MEPERIDINE

Meperidine is a narcotic analgesic used for the relief of moderate to severe pain, for obstetrical analgesia, as a preoperative medication, and for support of anesthesia (Prod Info DEMEROL(R) oral tablets, 2011).

FORMS

Meperidine is available as a parenteral solution (10, 25, 50, 75, and 100 mg/mL), as well as a syrup (50 mg/5 mL), solution (50 mg/5 mL), and tablets (50 and 100 mg) for oral administration (Prod Info DEMEROL(R) oral tablets, 2011; Prod Info DEMEROL(R) injection, 2005; Prod Info Demerol(R), 2002).

-CLINICAL EFFECTS

GENERAL CLINICAL EFFECTS

USES: Meperidine is a narcotic analgesic used for the relief of moderate to severe pain, obstetrical analgesia, as a preoperative medication, and for support of anesthesia.

PHARMACOLOGY: Meperidine is a mu and kappa opioid agonist. In therapeutic doses, it produces euphoria and analgesia.

TOXICOLOGY: Therapeutic and toxic effects are mediated by different opioid receptors. Mu 1: Supraspinal and peripheral analgesia, sedation, and euphoria. Mu 2: Spinal analgesia, respiratory depression, physical dependence, GI dysmotility, bradycardia and pruritus. Kappa 1: Spinal analgesia and miosis. Kappa 2: Dysphoria and psychotomimesis. Kappa 3: Supraspinal analgesia. Chronic opioid users develop tolerance to the analgesic and euphoric effects, but not to the respiratory depression effects. Meperidine has an active metabolite (normeperidine) which may accumulate after repeated high doses or in patients with renal failure and cause seizures and myoclonus. Meperidine inhibits serotonin uptake and may also precipitate serotonin syndrome in combination with other serotonergic drugs.

EPIDEMIOLOGY: Meperidine overdose is uncommon as the medication is decreasingly used. Severe toxicity can occur.

WITH POISONING/EXPOSURE

MILD TO MODERATE TOXICITY: Lightheadedness, dizziness, nausea, vomiting, urinary retention, sedation, and disorientation.
SEVERE TOXICITY: Higher doses and longer-term administration have been associated with central nervous system excitatory effects such as agitation, tremors, myoclonus, motor weakness, and seizures. Excitatory symptoms are thought to be due to the metabolite, normeperidine, which has a longer half-life than the parent compound and thus accumulates with frequently repeated high dose use of meperidine. Respiratory and CNS depression can occur from large doses. Meperidine can cause signs of serotonin toxicity such as muscle rigidity, tremor, confusion, behavioral changes, and autonomic instability usually when used with other serotonergic drugs. A syndrome closely resembling moderate to severe idiopathic Parkinson's disease has been described in intravenous and intranasal drug users following use of a derivative of meperidine, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Orofacial dyskinesias, arm flexion, and stiffening of the legs have been observed.
DRUG INTERACTION: Concomitant administration with monoamine oxidase inhibitors can cause a severe reaction (eg, hyperthermia, hypertension, muscle rigidity, coma, mental status changes, seizures, death). Meperidine may precipitate serotonin syndrome when administered with other serotonergic drugs.

WITH THERAPEUTIC USE

COMMON: Lightheadedness, dizziness, sedation, nausea, vomiting, and sweating. OTHER EFFECTS: Asthenia, confusion, headache, weakness, syncope, constipation, dry mouth, seizures, tremors, myoclonus, delirium, euphoria, dysphoria, agitation, transient hallucinations and disorientation, urinary retention, hypotension, tachycardia, bradycardia, palpitations, pruritus, flushing, urticaria, injection site pain and irritation, visual disturbances, anaphylactic reactions, muscle rigidity, biliary tract spasm, and respiratory depression. Histamine release, leading to hypotension and/or tachycardia, flushing, sweating, and pruritus, has been reported in patients receiving meperidine.

Editor's Note: An ERG guide with information appropriate to this material does not exist.

-FIRST AID

FIRST AID AND PREHOSPITAL TREATMENT

PREHOSPITAL: Prehospital decontamination is not recommended because of the potential for CNS depression and seizures.

-RANGE OF TOXICITY

MINIMUM LETHAL EXPOSURE

CASE REPORT: A 7-year-old boy received meperidine for pain control after an outpatient tonsillectomy and adenoidectomy. The patient became extremely lethargic after receiving meperidine. The medication was discontinued. Day one post-surgery the patient was found dead at home. Postmortem blood concentrations were as follows: 1.27 mcg/mL meperidine from the heart blood; 0.76 mcg/mL normeperidine from the heart blood; 0.86 mcg/mL meperidine in the CSF; 0.40 mcg/mL normeperidine in the CSF. The cause of death as determined by the medical examiner was meperidine intoxication complicated by pneumonia (Watson et al, 2003).

MAXIMUM TOLERATED EXPOSURE

CASE REPORT: A 17-year-old girl was found unconscious approximately 2.5 hours after ingesting 200 meperidine 50 mg tablets (15 g). She presented with a Glasgow Coma Score (GCS) of 3, respiratory rate of 6 breaths/min, a heart rate of 130 beats/min, and pinpoint pupils. She improved after 2 mg IV naloxone, but 90 minutes later seized and was intubated. She later developed tremor, hyperreflexia, myoclonus, clonus, dilated pupils, and tachycardia. Following supportive therapy, she gradually improved over the next 48 hours. The serum meperidine concentration at presentation was 6.5 mg/L and normeperidine was undetectable (Karunatilake & Buckley, 2007).

