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PROPYLENE OXIDE

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Propylene oxide is a chemically highly reactive colorless liquid used as a solvent and intermediate in chemical synthesis of detergents, herbicides, polyurethane foams, propylene glycols, and hydraulic fluids. The liquid is relatively stable but may react violently with materials having a labile hydrogen, particularly in the presence of catalysts. The liquid is also extremely flammable.

Specific Substances

    1) Epoxypropane
    2) Ethylene oxide, methyl
    3) Methyl ethylene oxide
    4) Methyl oxirane
    5) 1,2-Epoxypropane
    6) Propane, epoxy-
    7) Propene oxide
    8) Molecular Formula: C3-H6-O
    9) CAS 75-56-9
    10) PO
    1.2.1) MOLECULAR FORMULA
    1) C3-H6-O

Available Forms Sources

    A) FORMS
    1) Propylene oxide is a colorless liquid with a sweet, alcoholic odor (Bingham et al, 2001).
    2) The United States and western Europe have different formula specifications for propylene oxide. Formulations also vary between manufacturers (HSDB , 2001).
    3) Propylene oxide is often mixed with carbon dioxide to reduce the flammability risk and to absorb the oxides produced by the fumigated materials (HSDB , 2001).
    B) SOURCES
    1) Propylene oxide is synthesized commercially from propylene through the intermediate propylene chlorohydrin. It can also be made by direct oxidation of propylene with air or oxygen. It is not known to occur as a natural product (Bingham et al, 2001; Howard, 1989).
    2) Propylene oxide can be produced by the following methods:
    a) Ethylbenzene, propylene, and oxygen can be mixed by a Arco SM-PO process; and co-produced with styrene (Ashford, 1994).
    b) T-butl hydroperoxide and propylene can be mixed by a Acro TBA-PO process; and co-produced with t-butanol (Ashford, 1994).
    c) Through a process of hypochlorination and dehydrochlorination, propylene, chlorine, and calcium hydroxide can be mixed to form propylene oxide (Ashford, 1994).
    d) Chlorohydration of propylene followed by saponification with lime (Lewis, 1997).
    e) Peroxidation of propylene, but is not used very often (Harbison, 1998; Lewis, 1997).
    f) Epoxidation of propylene by a hydroperoxide complex with molybdenum catalyst or organic hydroperoxide (ACGIH, 1991; Lewis, 1997).
    g) Propylene treated with hypochlorous acid with a chlorohydrin intermediate in the presence of sodium or calcium hydroxide (Harbison, 1998).
    h) It can be emitted into the atmosphere through exhaust from stationary sources that burn hydrocarbons and vehicles (Howard, 1989).
    C) USES
    1) Propylene oxide is used as an anticorrosion agent for cooling agents, fumigant, herbicide, preservative, solvent, soil sterilant, oil demulsifiers, disinfectant and sterilizer, microbiocide, synthetic elastomers, isopropanol amines, and as a chemical intermediate in the preparation of polyethers to form polyurethanes, urethane polyols, dipropylene glycols, propylene glycols, propylene glycol ethers, propoxylated surfactants and detergents, propylene carbonate, synthetic lubricants, hydroxypropylcelluloses and sugars, isopropanolamine, and specialty tapioca starches (AAR, 2000; (ACGIH, 1991; Bingham et al, 2001; Budavari, 2000; Harbison, 1998; Lewis, 1997; Setzer et al, 1996; Verschueren, 2001).
    a) More than 500,000 workers in the USA may be exposed to propylene oxide (Setzer et al, 1996). Propylene oxide is used as a chemical intermediate and to a lesser extent, in foods (Anon, 1994).
    b) Its uses and effects are similar to ethylene oxide, but the effects are less severe and less toxic (Harbison, 1998; Lewis, 1998).

