conditions a may be calculated using the formula: [alpha = (d15-d50)/(35 x d50)], where d15 and d50 are the densities (in units of mass per unit volume) of the liquid at 15 degrees C (59 degrees F) and 50 degrees C (122 degrees F), respectively. TP13: Self-contained breathing apparatus must be provided when this hazardous material is transported by sea. TP27: A portable tank having a minimum test pressure of 4 bar (400 kPa) may be used provided the calculated test pressure is 4 bar or less based on the MAWP of the hazardous material, as defined in sxn. 178.275 of this subchapter, where the test pressure is 1.5 times the MAWP.
Packaging Authorizations (refer to 49 CFR 173.***): Exceptions: 153 Non-bulk packaging: 202 Bulk packaging: 243
Quantity Limitations: Vessel Stowage Requirements:
Hazardous materials descriptions and proper shipping name: Toxic, liquids, organic, n.o.s Symbol(s): Not Listed Hazard class or Division: 6.1 Identification Number: UN2810 Packing Group: III Label(s) required (if not excepted): 6.1 Special Provisions: IB3, T7, TP1, TP28 IB3: Authorized IBCs: Metal (31A, 31B and 31N); Rigid plastics (31H1 and 31H2); Composite (31HZ1 and 31HA2, 31HB2, 31HN2, 31HD2 and 31HH2). Additional Requirement: Only liquids with a vapor pressure less than or equal to 110 kPa at 50 °C (1.1 bar at 122 °F), or 130 kPa at 55 °C (1.3 bar at 131 °F) are authorized, except for UN2672 (also see Special Provision IP8 in Table 3 for UN2672). T7: Minimum test pressure (bar): 4; Minimum shell thickness (in mm-reference steel) (See sxn.178.274(d)): sxn.178.274(d)(2); Pressure-relief requirements (See sxn.178.275(g)): Normal; Bottom opening requirements (See sxn.178.275(d)): sxn.178.275(d)(3). TP1: The maximum degree of filling must not exceed the degree of filling determined by the following: [Degree of filling = 97/1+alpha(tr - tf)], where tr is the maximum mean bulk temperature during transport, and tf is the temperature in degrees celsius of the liquid during filling. TP28: A portable tank having a minimum test pressure of 2.65 bar (265 kPa) may be used provided the calculated test pressure is 2.65 bar or less based on the MAWP of the hazardous material, as defined in sxn. 178.275 of this subchapter, where the test pressure is 1.5 times the MAWP.
Packaging Authorizations (refer to 49 CFR 173.***): Exceptions: 153 Non-bulk packaging: 203 Bulk packaging: 241
Quantity Limitations: Vessel Stowage Requirements:
Hazardous materials descriptions and proper shipping name: Toxic, liquids, organic, n.o.s. Inhalation hazard, Packing Group I, Zone A Symbol(s): G Hazard class or Division: 6.1 Identification Number: UN2810 Packing Group: I Label(s) required (if not excepted): 6.1 Special Provisions: 1, B9, B14, B30, B72, T22, TP2, TP13, TP27, TP38, TP44 1: This material is poisonous by inhalation (see sxn. 171.8 of this subchapter) in Hazard Zone A (see sxn. 173.116(a) or sxn. 173.133(a) of this subchapter), and must be described as an inhalation hazard under the provisions of this subchapter. B9: Bottom outlets are not authorized. B14: Each bulk packaging, except a tank car or a multi-unit-tank car tank, must be insulated with an insulating material so that the overall thermal conductance at 15.5 °C (60 °F) is no more than 1.5333 kilojoules per hour per square meter per degree Celsius (0.075 Btu per hour per square foot per degree Fahrenheit) temperature differential. Insulating materials must not promote corrosion to steel when wet. B30: MC 312, MC 330, MC 331 and DOT 412 cargo tanks and DOT 51 portable tanks must be made of stainless steel, except that steel other than stainless steel may be used in accordance with the provisions of sxn. 173.24b(b) of this subchapter. Thickness of stainless steel for tank shell and heads for cargo tanks and portable tanks must be the greater of 7.62 mm (0.300 inch) or the thickness required for a tank with a design pressure at least equal to 1.5 times the vapor pressure of the lading at 46 °C (115 °F). In addition, MC 312 and DOT 412 cargo tank motor vehicles must: a. Be ASME Code (U) stamped for 100% radiography of all pressure-retaining welds; b. Have accident damage protection which conforms with sxn. 178.345-8 of this subchapter; c. Have a MAWP or design pressure of at least 87 psig: and d. Have a bolted manway cover. B72: Tank cars must have a test pressure of 34.47 Bar (500 psig) or greater and conform to Class 105J, 106, or 110. T22: Minimum test pressure (bar): 10; Minimum shell thickness (in mm-reference steel) (See sxn.178.274(d)): 10 mm; Pressure-relief requirements (See sxn.178.275(g)): sxn. 178.275(g)(3); Bottom opening requirements (See sxn.178.275(d)): Prohibited. TP2: a. The maximum degree of filling must not exceed the degree of filling determined by the following: [Degree of filling = 95/1+alpha(tr - tf)], where tr is the maximum mean bulk temperature during transport, tf is the temperature in degrees celsius of the liquid during filling, and alpha is the mean coefficient of cubical expansion of the liquid between the mean temperature of the liquid during filling (tf) and the maximum mean bulk temperature during transportation (tr) both in degrees celsius; and b. For liquids transported under ambient conditions a may be calculated using the formula: [alpha = (d15-d50)/(35 x d50)], where d15 and d50 are the densities (in units of mass per unit volume) of the liquid at 15 degrees C (59 degrees F) and 50 degrees C (122 degrees F), respectively. TP13: Self-contained breathing apparatus must be provided when this hazardous material is transported by sea. TP27: A portable tank having a minimum test pressure of 4 bar (400 kPa) may be used provided the calculated test pressure is 4 bar or less based on the MAWP of the hazardous material, as defined in sxn. 178.275 of this subchapter, where the test pressure is 1.5 times the MAWP. TP38: Each portable tank must be insulated with an insulating material so that the overall thermal conductance at 15.5 °C (60 °F) is no more than 1.5333 kilojoules per hour per square meter per degree Celsius (0.075 Btu per hour per square foot per degree Fahrenheit) temperature differential. Insulating materials may not promote corrosion to steel when wet. TP44: Each portable tank must be made of stainless steel, except that steel other than stainless steel may be used in accordance with the provisions of sxn. 173.24b(b) of this subchapter. Thickness of stainless steel for tank shell and heads must be the greater of 7.62 mm (0.300 inch) or the thickness required for a portable tank with a design pressure at least equal to 1.5 times the vapor pressure of the hazardous material at 46 °C (115 °F).
Packaging Authorizations (refer to 49 CFR 173.***): Exceptions: None Non-bulk packaging: 226 Bulk packaging: 244
Quantity Limitations: Vessel Stowage Requirements:
Hazardous materials descriptions and proper shipping name: Toxic, liquids, organic, n.o.s. Inhalation hazard, Packing Group I, Zone B Symbol(s): G Hazard class or Division: 6.1 Identification Number: UN2810 Packing Group: I Label(s) required (if not excepted): 6.1 Special Provisions: 2, B9, B14, B32, B74, T20, TP2, TP13, TP27, TP38, TP45 2: This material is poisonous by inhalation (see sxn. 171.8 of this subchapter) in Hazard Zone B (see sxn. 173.116(a) or sxn. 173.133(a) of this subchapter), and must be described as an inhalation hazard under the provisions of this subchapter. B9: Bottom outlets are not authorized. B14: Each bulk packaging, except a tank car or a multi-unit-tank car tank, must be insulated with an insulating material so that the overall thermal conductance at 15.5 °C (60 °F) is no more than 1.5333 kilojoules per hour per square meter per degree Celsius (0.075 Btu per hour per square foot per degree Fahrenheit) temperature differential. Insulating materials must not promote corrosion to steel when wet. B32: MC 312, MC 330, MC 331, DOT 412 cargo tanks and DOT 51 portable tanks must be made of stainless steel, except that steel other than stainless steel may be used in accordance with the provisions of sxn. 173.24b(b) of this subchapter. Thickness of stainless steel for tank shell and heads for cargo tanks and portable tanks must be the greater of 6.35 mm (0.250 inch) or the thickness required for a tank with a design pressure at least equal to 1.3 times the vapor pressure of the lading at 46 °C (115 °F). In addition, MC 312 and DOT 412 cargo tank motor vehicles must: a. Be ASME Code (U) stamped for 100% radiography of all pressure-retaining welds; b. Have accident damage protection which conforms with sxn. 178.345-8 of this subchapter; c. Have a MAWP or design pressure of at least 87 psig; and d. Have a bolted manway cover. B74: Tank cars must have a test pressure of 20.68 Bar (300 psig) or greater and conform to Class 105S, 106, 110, 112J, 114J or 120S. T20: Minimum test pressure (bar): 10; Minimum shell thickness (in mm-reference steel) (See sxn.178.274(d)): 8 mm; Pressure-relief requirements (See sxn.178.275(g)): sxn. 178.275(g)(3); Bottom opening requirements (See sxn.178.275(d)): Prohibited. TP2: a. The maximum degree of filling must not exceed the degree of filling determined by the following: [Degree of filling = 95/1+alpha(tr - tf)], where tr is the maximum mean bulk temperature during transport, tf is the temperature in degrees celsius of the liquid during filling, and alpha is the mean coefficient of cubical expansion of the liquid between the mean temperature of the liquid during filling (tf) and the maximum mean bulk temperature during transportation (tr) both in degrees celsius; and b. For liquids transported under ambient conditions a may be calculated using the formula: [alpha = (d15-d50)/(35 x d50)], where d15 and d50 are the densities (in units of mass per unit volume) of the liquid at 15 degrees C (59 degrees F) and 50 degrees C (122 degrees F), respectively. TP13: Self-contained breathing apparatus must be provided when this hazardous material is transported by sea. TP27: A portable tank having a minimum test pressure of 4 bar (400 kPa) may be used provided the calculated test pressure is 4 bar or less based on the MAWP of the hazardous material, as defined in sxn. 178.275 of this subchapter, where the test pressure is 1.5 times the MAWP. TP38: Each portable tank must be insulated with an insulating material so that the overall thermal conductance at 15.5 °C (60 °F) is no more than 1.5333 kilojoules per hour per square meter per degree Celsius (0.075 Btu per hour per square foot per degree Fahrenheit) temperature differential. Insulating materials may not promote corrosion to steel when wet. TP45: Each portable tank must be made of stainless steel, except that steel other than stainless steel may be used in accordance with the provisions of 173.24b(b) of this subchapter. Thickness of stainless steel for portable tank shells and heads must be the greater of 6.35 mm (0.250 inch) or the thickness required for a portable tank with a design pressure at least equal to 1.3 times the vapor pressure of the hazardous material at 46 °C (115 °F).