CASE REPORT: A 41-year-old man with a history of clompiramine-induced serotonin syndrome 5 years before presentation, developed serotonin syndrome immediately after receiving a single dose of meperidine 30 mg injection. He experienced dizziness, nausea, numbness of limbs, palpitations, nervousness, mild tremors with clonic jerks, chest pressure, hypertension, tachycardia, tachypnea, and fever. Following supportive care, including IV labetalol, his symptoms gradually improved after 30 minutes (Guo et al, 2009).

One retrospective review has shown that patients who receive more than 10 mg/kg/day of intravenous patient-controlled analgesia (IV PCA) meperidine are at higher risk of central nervous system excitatory effects (Simopoulos et al, 2002).

CASE REPORT: An 8-day old boy (gestational age of 27 weeks, birth weight 980 g) received a 10-fold overdose of meperidine. Meperidine was administered without dilution. The boy received 8 mg of meperidine instead of the prescribed 0.8 mg dose. The only observed adverse effect was a decline in blood pressure. The patient's blood pressure went from 45 mmHg to 30 mmHg. The child was given three doses of naloxone and a dopamine infusion was started to maintain blood pressure. A plasma meperidine concentration of 2397 ng/mL was measured 5 hours after the overdose. Meperidine was not detectable at 72 hours. The child showed normal development at one year of age (Pokela, 1997).

CASE REPORT: A 26-year-old woman was hospitalized with complaints of abdominal pain and headaches. Day 10 of hospital stay, the patient experienced bilateral twitching of upper extremities, which developed into tremors in all extremities, and eventually to a tonic clonic seizure lasting one minute in duration. The seizure abated with out medical treatment. The patient had received 300 mg of meperidine divided into three doses prior to the seizure. Review of the patients medication history revealed that she had received 5.4 grams of meperidine from the time of admission. Plasma meperidine and normeperidine levels were 590 ng/mL and 930 ng/mL, respectively from samples drawn 2 hours prior to the seizure. The seizure was attributed to meperidine as no neurologic findings were noted(Mauro et al, 1986).

CASE SERIES: Three cases if meperidine-related seizures were reported with patient-controlled analgesia pump (PCAP) administration of meperidine (Hagmeyer et al, 1993).

A 35-year-old woman was hospitalized for sickle cell crisis. She was initiated on meperidine 150 mg/hour via PCAP, with boluses of 25 mg meperidine every 15 minutes as needed. The patient experienced a generalized tonic-clonic seizure after approximately 135 hours of receiving meperidine. The patient was given lorazepam 1 mg. A second seizure was noted a few minutes later, which was treated with diazepam 5 mg. Meperidine was withheld and no further seizures occurred. The total dose of meperidine was 21 grams. Meperidine and normeperidine concentrations measured six hours after the seizures were 300 ng/mL (therapeutic, 70 - 500 ng/mL) and 7450 ng/mL (toxic, > 480 ng/mL), respectively.
A 33-year-old woman was hospitalized for a total abdominal hysterectomy and bilateral salpingo-oophorectomy. The patient was placed on PCAP with meperidine 10 mg every 15 minutes. The dose was titrated to meperidine 30 mg every 15 minutes, with no continuous infusion of meperidine. Post operation day 2, the patient seized for approximately 5 minutes. The patient also became diaphoretic, tachy cardiac, and combative. Meperidine was discontinued and no further events occurred. The cumulative meperidine dose was 2.7 grams over two days. Meperidine and normeperidine blood concentrations measured eight hours after the seizure were 1300 ng/mL (therapeutic, 70 - 500 ng/mL) and 1000 ng/mL (toxic, > 480 ng/mL), respectively.
A 22-year-old-man was admitted to the hospital in sickle-cell crisis. He was started on a PCAP with meperidine at 100 mg/hour and on demand boluses of 25 mg every 15 minutes as needed. Day 3, the meperidine dosage was decreased to 75 mg/hour with 25 mg demand doses every 30 minutes as needed. After a cumulative meperidine dose of 7.84 grams over 5 days, the patient experienced two episodes of myoclonic jerks involving his entire body that resolved without treatment. Meperidine was discontinued. Meperidine and normeperidine blood concentrations measured on Day 5 were 620 ng/mL (therapeutic, 70 - 500 ng/mL) and 1130 ng/mL (toxic, > 480 ng/mL), respectively.