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) Propylene oxide may be irritating to the eyes, skin, and mucous membranes. Exposure to high vapor concentrations may cause CNS effects characterized by headache, ataxia, incoordination, motor weakness, vomiting, and diarrhea.
    B) Contact with the liquid can cause corneal burns, dermatitis, and burns and skin necrosis.
    0.2.4) HEENT
    A) May cause eye irritation ranging from conjunctivitis to corneal burns.
    B) Complex nasal cavity epithelial hyperplasia and nasal tumors have been reported in exposed rats.
    0.2.6) RESPIRATORY
    A) Propylene oxide is an irritant that may cause coughing, dyspnea, noncardiogenic pulmonary edema, or chemical pneumonitis. Cyanosis has occurred. Lung injury has been observed in experimental animals.
    0.2.7) NEUROLOGIC
    A) In high concentrations propylene oxide has caused CNS effects, including CNS depression, headache, motor weakness, incoordination, ataxia, coma, and neuropathy in experimental animal studies.
    0.2.8) GASTROINTESTINAL
    A) Nausea, vomiting and diarrhea may occur after both oral or inhalation exposure.
    0.2.9) HEPATIC
    A) CHRONIC EXPOSURE - Liver injury is uncommon.
    0.2.14) DERMATOLOGIC
    A) Pure propylene oxide may evaporate without causing burns. If confined to the skin by clothing, it may cause irritation or dermal necrosis.
    0.2.20) REPRODUCTIVE
    A) At the time of this review, no reproductive studies were found for propylene oxide in humans.
    B) Propylene oxide may be teratogenic and effects on fertility have been noted in experimental animals. At the time of this review, no data were available to assess the potential effects of exposure to this agent on male reproductive effects or during lactation.
    0.2.21) CARCINOGENICITY
    A) At the time of this review, no studies were found on the potential carcinogenic activity of propylene oxide in humans.

Laboratory Monitoring

    A) If respiratory tract irritation or respiratory depression is evident, monitor arterial blood gases, chest x-ray, and pulmonary function tests.
    B) Monitoring pulse oximetry is recommended for patients with respiratory tract signs or symptoms.
    C) This agent may cause hepatotoxicity. Monitor liver function tests in patients with significant exposure.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) Inducing emesis is not recommended.
    B) 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).
    C) GASTRIC LAVAGE: Consider after ingestion of a potentially life-threatening amount of poison if it can be performed soon after ingestion (generally within 1 hour). Protect airway by placement in the head down left lateral decubitus position or by endotracheal intubation. Control any seizures first.
    1) CONTRAINDICATIONS: Loss of airway protective reflexes or decreased level of consciousness in unintubated patients; following ingestion of corrosives; hydrocarbons (high aspiration potential); patients at risk of hemorrhage or gastrointestinal perforation; and trivial or non-toxic ingestion.
    D) ACTIVATED CHARCOAL: Administer charcoal as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old.
    E) There is no specific antidote. Treatment is symptomatic and supportive.
    F) No studies have addressed the utilization of extracorporeal elimination techniques in poisoning with this agent.
    0.4.3) INHALATION EXPOSURE
    A) 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.
    B) ACUTE LUNG INJURY: Maintain ventilation and oxygenation and evaluate with frequent arterial blood gases and/or pulse oximetry monitoring. Early use of PEEP and mechanical ventilation may be needed.
    0.4.4) EYE EXPOSURE
    A) 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.
    0.4.5) DERMAL EXPOSURE
    A) OVERVIEW
    1) 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).
    2) Treat dermal irritation or burns with standard topical therapy. Patients developing dermal hypersensitivity reactions may require treatment with systemic or topical corticosteroids or antihistamines.

Range Of Toxicity

    A) No specific lethal dose has been established.
    B) The odor threshold is 200 ppm. CNS depressant effects occur in experimental animals exposed to airborne concentrations of 4000 ppm.
    C) The oral LD50 in experimental animals is 690 to 1000 mg/kg; the LC50 is 1700 to 1800 ppm.

Clinical Effects

Summary Of Exposure

    A) Propylene oxide may be irritating to the eyes, skin, and mucous membranes. Exposure to high vapor concentrations may cause CNS effects characterized by headache, ataxia, incoordination, motor weakness, vomiting, and diarrhea.
    B) Contact with the liquid can cause corneal burns, dermatitis, and burns and skin necrosis.