Packaging Authorizations (refer to 49 CFR 173.***): Exceptions: None Non-bulk packaging: 227 Bulk packaging: 244
Quantity Limitations: Vessel Stowage Requirements:
- ICAO International Shipping Name for UN2810 (ICAO, 2002):
LABELS
- NFPA Hazard Ratings for CAS51-75-2 (NFPA, 2002):
-HANDLING AND STORAGE
HANDLING
- Mechlorethamine is not stable on storage (pp 3-10).
- When transporting mechlorethamine hydrochloride to a home-care setting, the protocol for transporting hazardous drugs should be followed. The drugs should be appropriately contained in leak-proof and unbreakable containers that are securely capped and sealed (HSDB , 2001).
- The following procedure is recommended for transport of carcinogenic liquids (HSDB , 2001):
Enclose the chemical in a well-sealed, watertight container (primary container). Enclose the primary container in a second unbreakable and leak-proof container able to withstand chemical attack from the carcinogen (secondary container). Fill the space between the primary container and the secondary container with sufficient amount of absorbent material able to withstand chemical attack from the carcinogen. Enclose all in a strong outer box and fill the area between the secondary container and outer box with appropriate amount and type of shock-absorbent material.
STORAGE
- ROOM/CABINET RECOMMENDATIONS
Mechlorethamine should be stored at a temperature of less than 40 degrees C (preferably at 15-30 degrees C). In the dry form, it is stable at temperatures up to 40 degrees C (ASHP, 1986). Dry crystals of the hydrochloride are stable at temperatures below 40 degrees C (HSDB , 2001). Store in well-sealed containers (HSDB , 2001). Undiluted liquid mechlorethamine decomposes on standing and forms polymeric quaternary ammonium salts which are insoluble in the free base (Budavari, 2000).
-PERSONAL PROTECTION
SUMMARY
- RECOMMENDED PROTECTIVE CLOTHING - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 153 (ERG, 2004)
Wear positive pressure self-contained breathing apparatus (SCBA). Wear chemical protective clothing that is specifically recommended by the manufacturer. It may provide little or no thermal protection. Structural firefighters' protective clothing provides limited protection. fire situations ONLY; it is not effective in spill situations where direct contact with the substance is possible.
- Mechlorethamine will cause tumors upon contact with skin, and is toxic by inhalation, ingestion, and most other routes of exposure (Lewis, 2000). Proper protective equipment and clothing should be used at all times when working with this chemical (HSDB , 2001).
- Laidlaw et al (1984) studied the permeability of latex and polyvinyl chloride (PVC) gloves to 20 injectable antineoplastic drugs.
Four types of gloves were evaluated: latex surgical gloves, latex examination gloves, and PVC gloves in two thicknesses. Each glove material was exposed to each drug for 90 minutes, and permeation was tested using a mutagenicity assay. Individual fingertips of thin PVC gloves and latex surgical gloves were tested for permeability at five time points (2 to 30 minutes) using a doxorubicin coloration assay. Mechlorethamine permeated the thin PVC gloves as well as the thick PVC gloves. The latex examination gloves were permeable to mechlorethamine hydrochloride, whereas the latex surgical gloves exhibited borderline permeability to the drug. Glove thickness was a major determinant of permeability. The authors concluded that latex surgical gloves were the least permeable and thin PVC gloves the most permeable to the antineoplastic drugs tested. Within individual gloves and glove types, time and amount of permeation were not uniform.
- When working with antineoplastic agents, powder-free gloves should be worn, and double-gloving may be recommended (HSDB , 2001).
RESPIRATORY PROTECTION
- Mechlorethamine is a deadly poison by inhalation, and should never be used without wearing an appropriate gas mask (Budavari, 2000; Lewis, 1998).
- A self-contained (positive pressure) breathing apparatus is recommended for fire fighting and handling spills (epa, 1985).
- Refer to "Recommendations for respirator selection" in the NIOSH Pocket Guide to Chemical Hazards on TOMES Plus(R) for respirator information.
PROTECTIVE CLOTHING
- CHEMICAL PROTECTIVE CLOTHING. Search results for CAS 51-75-2.
-PHYSICAL HAZARDS
FIRE HAZARD
- FLAMMABILITY CLASSIFICATION
- NFPA Flammability Rating for CAS51-75-2 (NFPA, 2002):
- FIRE CONTROL/EXTINGUISHING AGENTS
- SMALL FIRE PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 153 (ERG, 2004)
- LARGE FIRE PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 153 (ERG, 2004)
Dry chemical, CO2, alcohol-resistant foam or water spray. Move containers from fire area if you can do it without risk. Dike fire control water for later disposal; do not scatter the material.
- TANK OR CAR/TRAILER LOAD FIRE PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 153 (ERG, 2004)
Fight fire from maximum distance or use unmanned hose holders or monitor nozzles. Do not get water inside containers. Cool containers with flooding quantities of water until well after fire is out. Withdraw immediately in case of rising sound from venting safety devices or discoloration of tank. ALWAYS stay away from tanks engulfed in fire.
- NFPA Extinguishing Methods for CAS51-75-2 (NFPA, 2002):
- If fire is in an enclosed area, ventilate area before entering. Fight the fire from the maximum distance possible (Sittig, 1991).
- Stay upwind of the fire, and avoid low areas. Wear appropriate positive pressure respiratory equipment and protective clothing. Move the container from area of fire if it can be done without risk (Sittig, 1991).
- Use dry chemical, carbon dioxide, water spray or foam to extinguish small fires. In the case of a large fire, water spray, fog or foam is recommended (Sittig, 1991).
- Dike water used in fire control for later disposal; do not scatter the material (Sittig, 1991).
EXPLOSION HAZARD
- When mechlorethamine is heated, it decomposes before its boiling point is reached. It tends to polymerize or condense; this reaction could generate enough heat to cause an explosion (pp 3-10).
DUST/VAPOR HAZARD
- The nitrogen mustard gases are severely damaging to the eyes, with the tendency to injure deeper ocular structures, such as the iris and lens. Respiratory tract, nose, and skin irritation are also likely (Grant & Schuman, 1993).
- Mechlorethamine is a deadly poison by inhalation and should not be used without wearing a gas mask (Lewis, 1998).
- When heated to decomposition, mechlorethamine releases toxic chlorine gas and nitrogen oxides fumes (Lewis, 2000).
REACTIVITY HAZARD
- Mechlorethamine reacts with water (Clayton & Clayton, 1981; HSDB , 2002).
- Undiluted liquid mechlorethamine decomposes on standing and forms polymeric quaternary ammonium salts which are insoluble in the free base (Budavari, 2000).
EVACUATION PROCEDURES
- Initial Isolation and Protective Action Distances (ERG, 2004)
Data presented from the Emergency Response Guidebook Table of Initial Isolation and Protective Action Distances are for use when a spill has occurred and there is no fire. If there is a fire, or if a fire is involved, evacuation information presented under FIRE - PUBLIC SAFETY EVACUATION DISTANCES should be used. Generally, a small spill is one that involves a single, small package such as a drum containing up to approximately 200 liters, a small cylinder, or a small leak from a large package. A large spill is one that involves a spill from a large package, or multiple spills from many small packages. Suggested distances to protect from vapors of toxic-by-inhalation and/or water-reactive materials during the first 30 minutes following the spill. DOT ID No. 2810 - HN-2 when used as a weapon SMALL SPILLS LARGE SPILLS
- SPILL - PUBLIC SAFETY EVACUATION DISTANCES - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 153 (ERG, 2004)
Increase, in the downwind direction, as necessary, the isolation distance of at least 50 meters (150 feet) for liquids and at least 25 meters (75 feet) for solids in all directions.