Carcinogenicity Ratings for CAS57-42-1 :

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): Not Listed
NIOSH (National Institute for Occupational Safety and Health, 2007): Not Listed
MAK (DFG, 2002): Not Listed
NTP (U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project ): Not Listed

TOXICITY AND RISK ASSESSMENT VALUES

EPA IRIS

EPA Risk Assessment Values for CAS57-42-1 (U.S. Environmental Protection Agency, 2011):

Not Listed

TOXICITY VALUES

LD50- (INTRAVENOUS)MOUSE:
- 34700 ug/kg (RTECS, 2006)
LD50- (INTRAVENOUS)RAT:
- 22500 ug/kg(RTECS, 2006)
LD50- (ORAL)RAT:
- 162 mg/kg (RTECS, 2006)
LD50- (SUBCUTANEOUS)RAT:
- 113 mg/kg (RTECS, 2006)
LD50- (ORAL)MOUSE:
- 200 mg/kg (RTECS, 2006)
LD50- (SUBCUTANEOUS)MOUSE:
- 112 mg/kg (RTECS, 2006)

-STANDARDS AND LABELS

WORKPLACE STANDARDS

ACGIH TLV Values for CAS57-42-1 (American Conference of Governmental Industrial Hygienists, 2010):

Not Listed

AIHA WEEL Values for CAS57-42-1 (AIHA, 2006):

Not Listed

NIOSH REL and IDLH Values for CAS57-42-1 (National Institute for Occupational Safety and Health, 2007):

Not Listed

OSHA PEL Values for CAS57-42-1 (U.S. Occupational Safety, and Health Administration (OSHA), 2010):

Not Listed

OSHA List of Highly Hazardous Chemicals, Toxics, and Reactives for CAS57-42-1 (U.S. Occupational Safety and Health Administration, 2010):

Not Listed

ENVIRONMENTAL STANDARDS

EPA CERCLA, Hazardous Substances and Reportable Quantities for CAS57-42-1 (U.S. Environmental Protection Agency, 2010):

Not Listed

EPA CERCLA, Hazardous Substances and Reportable Quantities, Radionuclides for CAS57-42-1 (U.S. Environmental Protection Agency, 2010):

Not Listed

EPA RCRA Hazardous Waste Number for CAS57-42-1 (U.S. Environmental Protection Agency, 2010b):

Not Listed
Editor's Note: The D, F, and K series waste numbers and Appendix VIII to Part 261 -- Hazardous Constituents were not included. Please refer to 40 CFR Part 261.

EPA SARA Title III, Extremely Hazardous Substance List for CAS57-42-1 (U.S. Environmental Protection Agency, 2010):

Not Listed

EPA SARA Title III, Community Right-to-Know for CAS57-42-1 (40 CFR 372.65, 2006; 40 CFR 372.28, 2006):

Not Listed

DOT List of Marine Pollutants for CAS57-42-1 (49 CFR 172.101 - App. B, 2005):

Not Listed

EPA TSCA Inventory for CAS57-42-1 (EPA, 2005):

Not Listed

LABELS

NFPA

NFPA Hazard Ratings for CAS57-42-1 (NFPA, 2002):

Not Listed

-PERSONAL PROTECTION

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

PROTECTIVE CLOTHING

CHEMICAL PROTECTIVE CLOTHING. Search results for CAS 57-42-1.

Specific recommendations and test data for this chemical were not found in the available manufacturers' product literature. A complete list of consulted manufacturers and references is presented below.

-PHYSICAL HAZARDS

FIRE HAZARD

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

FLAMMABILITY CLASSIFICATION

NFPA Flammability Rating for CAS57-42-1 (NFPA, 2002):

Not Listed

FIRE CONTROL/EXTINGUISHING AGENTS

Editor's Note: An ERG guide with information appropriate to this material does not exist.

NFPA Extinguishing Methods for CAS57-42-1 (NFPA, 2002):

Not Listed

EVACUATION PROCEDURES

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

AIHA ERPG Values for CAS57-42-1 (AIHA, 2006):

Not Listed

DOE TEEL Values for CAS57-42-1 (U.S. Department of Energy, Office of Emergency Management, 2010):

Not Listed

AEGL Values for CAS57-42-1 (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; 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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):

Not Listed

NIOSH IDLH Values for CAS57-42-1 (National Institute for Occupational Safety and Health, 2007):

Not Listed

CONTAINMENT/WASTE TREATMENT OPTIONS

SUMMARY

Editor's Note: An ERG guide with information appropriate to this material does not exist.

SMALL LEAK/SPILL

Editor's Note: An ERG guide with information appropriate to this material does not exist.

LARGE LEAK/SPILL

Editor's Note: An ERG guide with information appropriate to this material does not exist.

-PHYSICAL/CHEMICAL PROPERTIES

MOLECULAR WEIGHT

MEPERIDINE: 247.34 (Budavari, 1996)

MEPERIDINE HYDROCHLORIDE: 283.8 (Prod Info meperidine hcl oral tablets, oral solution, 2005)

DESCRIPTION/PHYSICAL STATE

Meperidine hydrochloride is a white crystalline substance that has a slightly bitter taste, a melting point of 186 to 189 degrees C, and is readily soluble in water (Prod Info DEMEROL(R) oral tablets, 2011; Prod Info meperidine hcl oral tablets, oral solution, 2005).

3.5 to 6 (injection) (Prod Info DEMEROL(R) injection, 2005)

OTHER/PHYSICAL

DISSOCIATION CONSTANT

pKa 7.7 to 8.15 (Osol & Hoover, 1975)

-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.

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.

AAP: Emergency drug doses for infants and children and naloxone use in newborns: clarification. AAP: Pediatrics 1989; 83:803.

AIHA: 2006 Emergency Response Planning Guidelines and Workplace Environmental Exposure Level Guides Handbook, American Industrial Hygiene Association, Fairfax, VA, 2006.

AMA Department of Drugs: AMA Drug Evaluations, 6th. American Medical Association, Chicago, IL, 1986.