Heent

    3.4.1) SUMMARY
    A) May cause eye irritation ranging from conjunctivitis to corneal burns.
    B) Complex nasal cavity epithelial hyperplasia and nasal tumors have been reported in exposed rats.
    3.4.3) EYES
    A) Propylene oxide caused moderate to severe eye irritation in rabbits in the Standard Draize Test (RTECS , 2001).
    1) CASE REPORT - A worker exposed to an airborne concentration of 1400 to 1500 milligrams per liter for 15 minutes had eye irritation a few minutes after exposure (Beljaev et al, 1971).
    B) Conjunctivitis, irritation, and lacrimation may occur after vapor exposure at levels considerably higher than current workplace permissible exposure levels (Bingham et al, 2001; HSDB , 2001; Jacobson et al, 1956; Plunkett, 1976).
    C) Corneal burns have occurred with direct splash contact. The eyes healed within 48 hours after treatment (McLaughlin, 1946).
    1) Liquid propylene oxide caused reversible damage to rabbit eyes, rated 5 on a scale of 1 to 10. The reaction was similar to that of acetone and reversible in this study (Grant & Schuman, 1993). Carpenter & Smyth (1946) observed severe injury and necrosis when liquid propylene oxide was placed into rabbit eyes.
    3.4.5) NOSE
    A) NASAL DISCHARGE - occurred in dogs exposed to an airborne concentration of 2030 ppm for 4 hours (Jacobson et al, 1956).
    B) Degenerative and hyperplastic changes of the nasal mucosa were observed in rats exposed by inhalation to propylene oxide at airborne concentrations of 30 to 300 ppm for 6 hrs/day, 5 days/wk for 28 months (Kuper et al, 1988; IARC, 1985).

Respiratory

    3.6.1) SUMMARY
    A) Propylene oxide is an irritant that may cause coughing, dyspnea, noncardiogenic pulmonary edema, or chemical pneumonitis. Cyanosis has occurred. Lung injury has been observed in experimental animals.
    3.6.2) CLINICAL EFFECTS
    A) ACUTE LUNG INJURY
    1) Propylene oxide is a primary respiratory irritant (ACGIH, 1991; HSDB , 2001). Noncardiogenic pulmonary edema or chemical pneumonitis with dyspnea may occur (Clayton & Clayton, 1993).
    B) CYANOSIS
    1) CASE REPORT - A worker who inhaled an airborne concentration of 1400 to 1500 mg/L for 10 minutes had headache, a substernal burning sensation, and general asthenia 90 minutes after exposure, followed by cyanosis and collapse (Beljaev et al, 1971; Gosselin et al, 1984).
    2) CASE REPORT - Cyanosis occurred in a Russian worker 2 hours after exposure to an airborne concentration of 1500 ppm for 10 minutes (Gosselin et al, 1984).
    3.6.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) RESPIRATORY DISORDER
    a) Inflammatory respiratory system lesions, lung irritation, and lung injury have been reported in experimental animals (IARC, 1985; Clayton & Clayton, 1981).