- FIRE - PUBLIC SAFETY EVACUATION DISTANCES - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 153 (ERG, 2004)
If tank, rail car or tank truck is involved in a fire, ISOLATE for 800 meters (1/2 mile) in all directions; also, consider initial evacuation for 800 meters (1/2 mile) in all directions.
- PUBLIC SAFETY MEASURES - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 153 (ERG, 2004)
CALL Emergency Response Telephone Number on Shipping Paper first. If Shipping Paper not available or no answer, refer to appropriate telephone number: MEXICO: SETIQ: 01-800-00-214-00 in the Mexican Republic; For calls originating in Mexico City and the Metropolitan Area: 5559-1588; For calls originating elsewhere, call: 011-52-555-559-1588.
CENACOM: 01-800-00-413-00 in the Mexican Republic; For calls originating in Mexico City and the Metropolitan Area: 5550-1496, 5550-1552, 5550-1485, or 5550-4885; For calls originating elsewhere, call: 011-52-555-550-1496, or 011-52-555-550-1552; 011-52-555-550-1485, or 011-52-555-550-4885.
ARGENTINA: CIQUIME: 0-800-222-2933 in the Republic of Argentina; For calls originating elsewhere, call: +54-11-4613-1100.
BRAZIL: PRÓ-QUÍMICA: 0-800-118270 (Toll-free in Brazil); For calls originating elsewhere, call: +55-11-232-1144 (Collect calls are accepted).
COLUMBIA: CISPROQUIM: 01-800-091-6012 in Colombia; For calls originating in Bogotá, Colombia, call: 288-6012; For calls originating elsewhere, call: 011-57-1-288-6012.
CANADA: UNITED STATES:
For additional details see the section entitled "WHO TO CALL FOR ASSISTANCE" under the ERG Instructions. As an immediate precautionary measure, isolate spill or leak area in all directions for at least 50 meters (150 feet) for liquids and at least 25 meters (75 feet) for solids. Keep unauthorized personnel away. Stay upwind. Keep out of low areas. Ventilate enclosed areas.
- AIHA ERPG Values for CAS51-75-2 (AIHA, 2006):
- DOE TEEL Values for CAS51-75-2 (U.S. Department of Energy, Office of Emergency Management, 2010):
Listed as Nitrogen mustard (Bis(b-chloroethyl)methylamine) TEEL-0 (units = mg/m3): 0.001 TEEL-1 (units = mg/m3): 0.003 TEEL-2 (units = mg/m3): 0.022 TEEL-3 (units = mg/m3): 0.37 Definitions: TEEL-0: The threshold concentration below which most people will experience no adverse health effects. TEEL-1: The airborne concentration (expressed as ppm [parts per million] or mg/m(3) [milligrams per cubic meter]) of a substance above which it is predicted that the general population, including susceptible individuals, could experience notable discomfort, irritation, or certain asymptomatic, nonsensory effects. However, these effects are not disabling and are transient and reversible upon cessation of exposure. TEEL-2: The airborne concentration (expressed as ppm or mg/m(3)) of a substance above which it is predicted that the general population, including susceptible individuals, could experience irreversible or other serious, long-lasting, adverse health effects or an impaired ability to escape. TEEL-3: The airborne concentration (expressed as ppm or mg/m(3)) of a substance above which it is predicted that the general population, including susceptible individuals, could experience life-threatening adverse health effects or death.
- AEGL Values for CAS51-75-2 (National Research Council, 2010; National Research Council, 2009; National Research Council, 2008; National Research Council, 2007; NRC, 2001; NRC, 2002; NRC, 2003; NRC, 2004; NRC, 2004; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; United States Environmental Protection Agency Office of Pollution Prevention and Toxics, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; 62 FR 58840, 1997; 65 FR 14186, 2000; 65 FR 39264, 2000; 65 FR 77866, 2000; 66 FR 21940, 2001; 67 FR 7164, 2002; 68 FR 42710, 2003; 69 FR 54144, 2004):
Listed as: Nitrogen mustard H-N2 Proposed Value: AEGL-1 10 min exposure: 30 min exposure: 1 hr exposure: 4 hr exposure: 8 hr exposure:
Definitions: AEGL-1 is the airborne concentration of a substance above which it is predicted that the general population, including susceptible individuals, could experience notable discomfort, irritation, or certain asymptomatic non-sensory effects. However, the effects are not disabling, are transient, and are reversible upon cessation of exposure.
Listed as: Nitrogen mustard H-N2 Proposed Value: AEGL-2 10 min exposure: 30 min exposure: ppm: mg/m3: 0.044 mg/m(3)
1 hr exposure: ppm: mg/m3: 0.022 mg/m(3)
4 hr exposure: ppm: mg/m3: 0.093 mg/m(3)
8 hr exposure: ppm: mg/m3: 0.0047 mg/m(3)
Definitions: AEGL-2 is the airborne concentration of a substance above which it is predicted that the general population, including susceptible individuals, could experience irreversible or other serious, long-lasting adverse health effects or an impaired ability to escape.
Listed as: Nitrogen mustard H-N2 Proposed Value: AEGL-3 10 min exposure: 30 min exposure: 1 hr exposure: 4 hr exposure: ppm: mg/m3: 0.093 mg/m(3)
8 hr exposure: ppm: mg/m3: 0.047 mg/m(3)
Definitions: AEGL-3 is the airborne concentration of a substance above which it is predicted that the general population, including susceptible individuals, could experience life-threatening health effects or death.
- NIOSH IDLH Values for CAS51-75-2 (National Institute for Occupational Safety and Health, 2007):
CONTAINMENT/WASTE TREATMENT OPTIONS
SPILL OR LEAK PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 153 (ERG, 2004) ELIMINATE all ignition sources (no smoking, flares, sparks or flames in immediate area). Do not touch damaged containers or spilled material unless wearing appropriate protective clothing. Stop leak if you can do it without risk. Prevent entry into waterways, sewers, basements or confined areas. Absorb or cover with dry earth, sand or other non-combustible material and transfer to containers. DO NOT GET WATER INSIDE CONTAINERS.
RECOMMENDED PROTECTIVE CLOTHING - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 153 (ERG, 2004) Wear positive pressure self-contained breathing apparatus (SCBA). Wear chemical protective clothing that is specifically recommended by the manufacturer. It may provide little or no thermal protection. Structural firefighters' protective clothing provides limited protection. fire situations ONLY; it is not effective in spill situations where direct contact with the substance is possible.
Bulk quantities of mechlorethamine used as antineoplastic drugs may be degraded using nickel-aluminum in potassium hydroxide solution; a saturated sodium bicarbonate solution may also be used (HSDB , 2001). Incineration may be the appropriate disposal method for clothing and equipment contaminated with mechlorethamine. However, local environmental regulatory agencies should be contacted for specific guidance (HSDB , 2001).
-ENVIRONMENTAL HAZARD MANAGEMENT
POLLUTION HAZARD
- Mechlorethamine's production and use as an antineoplastic agent and its former production as a gas warfare agent may result in its release to the environment through various waste streams (HSDB, 2004).
ENVIRONMENTAL FATE AND KINETICS
Mechlorethamine will exist primarily in the vapor phase in ambient air. Degradation occurs via reaction with hydroxyl radicals; the half-life in air is estimated at 2 days (HSDB, 2004). Based upon an estimated photooxidation rate, the half-life of mechlorethamine in air is between 0.89 and 8.9 hours (Howard, 1991). The estimated rate constant for the vapor-phase reaction of mechlorethamine with photochemically produced hydroxyl radicals is 8.4 X 10(-12) cm(3)/molecule-sec at 25 degrees C (HSDB, 2004).
SURFACE WATER Mechlorethamine should not adsorb to suspended solids or sediment in the water. Hydrolysis is a major fate process; mechlorethamine has a half-life in water of 11 hours (at 25 degrees C) (HSDB, 2004). Mechlorethamine is not expected to volatilize from water (HSDB, 2004). Its half-life in both surface water and groundwater is estimated to be between 30 minutes and 24 hours (Howard, 1991). Mechlorethamine reacts rapidly with water in a two-step process. Initially, the 1-methyl-1-(beta-chloroethyl)-ethylenimonium ion is formed, liberating chloride. The onium cation then reacts to form alcohol, subsequently hydrolyzing to form methyldiethanolamine (HSDB, 2004).
GROUND WATER
TERRESTRIAL Mechlorethamine is expected to have high mobility in soil. Hydrolysis in moist soil is expected to be a significant fate process. Volatilization is likely from dry soil surfaces (HSDB, 2004). Based upon its aqueous hydrolysis half-life, the half-life of mechlorethamine in soil is expected to be between 30 minutes and 24 hours (Howard, 1991).
OTHER Undiluted liquid mechlorethamine decomposes on standing and forms polymeric quaternary ammonium salts which are insoluble in the free base (Budavari, 2000). Mechlorethamine's duration of effectiveness as a chemical agent in the environment depends on weather, methods of dissemination, and conditions of terrain. Its duration of effectiveness is somewhat shorter than that for the sulfur mustard HD, which may persist for 1 to 2 days under average weather conditions, and a week or more under very cold conditions (pp 3-10).
ABIOTIC DEGRADATION
- Mechlorethamine's duration of effectiveness as a chemical agent in the environment depends on weather, methods of dissemination, and conditions of terrain. Its duration of effectiveness is somewhat shorter than that for the sulfur mustard HD, which may persist for 1 to 2 days under average weather conditions, and a week or more under very cold conditions (pp 3-10).