AMA Department of DrugsAMA Department of Drugs: AMA Evaluations Subscription, American Medical Association, Chicago, IL, 1992.

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: American Academy of Pediatrics: Reappraisal of lytic cocktail/Demerol(R), Phenergan(R), and Thorazine(R) (DPT) for the sedation of children. Pediatrics 1995; 95:598-601.

Anon: Street drugs yield primative Parkinson's model. JAMA 1983; 250:13-14.

Appleton R: Lorazepam vs diazepam in the acute treatment of epileptic seizures and status epilepticus.. Dev Med Child Neuro 1995; 37:682-688.

Armstrong PJ & Bersten A: Normeperidine toxicity. Anesth Analg 1986; 65:536-538.

Armstrong PJ & Bersten A: Normeperidine toxicity. Anesth Analg 1986a; 65:536-538.

Balaban M & Slinger P: Severe hypotension from epidural meperidine in a high-risk patient after thoracotomy. Can J Anaesth 1989; 36(4):450-453.

Balestrero LM, Beaver CR, & Rigas JR: Hypertensive crisis following meperidine administration and chemoembolization of a carcinoid tumor. Arch Intern Med 2000; 160:2394-2395.

Baris S, Karakaya D, & Sarihasan B: A dose of 1 mg kg(-1) meperidine causes muscle rigidity in infants? (letter). Paediatr Anaesth 2000; 10:684.

Beaule PE, Smith MI, & Nguyen VN: Meperidine-induced seizure after revision hip arthroplasty. J Arthroplasty 2004; 19(4):516-519.

Bennett WM, Aronoff GR, Golper TA, et alBennett WM, Aronoff GR, Golper TA, et al: Drug Prescribing in Renal Failure, American College of Physicians, Philadelphia, PA, 1987.

Bennett WM, Aronoff GR, Golper TA, et alBennett WM, Aronoff GR, Golper TA, et al: Drug Prescribing in Renal Failure, American College of Physicians, Philadelphia, PA, 1994.

Bergman H, Raz A, & Feingold A: Physiology of MPTP tremor. Movement Dis 1998; 13(Suppl 3):29-34.

Booth J, Lindsay DR, Olufolabi AJ, et al: Subarachnoid meperidine (pethidine) causes significant nausea and vomiting during labor. Anesthesiology 2000; 93(2):418-421.

Boreus LO, Skoldefors E, & Ehrnebo M: Appearance of pethidine and norpethidine in cerebrospinal fluid of man following intramuscular injection of pethidine. Acta Anaesthesiol Scand 1983; 27:222-225.

Boyer EW & Shannon M: The serotonin syndrome. N Eng J Med 2005; 352(11):1112-1120.

Brice JEH, Moreland TA, Parija AC, et al: Plasma naloxone levels in the newborn after intravenous and intramuscular administration. Br J Clin Pharmacol 1979; 8:412P-413P.

Brophy GM, Bell R, Claassen J, et al: Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012; 17(1):3-23.

Budavari S: The Merck Index, 12th ed, Merck & Company, Inc, Rahway, NJ, 1996.

Burn JJ: The physiological disposition and the fate of meperidine in man and a method for its estimation in plasma. J Pharmacol Exp Ther 1955; 114:289.

Burton AW, Conroy B, & Garcia E: Illicit substance abuse via an implanted intrathecal pump. Anesthesiol 1998; 89:1264-1267.

Chamberlain JM, Altieri MA, & Futterman C: A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children. Ped Emerg Care 1997; 13:92-94.

Chin RF , Neville BG , Peckham C , et al: Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. Lancet Neurol 2008; 7(8):696-703.

Choonara IA & Rane A: Therapeutic drug monitoring of anticonvulsants state of the art. Clin Pharmacokinet 1990; 18:318-328.

Christenson J, Etherington J, & Grafstein E: Early discharge of patients with presumed opioid overdose: development of a clinical prediction rule. Acad Emerg Med 2000; 7:1110-1118.

Claassen JAHR & Gelissen HPMM: The serotonin syndrome (letter). N Eng J Med 2005; 352(23):2455.

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.

Danziger LH, Martin SJ, & Blum RA: Central nervous system toxicity associated with meperidine use in hepatic disease. Pharmacotherapy 1994; 14:235-238.

Davis GC, Williams AC, & Markey SP: Chronic Parkinsonism secondary to intravenous injection of meperidine analogues. Psychiatr Res 1979; 1:249-254.

De Negri M & Baglietto MG: Treatment of status epilepticus in children. Paediatr Drugs 2001; 3(6):411-420.

Dougherty JA, Young H, & Shafi T: Serotonin syndrome induced by amitriptyline, meperidine, and venlafaxine. Ann Pharmacother 2002; 36(10):1647-1648.

Duberstein JL & Kaufman DM: A clinical study of an epidemic of heroin intoxication and heroin-induced pulmonary edema. Am J Med 1971; 51:704-714.

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/.

Eaton DG, Wertheim D, Oozeer R, et al: The effect of pethidine on the neonatal EEG. Dev Med Child Neurol 1992; 34:155-163.

Evans LE, Swainson CP, & Roscoe P: Treatment of drug overdosage with naloxone, a specific narcotic antagonist. Lancet 1973; 1:452-455.