Neurologic

    3.7.1) SUMMARY
    A) In high concentrations propylene oxide has caused CNS effects, including CNS depression, headache, motor weakness, incoordination, ataxia, coma, and neuropathy in experimental animal studies.
    3.7.2) CLINICAL EFFECTS
    A) CENTRAL NERVOUS SYSTEM DEFICIT
    1) In humans, effects of overexposure may include mild CNS depression and stupor (HSDB , 2001). In one case of poisoning due to vapor exposure, a male worker experienced initial asthenia, headache and diarrhea. This was followed in 2 hours by cyanosis and collapse. Following symptomatic therapy, he regained consciousness, but remained confused and weak (HSDB , 2001).
    2) In experimental animal studies, exposure to high airborne concentrations resulted in CNS depression (Ohnishi et al, 1988). Similar effects might occur in humans.
    B) NEUROPATHY
    1) In rats, chronic exposures resulted in polyneuropathies, which may be expected to occur in humans following high level exposures over time (Ohnishi et al, 1991).
    C) HEADACHE
    1) CASE REPORT - A worker who inhaled an airborne concentration of 1400 to 1500 milligrams per liter for 10 minutes had headache and general asthenia 90 minutes after exposure, followed by cyanosis and collapse (HSDB , 2001; Beljaev et al, 1971; Gosselin et al, 1984).
    3.7.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) CNS DEPRESSION
    a) Experimental animals exposed to various concentrations developed neuropathies, ataxia, incoordination, general CNS depression, and coma. Chronic high-level exposure for 7 weeks caused motor weakness with pathological findings of central-peripheral distal axonopathy (Hathaway, 1996; (Ohnishi et al, 1988; Jacobson et al, 1956; ACGIH, 1991).
    2) COMA
    a) CNS depression occurs in animals exposed to high concentrations (Hathaway, 1996).
    3) NEUROPATHY
    a) Peripheral motor weakness has been reported in exposed experimental animals (Ohnishi et al, 1988; Jacobson et al, 1956). Other predicted signs include ataxia and incoordination (ACGIH, 1991). Weakness of the hindlegs developed in rats exposed to high airborne concentrations of propylene oxide for 7 weeks. Pathologic findings were compatible with central-peripheral distal axonopathy (Ohnishi et al, 1988).
    b) LACK OF EFFECT - In non-human primates exposed by inhalation to airborne propylene oxide levels of 100 or 300 ppm for 24 months, there were no long-term treatment related peripheral nervous system effects (Setzer et al, 1996).

Gastrointestinal

    3.8.1) SUMMARY
    A) Nausea, vomiting and diarrhea may occur after both oral or inhalation exposure.
    3.8.2) CLINICAL EFFECTS
    A) DIARRHEA
    1) CASE REPORT - Diarrhea occurred in a worker exposed to an airborne concentration of 1500 ppm for 10 minutes (HSDB , 2001; Gosselin et al, 1984; Beljaev et al, 1971).
    3.8.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) VOMITING
    a) DOGS - Vomiting occurred in dogs exposed to an airborne concentration of 2030 ppm for 4 hours (Jacobson et al, 1956; HSDB , 2001).

Hepatic

    3.9.1) SUMMARY
    A) CHRONIC EXPOSURE - Liver injury is uncommon.
    3.9.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) HEPATOCELLULAR DAMAGE
    a) Liver injury is not a common finding, but a group of animals administered 0.3 g/kg had evidence of slight liver injury (Clayton & Clayton, 1993; HSDB , 2001). Slight fatty degeneration of the liver was observed in exposed male guinea pigs (HSDB , 2001).

Dermatologic

    3.14.1) SUMMARY
    A) Pure propylene oxide may evaporate without causing burns. If confined to the skin by clothing, it may cause irritation or dermal necrosis.
    3.14.2) CLINICAL EFFECTS
    A) SKIN IRRITATION
    1) Irritation, blistering, and burns are likely after acute dermal exposure to skin confined by shoes or clothing; solutions more dilute than 10 percent may be more irritating than concentrated solutions. There is usually no effect if the chemical is allowed to evaporate from uncovered skin (HSDB , 2001; Clayton & Clayton, 1993).
    B) CONTACT DERMATITIS
    1) Contact dermatitis and hand eczema have been reported (HSDB , 2001; Bingham et al, 2001).
    2) CASE REPORT - A 52-year-old laboratory technician had contact dermatitis with erythematous and edematous lesions following direct contact with propylene oxide. Positive patch tests to propylene oxide were noted (Steinkraus & Hausen, 1994).
    3.14.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) IRRITATION
    a) RABBITS - Propylene oxide induced severe skin irritation in rabbits in the standard Draize Test and moderate skin irritation in rabbits in the Open Draize Test (RTECS , 2001).
    2) SKIN NECROSIS
    a) RABBITS - 10 and 20 percent solutions were applied to rabbit skin for 6 minutes, producing edema and hyperemia. More significant exposures resulted in scarring (Rowe et al, 1956).
    3) NEOPLASM
    a) RATS - Palpable subcutaneous masses were found in rats chronically exposed to propylene oxide (HSDB , 2001).