- Mechlorethamine will exist primarily in the vapor phase in ambient air. Hydrolysis is a major fate process in water. Mechlorethamine is not expected to volatilize from water nor adsorb to suspended solids or sediment in water. Mechlorethamine is expected to have high mobility in soil, especially in moist soil where hydrolysis is expected to be a significant fate process. Volatilization is likely from dry soil surfaces. An estimated bioconcentration factor (BCF) of 3 suggests mechlorethamine will not bioaccumulate in aquatic organisms (HSDB, 2004).
BIOACCUMULATION
ENVIRONMENTAL TOXICITY
- No information was found on environmental toxicity of mechlorethamine at the time of this review.
-PHYSICAL/CHEMICAL PROPERTIES
MOLECULAR WEIGHT
- 192.5 (hydrochloride) (Prod Info Mustargen(R) intravenous injection, 2009)
DESCRIPTION/PHYSICAL STATE
- Colorless liquid when pure, but turns a yellow to amber color upon storage, and has the faint odor of herring (HSDB , 2002).
- Mechlorethamine hydrochloride can exist as a white, crystalline powder (HSDB , 2002). Mechlorethamine hydrochloride IV powder for solution is a light yellow brown, crystalline, hygroscopic powder that is very soluble in water and soluble in alcohol (Prod Info Mustargen(R) intravenous injection, 2009).
PH
- 3 to 4 for 2 percent aqueous solution (HSDB , 2002)
- 3 to 5 (reconstituted IV solution) (Prod Info Mustargen(R) intravenous injection, 2009)
VAPOR PRESSURE
- 0.29 mmHg (at 20 degrees C) (pp 3-10)
- 1.25 mmHg (at 40 degrees C) (pp 3-10)
- 0.17 mmHg (at 25 degrees C) (Lewis, 2000)
SPECIFIC GRAVITY
- NORMAL TEMPERATURE AND PRESSURE
DENSITY
- NORMAL TEMPERATURE AND PRESSURE
- OTHER TEMPERATURE AND/OR PRESSURE
FREEZING/MELTING POINT
-60 degrees C (Budavari, 2000) 1 degree C (at 10 mmHg) (Lewis, 2000) 108 to 111 degrees C (hydrochloride) (Prod Info Mustargen(R) intravenous injection, 2009)
BOILING POINT
87 degrees C (at 18 mmHg); 75 degrees C (at 10 mmHg); 64 degrees C (at 5 mmHg); 59 degrees C (at 2 mmHg) (Budavari, 2000) 189 degrees F (at 18 mmHg) (epa, 1985) 75 degrees C (at 15 mmHg); at atmospheric pressure, mechlorethamine decomposes below its boiling point (pp 3-10). 86 to 87 degrees C (at 11 mmHg) (Lewis, 2000)
FLASH POINT
- The flash point is high enough not to interfere with military use of the chemical (pp 3-10).
SOLUBILITY
It is miscible with dimethylformamide (DMF), carbon disulfide, carbon tetrachloride, and many other organic solvents and oils (Budavari, 2000). The hydrochloride salt is soluble in alcohol (Prod Info Mustargen(R) intravenous injection, 2009; Budavari, 2000).
HENRY'S CONSTANT
- 8.5 x 10(-8) atm-m(3)/mole (HSDB , 2001).
OTHER/PHYSICAL
- DECOMPOSITION TEMPERATURE
-REFERENCES
GENERAL BIBLIOGRAPHY- 40 CFR 372.28: Environmental Protection Agency - Toxic Chemical Release Reporting, Community Right-To-Know, Lower thresholds for chemicals of special concern. National Archives and Records Administration (NARA) and the Government Printing Office (GPO). Washington, DC. Final rules current as of Apr 3, 2006.
- 40 CFR 372.65: Environmental Protection Agency - Toxic Chemical Release Reporting, Community Right-To-Know, Chemicals and Chemical Categories to which this part applies. National Archives and Records Association (NARA) and the Government Printing Office (GPO), Washington, DC. Final rules current as of Apr 3, 2006.
- 49 CFR 172.101 - App. B: Department of Transportation - Table of Hazardous Materials, Appendix B: List of Marine Pollutants. National Archives and Records Administration (NARA) and the Government Printing Office (GPO), Washington, DC. Final rules current as of Aug 29, 2005.
- 49 CFR 172.101: Department of Transportation - Table of Hazardous Materials. National Archives and Records Administration (NARA) and the Government Printing Office (GPO), Washington, DC. Final rules current as of Aug 11, 2005.
- 62 FR 58840: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 1997.
- 65 FR 14186: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2000.
- 65 FR 39264: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2000.
- 65 FR 77866: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2000.
- 66 FR 21940: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2001.
- 67 FR 7164: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2002.
- 68 FR 42710: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2003.
- 69 FR 54144: Notice of the National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances - Proposed AEGL Values, Environmental Protection Agency, NAC/AEGL Committee. National Archives and Records Administration (NARA) and the Government Publishing Office (GPO), Washington, DC, 2004.
- AIHA: 2006 Emergency Response Planning Guidelines and Workplace Environmental Exposure Level Guides Handbook, American Industrial Hygiene Association, Fairfax, VA, 2006.
- ASHP: Drug Information, American Society of Hospital Pharmacists, Bethesda, MD, 1986, pp 445-447.
- Addiego JE, Ridgway D, & Bleyer WA: The acute management of intrathecal methotrexate overdose: pharmacologic rationale and guidelines. J Pediatr 1981; 98(5):825-828.
- Akintonwa A: Potentiation of nitrogen mustard toxicity by narcotic analgesic. Clin Toxicol 1981; 18:451-458.
- Alaspaa AO, Kuisma MJ, Hoppu K, et al: Out-of-hospital administration of activated charcoal by emergency medical services. Ann Emerg Med 2005; 45:207-12.
- American Conference of Governmental Industrial Hygienists : ACGIH 2010 Threshold Limit Values (TLVs(R)) for Chemical Substances and Physical Agents and Biological Exposure Indices (BEIs(R)), American Conference of Governmental Industrial Hygienists, Cincinnati, OH, 2010.
- Anon: ASHP technical assistance bulletin on handling cytotoxic and hazardous drugs. Am J Hosp Pharm 1990; 47:1033-1048.
- Anon: ASHP technical assistance bulletin on handling cytotoxic and hazardous drugs. Am J Hosp Pharm 1990a; 47:1033-1049.
- Anon: OSHA work-practice guidelines for personnel dealing with cytotoxic (antineoplastic) drugs. Am J Hosp Pharm 1986; 43:1193-1204.
- Artigas A, Bernard GR, Carlet J, et al: The American-European consensus conference on ARDS, part 2: ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling.. Am J Respir Crit Care Med 1998; 157:1332-1347.
- Aviles A, Diaz-Maqueo JC, & Talavera A et at: Growth and development of children of mothers treated with chemotherapy during pregnancy: current status of 43 children. Am J Haematol 1991; 36:243-248.
- Avril MF: La Caryolysine locale. Ann Dermatol Venereol 1987; 114:133-141.
- Banerjee A, Brotherston TM, Lamberty BG, et al: Cancer chemotherapy agent-induced perivenous extravasation injuries. Postgrad Med J 1987; 63(735):5-9.
- Bellin MF, Jakobsen JA, Tomassin I, et al: Contrast medium extravasation injury: guidelines for prevention and management. Eur Radiol 2002; 12(11):2807-2812.
- Bensinger W, Schubert M, Ang KK, et al: NCCN Task Force Report. prevention and management of mucositis in cancer care. J Natl Compr Canc Netw 2008; 6 Suppl 1:S1-21.
- Bethlenfalvay NC & Bergin JJ: Severe cerebral toxicity after intravenous nitrogen mustard therapy. Cancer 1972; 29:366-369.
- Brower RG, Matthay AM, & Morris A: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Eng J Med 2000; 342:1301-1308.
- Brown AS, Hoelzer DJ, & Piercy SA: Skin necrosis from extravasation of intravenous fluids in children. Plast Reconstr Surg 1979; 64(2):145-150.
- Budavari S: The Merck Index, 12th ed. on CD-ROM. Version 12:3a. Chapman & Hall/CRCnetBASE. Whitehouse Station, NJ. 2000.
- Burgess JL, Kirk M, Borron SW, et al: Emergency department hazardous materials protocol for contaminated patients. Ann Emerg Med 1999; 34(2):205-212.
- Caravati EM: Alkali. In: Dart RC, ed. Medical Toxicology, Lippincott Williams & Wilkins, Philadelphia, PA, 2004.
- Cataletto M: Respiratory Distress Syndrome, Acute(ARDS). In: Domino FJ, ed. The 5-Minute Clinical Consult 2012, 20th ed. Lippincott Williams & Wilkins, Philadelphia, PA, 2012.
- Centers for Disease Control and Prevention (CDC): NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2012. Centers for Disease Control and Prevention (CDC). Atlanta, GA. 2012. Available from URL: http://www.cdc.gov/niosh/docs/2012-150/pdfs/2012-150.pdf. As accessed 2013-05-14.
- Chait LA & Dinner MI: Ulceration caused by cytotoxic drugs. SA Med J 1975; 49:1935-1936.