Fischer CG & Cook DR: The respiratory and narcotic antagonistic effects of naloxone in infants. Anesth Analg 1974; 53:849-852.

Flacke JW, Flacke WE, Bloor BC, et al: Histamine release by four narcotics: a double-blind study in humans. Anesth Analg 1987; 66:723-730.

Fruncillo RJ: Toxin-induced Parkinsonism: recent developments. Clin Pharmacol 1986; 33:251-254.

Gal TJ: Naloxone reversal of buprenorphine-induced respiratory depression. Clin Pharmacol Ther 1989; 45:66-71.

Geller RJ: Meperidine in patient-controlled analgesia: a near-fatal mishap. Anesth Analg 1993; 76:655-657.

Giang DW & McBride MC : Lorazepam versus diazepam for the treatment of status epilepticus. Pediatr Neurol 1988; 4(6):358-361.

Gibbs J, Newson T, & Williams J: Naloxone hazard in infant of opioid abuser (letter). Lancet 1989; 2:159-160.

Gillman PK: Ecstasy, serotonin syndrome and the treatment of hyperpyrexia (letter). MJA 1997; 167:109-111.

Gillman PK: Successful treatment of serotonin syndrome with chlorpromazine (letter). MJA 1996; 165:345.

Gilman AG, Goodman LS, & Gilman AGilman AG, Goodman LS, & Gilman A (Eds): Goodman and Gilman's The Pharmacological Basis of Therapeutics, 7th. MacMillan Publishing Company, New York, 1985.

Goetting MG & Thirman MJ: Neurotoxicity of meperidine. Ann Emerg Med 1985; 14:1007-1009.

Goldberg RJ & Huk M: Serotonin syndrome from trazodone and buspirone (letter). Psychosomatics 1992; 33:235-236.

Graham PM: Successful treatment of the toxic serotonin syndrome with chlorpromazine (letter). Med J Australia 1997; 166:166-167.

Guo SL , Wu TJ , Liu CC , et al: Meperidine-induced serotonin syndrome in a susceptible patient. Br J Anaesth 2009; 103(3):369-370.

Hagmeyer KO, Mauro LS, & Mauro VF: Meperidine-related seizures associated with patient-controlled analgesia pumps. Ann Pharmacother 1993; 27(1):29-32.

Hassan H, Bastani B, & Gellens M: Successful treatment of normeperidine neurotoxicity by hemodialysis. Am J Kid Dis 2000; 35:146-149.

Hegenbarth MA & American Academy of Pediatrics Committee on Drugs: Preparing for pediatric emergencies: drugs to consider. Pediatrics 2008; 121(2):433-443.

Hershley LA: Meperidine and central neurotoxicity. Ann Intern Med 1983; 98:548-549.

Hilgenhurst G, Sukiennik AW, Anderson ML, et al: Paraplegia after continuous subdural meperidine infusion. Anesthesiology 1994; 80:462-466.

Hoffman JR, Schriger DL, & Luo JS: The empiric use of naloxone in patients with altered mental status: A reappraisal. Ann Emerg Med 1991; 20:246-252.

Howland MA & Nelson LS: Opioid Antagonists. In: Nelson LS, Lewin NA, Howland MA, et al, eds. Goldfrank’s Toxicologic Emergencies, McGraw Hill, New York, NY, 2011, pp 579-585.

Howland MA: Opioid Antagonists. In: Goldfrank LR, Flomenbaum N, eds. Goldfrank's Toxicologic Emergencies. 8th ed., 8th ed. McGraw-Hill, New York, NY, 2006, pp -.

Husemeyer RP, Cummings AJ, Rosankiewicz JR, et al: A study of pethidine kinetics and analgesia in women in labour following intravenous, intramuscular and epidural administration. Br J Clin Pharmacol 1982; 13:171-176.

Hvidberg EF & Dam M: Clinical pharmacokinetics of anticonvulsants. Clin Pharmacokinet 1976; 1:161.

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: 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.

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.

Isenhower HL & Mueller BA: Selection of narcotic analgesics for pain associated with pancreatitis. Am J Health-Syst Pharm 1998; 55:480-486.

Ito S: Drug therapy for breast-feeding women. NEJM 2000; 343(2):118-126.

Jacobsen J, Flachs H, Dich-Nielsen JO, et al: Comparative plasma concentration profiles after IV, IM, and rectal administration of pethidine in children. Br J Anaesth 1988; 60:623-626.

Jasinski DR, Pevnick JS, & Griffith ID: Human pharmacology and abuse potential of analgesic buprenorphine. Arch Gen Psychiatry 1978; 35:501-516.

Kaiko RF, Foley KM, Grabinski PY, et al: Central nervous system excitatory effects of meperidine in cancer patients. Ann Neurol 1983; 13:180-185.

Kaiser KG & Bainton CR: Treatment of intrathecal morphine overdose by aspiration of cerebrospinal fluid. Anesth Analg 1987; 66:475-477.

Karunatilake H & Buckley NA: Severe neurotoxicity following oral meperidine (pethidine) overdose. Clin Toxicol (Phila) 2007; 45(2):200-201.

Kelly AM & Koutsogiannis Z: Intranasal naloxone for life threatening opioid toxicity. Emerg Med J 2002; 19:375.

Kerr D , Kelly AM , Dietze P , et al: Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction 2009; 104(12):2067-2074.