Endocrine

    3.16.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) NEOPLASM
    a) In rats exposed to propylene oxide, the incidence of adrenal pheochromocytomas and proliferative lesions of the nasal cavity were increased (Lynch et al, 1984).

Reproductive

    3.20.1) SUMMARY
    A) At the time of this review, no reproductive studies were found for propylene oxide in humans.
    B) Propylene oxide may be teratogenic and effects on fertility have been noted in experimental animals. At the time of this review, no data were available to assess the potential effects of exposure to this agent on male reproductive effects or during lactation.
    3.20.2) TERATOGENICITY
    A) ANIMAL STUDIES
    1) LACK OF EFFECT
    a) Rats exposed to airborne levels of 500 ppm for 7 hours per day, 5 days/week for 3 weeks had a significant reduction in the number of corpora lutea, but no overt teratogenic activity was found (Hardin et al, 1983a). These results indicate that propylene oxide was embryotoxic or fetotoxic, but did not cause birth defects.
    2) FETOTOXICITY
    a) RATS - fetotoxicity and specific developmental abnormalities in the musculoskeletal system and craniofacial area (including nose and tongue) were observed. Changes in litter size were also observed (RTECS , 2001).
    b) Inhalation by pregnant rats has a TCLo of 500 ppm/7 H (1-160 preg) (NTP, 2000).
    c) Exposure of pregnant rats to 500 ppm orally for 6 H/day on days 6-15 of gestation resulted in an increased frequency of seventh cervical ribs in fetuses. The NOAEL was considered to be 300 ppm (Harris, 1989).
    3.20.3) EFFECTS IN PREGNANCY
    A) ANIMAL STUDIES
    1) WEIGHT DECREASE
    a) Parental rats exposed to propylene oxide airborne levels of 300 ppm for 6 hours/day, 5 days/week for 14 weeks had a significant decrease in body weight. No treatment-related effects on mating, fertility, conception, pup survival, pup weights, or pathologic changes were observed (Hayes et al, 1988).
    2) PREGNANCY DISORDER
    a) In rats, inhalation of propylene oxide caused reproductive effects such as decreased implantation sites per dam, corpora lutea, and live fetuses per litter. The percentage of resorbed implantation sites was highest in rats exposed from days 7 through 16 of gestation (Hackett et al, 1982).
    b) In rats, inhalation of propylene oxide before and during the gestational period caused decreased maternal weights, corpora lutea populations, implantation site numbers, live fetus counts, and fetal growth; increasing numbers of rib dysmorphology were found (IARC, 1991).
    c) Increased numbers of resorptions were noted in rabbit litters exposed to propylene oxide from days 1 through 19 of gestation; however, no fetal anomalies were noted (Hackett et al, 1982).
    3.20.4) EFFECTS DURING BREAST-FEEDING
    A) HUMANS
    1) LACK OF INFORMATION
    a) At the time of this review, no data were available to assess the potential effects of exposure to this agent during lactation.
    3.20.5) FERTILITY
    A) ANIMAL STUDIES
    1) FERTILITY DECREASED FEMALE
    a) In rats, pre-implantation mortality, litter size, and other effects on fertility were observed (RTECS , 2001).