- Chasse MA & Gaudet S: Safe handling of cytotoxic agents. AARN News Letter 1992; 48:14-15.
- Chyka PA, Seger D, Krenzelok EP, et al: Position paper: Single-dose activated charcoal. Clin Toxicol (Phila) 2005; 43(2):61-87.
- Clayton GD & Clayton FE: Patty's Industrial Hygiene and Toxicology, Vol 2A, John Wiley & Sons, New York, NY, 1981, pp 2683.
- Cohan RH, Ellis JH, & Garner WL: Extravasation of radiographic contrast material: recognition, prevention, and treatment. Radiology 1996; 200(3):593-604.
- Crespi CL, Seixas GM, & Penman BW: The induction of aneuploidy by nitrogen mustard in a human lymphoblastoid cell line. Mutat Res 1987; 190:69-76.
- Cummings CW: Experimental observations on the ototoxicity of nitrogen mustard. Laryngoscope 1968; 78:530-538.
- Cunningham FG, MacDonald PC, Leveno KF, et alCunningham FG, MacDonald PC, Leveno KF, et al (Eds): Williams Obstetrics, 19th. Appleton & Lange, Norwalk, CT, 1993.
- DFG: List of MAK and BAT Values 2002, Report No. 38, Deutsche Forschungsgemeinschaft, Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area, Wiley-VCH, Weinheim, Federal Republic of Germany, 2002.
- Dagnone D, Matsui D, & Rieder MJ: Assessment of the palatability of vehicles for activated charcoal in pediatric volunteers. Pediatr Emerg Care 2002; 18:19-21.
- Daughters D, Zacheim H, & Maibach H: Urticaria and anaphylactoid reactions after topical application of mechlorethamine. Arch Dermatol 1973; 107:429-430.
- Doll DC, Ringenberg QS, & Yarbro JW: Management of cancer during pregnancy. Arch Intern Med 1988; 148:2058-2064.
- Dorr RT & Fritz WL: Cancer Chemotherapy Handbook, Elsevier, New York, NY, 1980, pp 498-506.
- Dorr RT & Fritz WL: Cancer Chemotherapy Handbook, Elsevier, New York, NY, 1980a.
- Du Vivier A, Vonderheid EC, & Van Scott EJ: Br J Dermatol 1978; 99:61.
- Dupuis LL & Nathan PC: Options for the prevention and management of acute chemotherapy-induced nausea and vomiting in children. Paediatr Drugs 2003; 5(9):597-613.
- EPA: Search results for Toxic Substances Control Act (TSCA) Inventory Chemicals. US Environmental Protection Agency, Substance Registry System, U.S. EPA's Office of Pollution Prevention and Toxics. Washington, DC. 2005. Available from URL: http://www.epa.gov/srs/.
- ERG: Emergency Response Guidebook. A Guidebook for First Responders During the Initial Phase of a Dangerous Goods/Hazardous Materials Incident, U.S. Department of Transportation, Research and Special Programs Administration, Washington, DC, 2004.
- Elliot CG, Colby TV, & Kelly TM: Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal. Chest 1989; 96:672-674.
- Epstein JH: Effects of mechlorethamine (HN2, nitrogen mustard) on UV-induced carcinogenesis in hairless mouse skin. J Natl Cancer Inst 1984; 72:383-385.
- FDA: Poison treatment drug product for over-the-counter human use; tentative final monograph. FDA: Fed Register 1985; 50:2244-2262.
- Flaxman BA, Sosis AC, & Van Scott EJ: Changes in melanosome distribution in Caucasoid skin following topical application of nitrogen mustard. J Invest Dermatol 1973; 60:321-326.
- Freifeld AG, Bow EJ, Sepkowitz KA, et al: Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 2011; 52(4):e56-e93.
- Freireich EJ, Gehan EA, & Rall DP: Quantitative comparison of toxicity of anticancer agents in mouse, rat, hamster, dog, monkey, and man. Cancer Chemother Rep 1966; 50:219-244.
- Garrett MJ: Teratogenic effects of combination chemotherapy. Ann Intern Med 1974; 80:667.
- Garrett MJ: Teratogenic effects of combination chemotherapy. Ann Intern Med 1974a; 80:667.
- Gilman AG, Goodman LS, & Gilman A: The Pharmacological Basis of Therapeutics, 6th ed, Macmillan, New York, NY, 1980, pp 1263-1264.
- Gippsland Oncology Nurses Group: Assessment, Prevention & Management Of Extravasation Of Cytotoxic Medications. GONG Cancer Care Guidelines. Gippsland Oncology Nurses Group. Gippsland, Victoria, Australia. 2010. Available from URL: http://www.gha.net.au/Uploadlibrary/393586908extravasation_guidelines0907.pdf. As accessed 2010-12-08.
- Glantz JC: Reproductive toxicology of alkylating agents. Obstet Gynecol Surv 1994; 49:709-715.
- Goday JJ, Aguirre A, & Raton JA: Local bullous reaction to topical mechlorethamine (mustine). Contact Dermatitis 1990; 22:306-307.
- Goldstein LS: Dominant lethal mutations induced in mouse spermatogonia by mechlorethamine, procarbazine and vincristine administered in 2-drug and 3-drug combinations. Mutat Res 1987; 191:171-176.
- Golej J, Boigner H, Burda G, et al: Severe respiratory failure following charcoal application in a toddler. Resuscitation 2001; 49:315-318.
- Gonzalez GG, Gallar J, & Belmonte C: Influence of diltiazem on the ocular irritative response to nitrogen mustard. Exp Eye Res 1995; 61(2):205-212.
- Gosselin S & Isbister GK: Re: Treatment of accidental intrathecal methotrexate overdose. J Natl Cancer Inst 2005; 97(8):609-610.
- Graff GR, Stark J, & Berkenbosch JW: Chronic lung disease after activated charcoal aspiration. Pediatrics 2002; 109:959-961.
- Grant WM & Schuman JS: Toxicology of the Eye, 4th Ed, Charles C. Thomas, Springfield, IL, 1993.
- Grunnet E: Contact urticaria and anaphylactoid reaction induced by topical application of nitrogen mustard. Br J Dermatol 1976; 94:101-103.
- Guenther Skokan E, Junkins EP, & Corneli HM: Taste test: children rate flavoring agents used with activated charcoal. Arch Pediatr Adolesc Med 2001; 155:683-686.
- HSDB : Hazardous Substances Data Bank. National Library of Medicine. Bethesda, MD (Internet Version). Edition expires 2000; provided by Truven Health Analytics Inc., Greenwood Village, CO.
- HSDB : Hazardous Substances Data Bank. National Library of Medicine. Bethesda, MD (Internet Version). Edition expires 2004; provided by Truven Health Analytics Inc., Greenwood Village, CO.
- HSDB : Hazardous Substances Data Bank. National Library of Medicine. Bethesda, MD (Internet Version). Edition expires 4/30/2001; provided by Truven Health Analytics Inc., Greenwood Village, CO.
- HSDB : Hazardous Substances Data Bank. National Library of Medicine. Bethesda, MD (Internet Version). Edition expires 8/31/2002; provided by Truven Health Analytics Inc., Greenwood Village, CO.
- Haas CF: Mechanical ventilation with lung protective strategies: what works?. Crit Care Clin 2011; 27(3):469-486.
- Harris CR & Filandrinos D: Accidental administration of activated charcoal into the lung: aspiration by proxy. Ann Emerg Med 1993; 22:1470-1473.
- Hartley-Asp B & Hyldig-Nielsen F: Comparative genotoxicity of nitrogen mustard and nor-nitrogen mustard. Carcinogenesis 1984; 5:1637-1640.
- Hartman LC, Tschetter LK, Habermann TM, et al: Granulocyte colony-stimulating factor in severe chemotherapy-induced afebrile neutropenia.. N Engl J Med 1997; 336:1776-1780.
- Hensley ML, Hagerty KL, Kewalramani T, et al: American Society of Clinical Oncology 2008 clinical practice guideline update: use of chemotherapy and radiation therapy protectants. J Clin Oncol 2009; 27(1):127-145.
- Hirsh JD & Conlon PF: Implementing guidelines for managing extravasation of antineoplastics. Am J Hosp Pharm 1983; 40:1516-1519.
- Hoff JV, Beatty PA, & Wade JL: Dermal necrosis from dobutamine. N Engl J Med 1979; 300:1280.
- Howard PH: Handbook of Environmental Fate & Exposure Data for Organic Chemicals, Vol 3, Lewis Publishers, Chelsea, MI, 1991.
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans : IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: 1,3-Butadiene, Ethylene Oxide and Vinyl Halides (Vinyl Fluoride, Vinyl Chloride and Vinyl Bromide), 97, International Agency for Research on Cancer, Lyon, France, 2008.
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans : IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Formaldehyde, 2-Butoxyethanol and 1-tert-Butoxypropan-2-ol, 88, International Agency for Research on Cancer, Lyon, France, 2006.
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans : IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Household Use of Solid Fuels and High-temperature Frying, 95, International Agency for Research on Cancer, Lyon, France, 2010a.
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans : IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines, 89, International Agency for Research on Cancer, Lyon, France, 2007.
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans : IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Some Non-heterocyclic Polycyclic Aromatic Hydrocarbons and Some Related Exposures, 92, International Agency for Research on Cancer, Lyon, France, 2010.