Kitagawa N, Oda M, & Totoki T: Meperidine-induced muscular rigidity during spinal anesthesia?. Anesth Analg 2006; 103(2):490-491.

Kleinman ME, Chameides L, Schexnayder SM, et al: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 14: pediatric advanced life support. Circulation 2010; 122(18 Suppl.3):S876-S908.

Kline SS, Mauro LS, & Scala-Barnett DM: Serotonin syndrome versus neuroleptic malignant syndrome as a cause of death. Clin Pharmac 1989; 8:510-514.

Klotz U, McHorse TS, Wilkinson GR, et al: The effect of cirrhosis on the disposition and elimination of meperidine. Clin Pharmacol Ther 1974; 16:667-675.

Knight B, Thomson N, & Perry G: Seizures due to norpethidine toxicity. Aust N Z J Med 2000; 30:513.

Knight B, Thomson N, & Perry G: Seizures due to norpethidine toxicity. Aust NZ J Med 2000a; 30:513.

Krauss B & Green SM: Procedural sedation and analgesia in children. Lancet 2006; 367(9512):766-780.

Langston JW: MPTP neurotoxicity: an overview and characterization of phases of toxicity. Life Sciences 1985; 36:201-206.

Lavonas EJ, Drennan IR, Gabrielli A, et al: Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132(18 Suppl 2):S501-S518.

Lawrence CA: Pethidine-induced hypertension in phaeochromocytoma. Br Med J 1978; 21:149-150.

Lee RV: Drug abuse In: Burrow GN & Ferris TF (Eds): Medical Complications During Pregnancy, 4th. WB Saunders Company, Philadelphia, PA, 1994.

Levy JH & Rockoff MA: Anaphylaxis to meperidine. Anesth Analg 1982; 3:301-303.

Lieberman AN & Goldstein M: Reversible parkinsonism related to meperidine (letter). N Engl J Med 1985; 312(8):509.

Loddenkemper T & Goodkin HP: Treatment of Pediatric Status Epilepticus. Curr Treat Options Neurol 2011; Epub:Epub.

Maio RF, Gaukel B, & Freeman B: Intralingual naloxone injection for narcotic-induced respiratory depression. Ann Emerg Med 1987; 16:572-573.

Manno EM: New management strategies in the treatment of status epilepticus. Mayo Clin Proc 2003; 78(4):508-518.

Marinella MA: Meperidine-induced generalized seizures with normal renal function. South Med J 1997; 90:556-558.

Mason PJ, Morris VA, & Balcezak TJ: Serotonin syndrome. Presentation of 2 cases and review of the literature. Medicine (Baltimore) 2000; 79(4):201-209.

Mather LE, Tucker GT, Pflug AE, et al: Meperidine kinetics in man: intravenous injection in surgical patients and volunteers. Clin Pharmacol Ther 1975; 17:21-30.

Maurette P, Bonada G, Djiane V, et al: A comparison between lidocaine alone and lidocaine with meperidine for continuous spinal anesthesia. Reg Anesth 1993; 18(5):290-295.

Maurette P, Tauzin-Fin P, Vincon G, et al: Arterial and ventricular CSF pharmacokinetics after intrathecal meperidine in humans. Anesthesiology 1989; 70:961-966.

Mauro VF, Bonfiglio MF, & Spunt AL: Meperidine-induced seizure in a patient without renal dysfunction or sickle cell anemia. Clin Pharm 1986; 5(10):837-839.

Mauro VF, Bonfiglio MF, & Spunt AL: Meperidine-induced seizure in a patient without renal dysfunction or sickle cell anemia. Clin Pharm 1986a; 5:837-839.

McCann B, Hunter R, & McCann J: Cocaine/heroin induced rhabdomyolysis and ventricular fibrillation. Emerg Med J 2002; 19:264-265.

McHorse TS, Wilkinson GR, Johnson RF, et al: Effects of acute viral hepatitis in man on the disposition and elimination of meperidine. Gastroenterology 1975; 68:775-780.

McHugh GJ: Norpethidine accumulation and generalized seizure during pethidine patient-controlled analgesia. Anaesth Intensive Care 1999; 27(3):289-291.

Mills KC: Serotonin syndrome: a clinical update. Med Toxicol 1997; 13:763-783.

Mitchell WG: Status epilepticus and acute repetitive seizures in children, adolescents, and young adults: etiology, outcome, and treatment. Epilepsia 1996; 37(S1):S74-S80.

Mofenson HC & Caraccio TR: Continuous infusion of intravenous naloxone (letter). Ann Emerg Med 1987; 16:374-375.

Morisy L & Platt D: Hazards of high-dose meperidine. JAMA 1986; 255(4):467-468.

Morisy L & Platti D: Hazards of high-dose meperidine. JAMA 1986; 255:467-468.

NFPA: Fire Protection Guide to Hazardous Materials, 13th ed., National Fire Protection Association, Quincy, MA, 2002.

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.

Nahata MC, Clotz MA, & Krogg EA: Adverse effects of meperidine, promethazine and chlorpromazine for sedation in pediatric patients. Clin Pediatr 1985; 24:558-560.

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 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 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.

Odar-Cederlof I, Boreus LO, Bondesson U, et al: Comparison of renal excretion of pethidine (meperidine) and its metabolites in old and young patients. Eur J Clin Pharmacol 1985; 28(2):171-175.