- IARC: IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man, International Agency for Research on Cancer, World Health Organization, Geneva, Switzerland, 1975, pp 193-203.
- IARC: List of all agents, mixtures and exposures evaluated to date - IARC Monographs: Overall Evaluations of Carcinogenicity to Humans, Volumes 1-88, 1972-PRESENT. World Health Organization, International Agency for Research on Cancer. Lyon, FranceAvailable from URL: http://monographs.iarc.fr/monoeval/crthall.html. As accessed Oct 07, 2004.
- ICAO: Technical Instructions for the Safe Transport of Dangerous Goods by Air, 2003-2004. International Civil Aviation Organization, Montreal, Quebec, Canada, 2002.
- ITI: Toxic and Hazardous Industrial Chemicals Safety Manual, The International Technical Information Institute, Tokyo, Japan, 1995.
- Ignoffo RJ & Friedman MA: Therapy of local toxicities caused by extravasation of cancer chemotherapeutic drugs. Cancer Treat Rev 1980; 7(1):17-27.
- International Agency for Research on Cancer (IARC): IARC monographs on the evaluation of carcinogenic risks to humans: list of classifications, volumes 1-116. International Agency for Research on Cancer (IARC). Lyon, France. 2016. Available from URL: http://monographs.iarc.fr/ENG/Classification/latest_classif.php. As accessed 2016-08-24.
- International Agency for Research on Cancer: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. World Health Organization. Geneva, Switzerland. 2015. Available from URL: http://monographs.iarc.fr/ENG/Classification/. As accessed 2015-08-06.
- Jager V, Wintrobe MM, & Ginzler AM: Oral ingestion of tris(beta- chloroethyl)amine hydrochloride by humans. Report No. 1, Med Res Lab, Med Div, Army Medical Center, Washington, DC, 1943.
- Jeffrey LP, Anderson RW & Fortner CL et al: Recommendations for handling cytotoxic agents. National Study Commission on Cytotoxic Exposure (Sept), 1984.
- Jones RT & Weinerman ER: MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) given during pregnancy. Obstet Gynecol 1979; 54:477-478.
- Karnofsky DA: Summary of results obtained with nitrogen mustard in the treatment of neoplastic disease. Ann Acad Sci 1958; 68:899-914.
- Kollef MH & Schuster DP: The acute respiratory distress syndrome. N Engl J Med 1995; 332:27-37.
- Kravitz Ph & McDonald CJ: Acta derm-vener, Stockholm 1978; 58:421.
- Kris MG, Hesketh PJ, Somerfield MR, et al: American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 2006; 24(18):2932-2947.
- Larson DL: Treatment of tissue extravasation by antitumor agents. Cancer 1982; 49:1796-1799.
- Lau CC & Pardee AB: Mechanism by which caffeine potentiates lethality of nitrogen mustard. Proc Natl Acad Sci USA 1982; 79:2942-2946.
- Leibowitz MJ & Merker PC: The effect of nitrogen mustard intoxication on glucose absorption from the small intestine of the rat. Gut 1971; 12:123-125.
- Lewis RA: Lewis' Dictionary of Toxicology, Lewis Publishers, Boca Raton, FL, 1998.
- Lewis RJ: Sax's Dangerous Properties of Industrial Materials, 10th ed, Van Nostrand Reinhold Company, New York, NY, 2000.
- Lieberman P, Nicklas R, Randolph C, et al: Anaphylaxis-a practice parameter update 2015. Ann Allergy Asthma Immunol 2015; 115(5):341-384.
- Lieberman P, Nicklas RA, Oppenheimer J, et al: The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol 2010; 126(3):477-480.
- Loth TS & Eversmann WW Jr: Treatment methods for extravasation of chemotherapeutic agents. J Hand Surg 1986; 388-396.
- Lynch DJ, Key JC, & White RR: Management and prevention of infiltration and extravasation injury. Surg Clin North Am 1979; 59:939-949.
- Meggs WJ & Hoffman RS: Fatality resulting from intraventricular vincristine administration. J Toxicol Clin Toxicol 1998; 36(3):243-246.
- Mennuti MT, Shepard TH, & Mellman WJ: Fetal renal malformation following treatment of Hodgkin's disease during pregnancy. Obstet Gynecol 1975; 46:194-196.
- Mennuti MT, Shepard TH, & Mellman WJ: Fetal renal malformation following treatment of Hodgkins disease during pregnancy. Obstet Gynecol 1975a; 46:194-196.
- Mitchell MS: Neoplastic diseases In: Burrow GN & Ferris TF (Eds): Medical Complications During Pregnancy, 4th. WB Saunders Company, Philadelphia, PA, 1995.
- Muller M: Does nitrogen mustard affect the foetus directly or secondarily by its effects on the mother?. Experientia 1966; 22:247.
- NFPA: Fire Protection Guide to Hazardous Materials, 13th ed., National Fire Protection Association, Quincy, MA, 2002.
- NHLBI ARDS Network: Mechanical ventilation protocol summary. Massachusetts General Hospital. Boston, MA. 2008. Available from URL: http://www.ardsnet.org/system/files/6mlcardsmall_2008update_final_JULY2008.pdf. As accessed 2013-08-07.
- NRC: Acute Exposure Guideline Levels for Selected Airborne Chemicals - Volume 1, Subcommittee on Acute Exposure Guideline Levels, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission of Life Sciences, National Research Council. National Academy Press, Washington, DC, 2001.
- NRC: Acute Exposure Guideline Levels for Selected Airborne Chemicals - Volume 2, Subcommittee on Acute Exposure Guideline Levels, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission of Life Sciences, National Research Council. National Academy Press, Washington, DC, 2002.
- NRC: Acute Exposure Guideline Levels for Selected Airborne Chemicals - Volume 3, Subcommittee on Acute Exposure Guideline Levels, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission of Life Sciences, National Research Council. National Academy Press, Washington, DC, 2003.
- NRC: Acute Exposure Guideline Levels for Selected Airborne Chemicals - Volume 4, Subcommittee on Acute Exposure Guideline Levels, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission of Life Sciences, National Research Council. National Academy Press, Washington, DC, 2004.
- Naradzay J & Barish RA: Approach to ophthalmologic emergencies. Med Clin North Am 2006; 90(2):305-328.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 1,2,3-Trimethylbenzene (Proposed). United States Environmental Protection Agency. Washington, DC. 2006k. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d68a&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 1,2,4-Trimethylbenzene (Proposed). United States Environmental Protection Agency. Washington, DC. 2006m. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d68a&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 1,2-Butylene Oxide (Proposed). United States Environmental Protection Agency. Washington, DC. 2008d. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648083cdbb&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 1,2-Dibromoethane (Proposed). United States Environmental Protection Agency. Washington, DC. 2007g. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064802796db&disposition=attachment&contentType=pdf. As accessed 2010-08-18.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 1,3,5-Trimethylbenzene (Proposed). United States Environmental Protection Agency. Washington, DC. 2006l. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d68a&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for 2-Ethylhexyl Chloroformate (Proposed). United States Environmental Protection Agency. Washington, DC. 2007b. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648037904e&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Acrylonitrile (Proposed). United States Environmental Protection Agency. Washington, DC. 2007c. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648028e6a3&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Adamsite (Proposed). United States Environmental Protection Agency. Washington, DC. 2007h. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020fd29&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Agent BZ (3-quinuclidinyl benzilate) (Proposed). United States Environmental Protection Agency. Washington, DC. 2007f. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064803ad507&disposition=attachment&contentType=pdf. As accessed 2010-08-18.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Allyl Chloride (Proposed). United States Environmental Protection Agency. Washington, DC. 2008. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648039d9ee&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Aluminum Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005b. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Arsenic Trioxide (Proposed). United States Environmental Protection Agency. Washington, DC. 2007m. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480220305&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Automotive Gasoline Unleaded (Proposed). United States Environmental Protection Agency. Washington, DC. 2009a. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7cc17&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Biphenyl (Proposed). United States Environmental Protection Agency. Washington, DC. 2005j. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064801ea1b7&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Bis-Chloromethyl Ether (BCME) (Proposed). United States Environmental Protection Agency. Washington, DC. 2006n. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648022db11&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Boron Tribromide (Proposed). United States Environmental Protection Agency. Washington, DC. 2008a. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064803ae1d3&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Bromine Chloride (Proposed). United States Environmental Protection Agency. Washington, DC. 2007d. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648039732a&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Bromoacetone (Proposed). United States Environmental Protection Agency. Washington, DC. 2008e. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064809187bf&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Calcium Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005d. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Carbonyl Fluoride (Proposed). United States Environmental Protection Agency. Washington, DC. 2008b. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064803ae328&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Carbonyl Sulfide (Proposed). United States Environmental Protection Agency. Washington, DC. 2007e. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648037ff26&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Chlorobenzene (Proposed). United States Environmental Protection Agency. Washington, DC. 2008c. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064803a52bb&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Cyanogen (Proposed). United States Environmental Protection Agency. Washington, DC. 2008f. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064809187fe&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Dimethyl Phosphite (Proposed). United States Environmental Protection Agency. Washington, DC. 2009. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7cbf3&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Diphenylchloroarsine (Proposed). United States Environmental Protection Agency. Washington, DC. 2007l. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020fd29&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Ethyl Isocyanate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008h. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648091884e&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Ethyl Phosphorodichloridate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008i. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480920347&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Ethylbenzene (Proposed). United States Environmental Protection Agency. Washington, DC. 2008g. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064809203e7&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Ethyldichloroarsine (Proposed). United States Environmental Protection Agency. Washington, DC. 2007j. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020fd29&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Germane (Proposed). United States Environmental Protection Agency. Washington, DC. 2008j. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480963906&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Hexafluoropropylene (Proposed). United States Environmental Protection Agency. Washington, DC. 2006. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064801ea1f5&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Ketene (Proposed). United States Environmental Protection Agency. Washington, DC. 2007. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020ee7c&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Magnesium Aluminum Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005h. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Magnesium Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005g. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Malathion (Proposed). United States Environmental Protection Agency. Washington, DC. 2009k. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064809639df&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Mercury Vapor (Proposed). United States Environmental Protection Agency. Washington, DC. 2009b. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a8a087&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methyl Isothiocyanate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008k. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480963a03&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methyl Parathion (Proposed). United States Environmental Protection Agency. Washington, DC. 2008l. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480963a57&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methyl tertiary-butyl ether (Proposed). United States Environmental Protection Agency. Washington, DC. 2007a. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064802a4985&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methylchlorosilane (Proposed). United States Environmental Protection Agency. Washington, DC. 2005. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5f4&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methyldichloroarsine (Proposed). United States Environmental Protection Agency. Washington, DC. 2007i. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020fd29&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Methyldichlorosilane (Proposed). United States Environmental Protection Agency. Washington, DC. 2005a. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c646&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Nitrogen Mustard (HN1 CAS Reg. No. 538-07-8) (Proposed). United States Environmental Protection Agency. Washington, DC. 2006a. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d6cb&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Nitrogen Mustard (HN2 CAS Reg. No. 51-75-2) (Proposed). United States Environmental Protection Agency. Washington, DC. 2006b. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d6cb&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Nitrogen Mustard (HN3 CAS Reg. No. 555-77-1) (Proposed). United States Environmental Protection Agency. Washington, DC. 2006c. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d6cb&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Nitrogen Tetroxide (Proposed). United States Environmental Protection Agency. Washington, DC. 2008n. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648091855b&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Nitrogen Trifluoride (Proposed). United States Environmental Protection Agency. Washington, DC. 2009l. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480963e0c&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Parathion (Proposed). United States Environmental Protection Agency. Washington, DC. 2008o. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480963e32&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Perchloryl Fluoride (Proposed). United States Environmental Protection Agency. Washington, DC. 2009c. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7e268&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Perfluoroisobutylene (Proposed). United States Environmental Protection Agency. Washington, DC. 2009d. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7e26a&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phenyl Isocyanate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008p. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648096dd58&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phenyl Mercaptan (Proposed). United States Environmental Protection Agency. Washington, DC. 2006d. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020cc0c&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phenyldichloroarsine (Proposed). United States Environmental Protection Agency. Washington, DC. 2007k. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020fd29&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phorate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008q. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648096dcc8&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phosgene (Draft-Revised). United States Environmental Protection Agency. Washington, DC. 2009e. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a8a08a&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Phosgene Oxime (Proposed). United States Environmental Protection Agency. Washington, DC. 2009f. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7e26d&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Potassium Cyanide (Proposed). United States Environmental Protection Agency. Washington, DC. 2009g. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7cbb9&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Potassium Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005c. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Propargyl Alcohol (Proposed). United States Environmental Protection Agency. Washington, DC. 2006e. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020ec91&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Selenium Hexafluoride (Proposed). United States Environmental Protection Agency. Washington, DC. 2006f. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020ec55&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Silane (Proposed). United States Environmental Protection Agency. Washington, DC. 2006g. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d523&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Sodium Cyanide (Proposed). United States Environmental Protection Agency. Washington, DC. 2009h. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7cbb9&disposition=attachment&contentType=pdf. As accessed 2010-08-15.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Sodium Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005i. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Strontium Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005f. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Sulfuryl Chloride (Proposed). United States Environmental Protection Agency. Washington, DC. 2006h. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020ec7a&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Tear Gas (Proposed). United States Environmental Protection Agency. Washington, DC. 2008s. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648096e551&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Tellurium Hexafluoride (Proposed). United States Environmental Protection Agency. Washington, DC. 2009i. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7e2a1&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Tert-Octyl Mercaptan (Proposed). United States Environmental Protection Agency. Washington, DC. 2008r. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648096e5c7&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Tetramethoxysilane (Proposed). United States Environmental Protection Agency. Washington, DC. 2006j. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d632&disposition=attachment&contentType=pdf. As accessed 2010-08-17.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Trimethoxysilane (Proposed). United States Environmental Protection Agency. Washington, DC. 2006i. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d632&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Trimethyl Phosphite (Proposed). United States Environmental Protection Agency. Washington, DC. 2009j. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=0900006480a7d608&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Trimethylacetyl Chloride (Proposed). United States Environmental Protection Agency. Washington, DC. 2008t. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648096e5cc&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for Zinc Phosphide (Proposed). United States Environmental Protection Agency. Washington, DC. 2005e. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020c5ed&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances: Acute Exposure Guideline Levels (AEGLs) for n-Butyl Isocyanate (Proposed). United States Environmental Protection Agency. Washington, DC. 2008m. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=09000064808f9591&disposition=attachment&contentType=pdf. As accessed 2010-08-12.
- National Heart,Lung,and Blood Institute: Expert panel report 3: guidelines for the diagnosis and management of asthma. National Heart,Lung,and Blood Institute. Bethesda, MD. 2007. Available from URL: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf.
- National Institute for Occupational Safety and Health: NIOSH Pocket Guide to Chemical Hazards, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Cincinnati, OH, 2007.
- National Institutes of Health Clinical Center Nursing Department: SOP: care of the patient receiving intravenous cytotoxics or biological agents. NIH. Bethesda, MDAvailable from URL: http://www.cc.nih.gov/nursing/ivctxsop.html.
- National Research Council : Acute exposure guideline levels for selected airborne chemicals, 5, National Academies Press, Washington, DC, 2007.
- National Research Council: Acute exposure guideline levels for selected airborne chemicals, 6, National Academies Press, Washington, DC, 2008.
- National Research Council: Acute exposure guideline levels for selected airborne chemicals, 7, National Academies Press, Washington, DC, 2009.
- National Research Council: Acute exposure guideline levels for selected airborne chemicals, 8, National Academies Press, Washington, DC, 2010.
- None Listed: ASHP Therapeutic Guidelines on the Pharmacologic Management of Nausea and Vomiting in Adult and Pediatric Patients Receiving Chemotherapy or Radiation Therapy or Undergoing Surgery. Am J Health Syst Pharm 1999; 56(8):729-764.
- None Listed: Position paper: cathartics. J Toxicol Clin Toxicol 2004; 42(3):243-253.
- Nowak RM & Macias CG : Anaphylaxis on the other front line: perspectives from the emergency department. Am J Med 2014; 127(1 Suppl):S34-S44.
- O'Marcaigh AS, Johnson CM, & Smithson WA: Successful treatment of intrathecal methotrexate overdose by using ventriculolumbar perfusion and trathecal instillation of carboxypeptidase G2. Mayo Clin Proc 1996; 71:161-165.
- Peate WF: Work-related eye injuries and illnesses. Am Fam Physician 2007; 75(7):1017-1022.
- Peters BG: Technical considerations in the preparation and dispensing of chemotherapy. Top Hosp Pharm Manage 1995; 14:78-88.
- Pollack MM, Dunbar BS, & Holbrook PR: Aspiration of activated charcoal and gastric contents. Ann Emerg Med 1981; 10:528-529.
- Product Information: COMPAZINE(R) tablets, injection, suppositories, syrup, prochlorperazine tablets, injection, suppositories, syrup. GlaxoSmithKline, Research Triangle Park, NC, 2004.
- Product Information: Compazine(R), prochlorperazine maleate spansule. GlaxoSmithKline, Research Triangle Park, NC, 2002.
- Product Information: KEPIVANCE(TM) IV injection, palifermin IV injection. Amgen Inc, Thousand Oaks, CA, 2005.
- Product Information: LEUKINE(R) subcutaneous, IV injection, sargramostim subcutaneous, IV injection. Bayer Healthcare, Seattle, WA, 2008.
- Product Information: Mustargen(R) intravenous injection, mechlorethamine HCl intravenous injection. Merck & Co. Inc., Whitehouse Station, NJ, 2009.
- Product Information: NEUPOGEN(R) IV, subcutaneous injection, filgrastim IV, subcutaneous injection. Amgen Manufacturing, Thousand Oaks, CA, 2010.
- Product Information: VALCHLOR(TM) topical gel, mechlorethamine topical gel. Ceptaris Therapeutics, Inc. (per FDA), Malvern, PA, 2013.
- Product Information: diphenhydramine HCl intravenous injection solution, intramuscular injection solution, diphenhydramine HCl intravenous injection solution, intramuscular injection solution. Hospira, Inc. (per DailyMed), Lake Forest, IL, 2013.
- Product Information: promethazine hcl rectal suppositories, promethazine hcl rectal suppositories. Perrigo, Allegan, MI, 2007.