Osol A & Hoover JE (Eds): Remington's Pharmaceutical Sciences, 15th ed. Mack Publishing Company, Easton, PA, USA, 1975.

Peberdy MA , Callaway CW , Neumar RW , et al: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care science. Part 9: post–cardiac arrest care. Circulation 2010; 122(18 Suppl 3):S768-S786.

Persson MP, Hartvig P, Wiklund L, et al: Pulmonary disposition of pethidine in postoperative patients. Br J Clin Pharmacol 1988; 25:235-241.

Pokela ML: Overdoses of pethidine given to two preterm neonates. Acta Paediatr 1997; 86(3):323-325.

Product Information: ATIVAN(R) injection, lorazepam injection. Baxter Healthcare Corporation, Deerfield, IL, 2003.

Product Information: DEMEROL(R) injection, meperidine hcl injection. Hospira,Inc, Lake Forest, IL, 2005.

Product Information: DEMEROL(R) oral tablets, meperidine HCl oral tablets. sanofi-aventis U.S. LLC (per DailyMed), Bridgewater, NJ, 2014.

Product Information: DEMEROL(R) oral tablets, meperidine HCl oral tablets. sanofi-aventis U.S. LLC, Bridgewater, NJ, 2011.

Product Information: Demerol(R) oral tablets, meperidine HCl oral tablets. sanofi-aventis U.S. LLC (per FDA), Bridgewater, NJ, 2011.

Product Information: Demerol(R), meperidine hydrochloride. Sanofi-Synthelabo Inc., New York, NY, 2002.

Product Information: Demerol(R), meperidine hydrochloride. Sanofi-Synthelabo Inc., New York, NY, 2002a.

Product Information: EVZIO(TM) injection solution, naloxone HCl injection solution. Kaleo, Inc. (per FDA), Richmond, VA, 2014.

Product Information: Meperidine HCl intramuscular subcutaneous intravenous injection, meperidine HCl intramuscular subcutaneous intravenous injection. West-ward Pharmaceutical Corp. (per DailyMed), Eatontown, NJ, 2011.

Product Information: NARCAN(R) nasal spray, naloxone HCl nasal spray. Adapt Pharma (per FDA), Radnor, PA, 2015.

Product Information: diazepam IM, IV injection, diazepam IM, IV injection. Hospira, Inc (per Manufacturer), Lake Forest, IL, 2008.

Product Information: dopamine hcl, 5% dextrose IV injection, dopamine hcl, 5% dextrose IV injection. Hospira,Inc, Lake Forest, IL, 2004.

Product Information: lorazepam IM, IV injection, lorazepam IM, IV injection. Akorn, Inc, Lake Forest, IL, 2008.

Product Information: meperidine hcl injection, meperidine hcl injection. Hospira,Inc, Lake Forest, IL, 2005.

Product Information: meperidine hcl oral tablets, oral solution, meperidine hcl oral tablets, oral solution. Roxane Laboratories,Inc, Columbus, OH, 2005.

Product Information: naloxone HCl IV, IM, subcutaneous injection solution, naloxone HCl IV, IM, subcutaneous injection solution. Hospira, Inc (per DailyMed), Lake Forest, IL, 2008.

Product Information: norepinephrine bitartrate injection, norepinephrine bitartrate injection. Sicor Pharmaceuticals,Inc, Irvine, CA, 2005.

Przedborski S & Jackson-Lewis V: Mechanisms of MPTP toxicity. Movement Dis 1998; 13(Suppl 1):35-38.

Qureshi A, Wassmer E, Davies P, et al: Comparative audit of intravenous lorazepam and diazepam in the emergency treatment of convulsive status epilepticus in children. Seizure 2002; 11(3):141-144.

RTECS: Registry of Toxic Effects of Chemical Substances. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires 2006; provided by Truven Health Analytics Inc., Greenwood Village, CO.

Rayburn W, Leuschen P, Earl R, et al: Intravenous meperidine during labor: a randomized comparison between nursing- and patient-controlled administration. Obstet Gynecol 1989; 74:702-706.

Redfern N: Dihydrocodeine overdose treated with naloxone infusion. Br Med J 1983; 287:751-752.

Ross RT: Drug-induced parkinsonism and other movement disorders. Can J Neurol Sci 1990; 17:155-162.

Rossiter A & Souney PF: Interaction between MAOIs and opioids: pharmacologic and clinical considerations. Hosp Formul 1993; 28:692-698.

Saneto RP, Fitch JA, & Cohen BH: Acute neurotoxicity of meperidine in an infant. Pediatr Neurol 1996; 14(4):339-341.

Savona-Ventura C, Sammut M, & Sammut C: Pethidine blood concentrations at time of birth. Int J Gynecol Obstet 1991; 36:103-107.

Scott R, Besag FMC, & Neville BGR: Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomized trial. Lancet 1999; 353:623-626.

Silverman ME, Shih RD, & Allegra J: Morphine induces less nausea than meperidine when administered parenterally. J Emerg Med 2004; 27(3):241-243.

Simon EJ & Hiller JMI: The opiate receptors. Ann Rev Pharmacol Toxicol 1978; 18:371-394.

Simopoulos TT , Smith HS , Peeters-Asdourian C , et al: Use of meperidine in patient-controlled analgesia and the development of a normeperidine toxic reaction. Arch Surg 2002; 137(1):84-88.