- RTECS : Registry of Toxic Effects of Chemical Substances. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires 1988; provided by Truven Health Analytics Inc., Greenwood Village, CO.
- RTECS : Registry of Toxic Effects of Chemical Substances. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires 1991; provided by Truven Health Analytics Inc., Greenwood Village, CO.
- RTECS : Registry of Toxic Effects of Chemical Substances. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires 4/30/2001; provided by Truven Health Analytics Inc., Greenwood Village, CO.
- RTECS : Registry of Toxic Effects of Chemical Substances. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires 8/31/2002; provided by Truven Health Analytics Inc., Greenwood Village, CO.
- Rau NR, Nagaraj MV, Prakash PS, et al: Fatal pulmonary aspiration of oral activated charcoal. Br Med J 1988; 297:918-919.
- Requena L, Requena C, & Sanchez M: Chemical Warfare. Cutaneous lesions from mustard gas. J Am Acad Dermatol 1988; 19:529-536.
- Schardein JL: Chemically Induced Birth Defects, 3rd ed, Marcel Dekker Inc, New York, NY, 1993.
- Schulmeister L: Extravasation management: clinical update. Semin Oncol Nurs 2011; 27(1):82-90.
- Schulmeister L: Managing vesicant extravasations. Oncologist 2008; 13(3):284-288.
- Sensenbrenner LL & Owens AH Jr: The effects of mechlorethamine on bone marrow function and iron metabolism in man. Johns Hopkins Med J 1967; 121:162-174.
- Sharp JG, Thomas DB, & Briscoe CV: Prolonged effects of nitrogen mustard on mouse haematopoietic and lymphoid tissues. Scand J Haematol 1975; 14:313-319.
- Sittig M: Handbook of Toxic and Hazardous Chemicals and Carcinogens, 3rd ed, Noyes Publications, Park Ridge, NJ, 1991.
- Smith TJ, Khatcheressian J, Lyman GH, et al: 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 2006; 24(19):3187-3205.
- Spiller HA & Rogers GC: Evaluation of administration of activated charcoal in the home. Pediatrics 2002; 108:E100.
- Stolbach A & Hoffman RS: Respiratory Principles. In: Nelson LS, Hoffman RS, Lewin NA, et al, eds. Goldfrank's Toxicologic Emergencies, 9th ed. McGraw Hill Medical, New York, NY, 2011.
- Stull DM, Bilmes R, Kim H, et al: Comparison of sargramostim and filgrastim in the treatment of chemotherapy-induced neutropenia. Am J Health Syst Pharm 2005; 62(1):83-87.
- Thakore S & Murphy N: The potential role of prehospital administration of activated charcoal. Emerg Med J 2002; 19:63-65.
- The University of Kansas Hospital: Guide to extravasation management in adult & pediatric patients. The University of Kansas Hospital. Kansas City, KS. 2009. Available from URL: http://www2.kumc.edu/pharmacy/guidelines/Extravasations%20diagram.pdf. As accessed 2012-09-11.
- Thomas L & Andes WA: Fetal anomaly associated with successful chemotherapy for Hodgkin's disease in the pregnant patient. Cancer 1976; 38:1443-1451.
- Trainor KJ, Seshadri RS, & Morley AA: Residual marrow injury following cytotoxic drugs. Leukemia Res 1979; 3:205-210.
- Trethewie ER: Wartime research on nitrogen mustard. Nature 1979; 282:128.
- U.S. Department of Energy, Office of Emergency Management: Protective Action Criteria (PAC) with AEGLs, ERPGs, & TEELs: Rev. 26 for chemicals of concern. U.S. Department of Energy, Office of Emergency Management. Washington, DC. 2010. Available from URL: http://www.hss.doe.gov/HealthSafety/WSHP/Chem_Safety/teel.html. As accessed 2011-06-27.
- U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project : 11th Report on Carcinogens. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Washington, DC. 2005. Available from URL: http://ntp.niehs.nih.gov/INDEXA5E1.HTM?objectid=32BA9724-F1F6-975E-7FCE50709CB4C932. As accessed 2011-06-27.
- U.S. Environmental Protection Agency: Discarded commercial chemical products, off-specification species, container residues, and spill residues thereof. Environmental Protection Agency's (EPA) Resource Conservation and Recovery Act (RCRA); List of hazardous substances and reportable quantities 2010b; 40CFR(261.33, e-f):77-.
- U.S. Environmental Protection Agency: Integrated Risk Information System (IRIS). U.S. Environmental Protection Agency. Washington, DC. 2011. Available from URL: http://cfpub.epa.gov/ncea/iris/index.cfm?fuseaction=iris.showSubstanceList&list_type=date. As accessed 2011-06-21.
- U.S. Environmental Protection Agency: List of Radionuclides. U.S. Environmental Protection Agency. Washington, DC. 2010a. Available from URL: http://www.gpo.gov/fdsys/pkg/CFR-2010-title40-vol27/pdf/CFR-2010-title40-vol27-sec302-4.pdf. As accessed 2011-06-17.
- U.S. Environmental Protection Agency: List of hazardous substances and reportable quantities. U.S. Environmental Protection Agency. Washington, DC. 2010. Available from URL: http://www.gpo.gov/fdsys/pkg/CFR-2010-title40-vol27/pdf/CFR-2010-title40-vol27-sec302-4.pdf. As accessed 2011-06-17.
- U.S. Environmental Protection Agency: The list of extremely hazardous substances and their threshold planning quantities (CAS Number Order). U.S. Environmental Protection Agency. Washington, DC. 2010c. Available from URL: http://www.gpo.gov/fdsys/pkg/CFR-2010-title40-vol27/pdf/CFR-2010-title40-vol27-part355.pdf. As accessed 2011-06-17.
- U.S. Occupational Safety and Health Administration: Part 1910 - Occupational safety and health standards (continued) Occupational Safety, and Health Administration's (OSHA) list of highly hazardous chemicals, toxics and reactives. Subpart Z - toxic and hazardous substances. CFR 2010 2010; Vol6(SEC1910):7-.
- U.S. Occupational Safety, and Health Administration (OSHA): Process safety management of highly hazardous chemicals. 29 CFR 2010 2010; 29(1910.119):348-.
- US Army: Military Chemistry and Chemical Compounds. Departments of The Army and Air Force, Washington, DC (Field Manual No 3. Air Force Regulation No 355-7, 1975.
- United States Environmental Protection Agency Office of Pollution Prevention and Toxics: Acute Exposure Guideline Levels (AEGLs) for Vinyl Acetate (Proposed). United States Environmental Protection Agency. Washington, DC. 2006. Available from URL: http://www.regulations.gov/search/Regs/contentStreamer?objectId=090000648020d6af&disposition=attachment&contentType=pdf. As accessed 2010-08-16.
- Upton J, Mulliken JB, & Murray JE: Major intravenous extravasation injuries. Am J Surg 1979; 137(4):497-506.
- Upton J, Mulliken JB, & Murray JE: Major intravenous extravasation injuries. Am J Surg 1979a; 137:497-506.
- Van Scott EJ & Yu RJ: Melanogenesis from topical mechlorethamine and analogues in skin of hairless mice and in vitiligo. J Invest Dermatol 1975; 65:476-478.
- Vanden Hoek,TL; Morrison LJ; Shuster M; et al: Part 12: Cardiac Arrest in Special Situations 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. American Heart Association. Dallas, TX. 2010. Available from URL: http://circ.ahajournals.org/cgi/reprint/122/18_suppl_3/S829. As accessed 2010-10-21.
- Vonderheid EC: Topical mechlorethamine chemotherapy. Int J Dermatol 1984; 23:180-186.
- Wang GQ & Xia ZF: Tissue injury by hot fluid containing nitrogen mustard. Burns 2007; 33(7):923-926.
- Weiss HD, Walker MD, & Wiernik PH: Neurotoxicity of commonly used antineoplastic agents (Second of two parts). New Eng J Med 1974; 291:127-133.
- Wengstrom Y, Margulies A, & European Oncology Nursing Society Task Force: European Oncology Nursing Society extravasation guidelines. Eur J Oncol Nurs 2008; 12(4):357-361.
- Widemann BC, Balis FM, Shalabi A, et al: Treatment of accidental intrathecal methotrexate overdose with intrathecal carboxypeptidase G2. J Nat Cancer Inst 2004; 96(20):1557-1559.
- Willson DF, Truwit JD, Conaway MR, et al: The Adult Calfactant in Acute Respiratory Distress Syndrome (CARDS) Trial. Chest 2015; Epub:Epub.
- Wilson DF, Thomas NJ, Markovitz BP, et al: Effect of exogenous surfactant (calfactant) in pediatric acute lung injury. A randomized controlled trial. JAMA 2005; 293:470-476.
- Yosowitz P, Ekland DA, & Shaw RC: Peripheral intravenous infiltration necrosis. Ann Surg 1975; 182:553-556.
- Zackheim HS & Smuckler EA: Tumorigenic effect of topical mechlorethamine, BCNU and CCNU in mice. Experientia 1980; 36:1211-1212.
- Zemlickis D, Lishner M, Degendorfer P, et al: Fetal outcome after in utero exposure to cancer chemotherapy. Arch Intern Med 1992; 152:573-576.
- epa: EPA chemical profile on mechlorethamine, Environmental Protection Agency, Washington, DC, 1985.
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