Snyder SH, Pert CB, & Posternak GW: The opiate receptor. Ann Intern Med 1974; 81:534-540.

Snyder SH: The opiate receptor and morphine-like peptides in the brain. Am J Psychiatry 1978; 135:645-652.

Sreenath TG, Gupta P, Sharma KK, et al: Lorazepam versus diazepam-phenytoin combination in the treatment of convulsive status epilepticus in children: A randomized controlled trial. Eur J Paediatr Neurol 2009; Epub:Epub.

Stambaugh JE: The clinical pharmacology of meperidine -- comparison of routes of administration. J Clin Pharmacol 1976; 16:245.

Steinberg AD & Karlinger JS: The clinical spectrum of heroin pulmonary edema. Arch Intern Med 1968; 122:122-127.

Stern Y: MPTP-induced Parkinsonism. Progress Neurobiol 1990; 34:107-114.

Sternbach H: The serotonin syndrome. Am J Psychiatr 1991; 148:705-713.

Striebel WH, Malewicz J, Hermanns K, et al: Intranasal meperidine titration for postoperative pain relief. Anesth Analg 1993; 76:1047-1051.

Szeto HA, Inturrisi CE, & Houde R: Accumulation of normeperidine, an active metabolite of meperidine, in patients with renal failure or cancer. Ann Intern Med 1977a; 86:738-741.

Szeto HH, Inturrisi CE, Houde R, et al: Accumulation of normeperidine - an active metabolite of meperidine in patients with renal failure or cancer. Ann Intern Med 1977; 86:738-741.

Tandberg D & Abercrombie D: Treatment of heroin overdose with endotracheal naloxone. Ann Emerg Med 1982; 11:443-445.

Tenenbein M: Continuous naloxone infusion for opiate poisoning in infancy. J Pediatr 1984; 105:645-648.

Terenius S: Endogenous peptides and analgesia. Ann Rev Pharmacol Toxicol 1978; 18:189-204.

Tetrud JW & Langston JW: Tremor in MPTP-induced parkinsonism. Neurology 1992; 42:407-410.

Tetrud JW, Langston JW, & Garbe PL: Mild parkinsonism in persons exposed to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Neurology 1989; 39:1483-1487.

Tissot TA: Probable meperidine-induced serotonin syndrome in a patient with a history of fluoxetine use. Anesthesiology 2003; 98(6):1511-1512.

Tomson G, Garle RIM, Thalme B, et al: Maternal kinetics and transplacental passage of pethidine during labour. Br J Clin Pharmacol 1982; 13:653-659.

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-.

Umans JG & Szeto HH: Precipitated opiate abstinence in utero. Am J Obstet Gynecol 1985; 151:441-444.

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.

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.

VandenHoek TL , Morrison LJ , Shuster M , et al: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care science. Part 12: cardiac arrest in special situations. Circulation 2010; 122(18 Suppl 3):S829-S861.

Verbeeck RK, Branch RA, & Wilkinson SR: Meperidine disposition in young adult men. Pharmacologist 1980; 22:230.

Wanger K, Brough L, & Macmillan I: Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose. Acad Emerg Med 1998; 5:293-299.

Watson WA, Litovitz TL, Rodgers GC, et al: 2002 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2003; 21(5):353-421.

Watson WA, Steele MT, & Muelleman RL: Opioid toxicity recurrence after an initial response to naloxone. Clin Toxicol 1998; 36:11-17.

Weber JM, Tataris KL, Hoffman JD, et al: Can nebulized naloxone be used safely and effectively by emergency medical services for suspected opioid overdose?. Prehosp Emerg Care 2012; 16(2):289-292.

Welles B, Belfrage P, & de Chateau P: Effects of naloxone on newborn infant behavior after maternal analgesia with pethidine during labor. Acta Obstet Gynecol Scand 1984; 63:617-619.

Westerling D, Sawe J, & Eklundh G: Near fatal intoxication with controlled- release morphine tablets in a depressed woman. Acta Anaesthesiol Scand 1998; 42:586-589.

Wheless JW : Treatment of status epilepticus in children. Pediatr Ann 2004; 33(6):376-383.

Wiener PC, Hogg MIJ, & Rosen M: Effects of naloxone on pethidine-induced neonatal depression. Part I. Br Med J 1977; 2:228-229.

Wilen SB, Ulreich S, & Rabinowitz JG: Roentgenographic manifestations of methodone-induced pulmonary edema. Radiology 1975; 114:51-55.

Wooten JM: Meperidine-induced neurotoxicity. Intern Med Alert 1992; 14:23.

Wright JM, Wall RA, & Perry TL: Chronic parkinsonism secondary to intranasal administration of a product of meperidine-analogue synthesis. N Engl J Med 1984; 310:325.

Zornberg GL, Bodkin JA, & Cohen BM: Severe adverse interaction between pethidine and selegiline.. Lancet 1991; 337:246.

Zuckerman M, Weisberg SN, & Boyer EW: Pitfalls of intranasal naloxone. Prehosp Emerg Care 2014; 18(4):550-554.

Zuspan GP, Gumpel JA, & Mejia-Zelaya A: Fetal stress from methadone withdrawal. Am J Obstet Gynecol 1975; 122:43-46.

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