Carcinogenicity

    3.21.1) IARC CATEGORY
    A) IARC Carcinogenicity Ratings for CAS75-56-9 (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):
    1) IARC Classification
    a) Listed as: Propylene oxide
    b) Carcinogen Rating: 2B
    1) The agent (mixture) is possibly carcinogenic to humans. The exposure circumstance entails exposures that are possibly carcinogenic to humans. This category is used for agents, mixtures and exposure circumstances for which there is limited evidence of carcinogenicity in humans and less than sufficient evidence of carcinogenicity in experimental animals. It may also be used when there is inadequate evidence of carcinogenicity in humans but there is sufficient evidence of carcinogenicity in experimental animals. In some instances, an agent, mixture or exposure circumstance for which there is inadequate evidence of carcinogenicity in humans but limited evidence of carcinogenicity in experimental animals together with supporting evidence from other relevant data may be placed in this group.
    3.21.2) SUMMARY/HUMAN
    A) At the time of this review, no studies were found on the potential carcinogenic activity of propylene oxide in humans.
    3.21.3) HUMAN STUDIES
    A) LACK OF INFORMATION
    1) Human data was either missing or inconclusive on both the carcinogenic or mutagenic potential in man (Anon, 1994; IARC, 1984).
    B) PANCREATIC CANCER
    1) A study of 1,361 workers employed for at least one year in plants producing ethylene and propylene chlorohydrins and with at least one month of exposure between 1940 and 1992 found no increased mortality from pancreatic cancer (1 observed vs 4 expected) (Olsen et al, 1997). There was also no increased risk of death from lymphopoietic or hematopoietic cancers in this cohort (Olsen et al, 1997).
    3.21.4) ANIMAL STUDIES
    A) CARCINOMA
    1) Propylene oxide was found to be an equivocal tumorigenic agent, carcinogenic, and neoplastic by RTECS criteria in rats with gastrointestinal tumors, endocrine tumors, skin and appendages tumors, and sense organs and special senses tumors. In rats, propylene oxide also appeared to facilitate the action of known carcinogens (RTECS , 2001).
    2) In the mouse, propylene oxide was found to be carcinogenic and neoplastic by RTECS criteria with sense organs and special senses tumors, tumors at the site of application, and the presence of lymphomas including Hodgkin's disease (RTECS , 2001).
    3) In NTP Carcinogenesis Studies (Inhalation), clear evidence of carcinogenicity was found in the mouse and some evidence of carcinogenicity was found in the rat (RTECS , 2001).
    4) Nilsson et al (1991) have determined the human inhalation carcinogenic potency factor for propylene oxide to be 0.001 (mg/Kg/day) based on relevant and pharmacokinetically accurate methods of converting data gained from inhalational studies in mice.
    B) SARCOMA
    1) Dunkelberg (1979) injected (SC) mice with 0.1 to 2.5 mg/animal of propylene oxide. Sarcomas were seen at the injection site, but no significant difference from controls could be seen in tumors at other sites. The frequency was dose related. Sarcomas were also seen in a study by Wapole (1958).
    2) Hemangiomas and hemangiosarcomas of the nasal submucosa were noted in mice exposed to 400 ppm of propylene oxide for 2 years (Renne et al, 1986).
    a) Degenerative and hyperplastic changes of the nasal mucosa were observed in rats exposed by inhalation to propylene oxide in concentrations of 30 to 300 ppm for 6 hrs/day, 5 days/wk for 28 months (Kuper et al, 1988).
    C) CARCINOMA
    1) Propylene oxide caused suppurative inflammation, hyperplasia, and squamous metaplasia in the respiratory epithelium of the nasal turbinates in rats and C-cell adenomas and carcinomas among females; inflammation has been noted in mice (Hathaway, 1996; (IARC, 1985). The nasal cavity is the major site of tumor induction in rats with inhalation exposure (Segerback et al, 1998).
    2) Local squamous-cell carcinomas of the forestomach were observed in rats given 60 and 15 mg/kg propylene oxide in salad oil for 3 years. The first tumors were seen at 79 weeks. No tumors were seen at sites away from the point of administration (Dunkelberg, 1982).
    3) RATS exposed by inhalation to 300 ppm propylene oxide for 6 hrs/day, 5 days/wk for 28 months demonstrated an increased incidence of malignant tumors. Benign and malignant mammary tumors in female rats occurred with the greatest frequency (Kuper et al, 1988). Nasal carcinogenesis in rodents may not be associated with the extent of nonneoplastic nasal lesions in inhalation studies (Haseman & Hailey, 1997).
    D) PHEOCHROMOCYTOMA
    1) In RATS exposed to propylene oxide, the incidence of adrenal pheochromocytomas and proliferative lesions of the nasal cavity was increased (Lynch et al, 1984).
    E) MESOTHELIOMA
    1) RATS - Peritoneal mesotheliomas have been reported following chronic exposure in rats (IARC, 1984).

Genotoxicity

    A) Propylene oxide has been mutagenic in experimental animals. It is mutagenic in Salmonella typhimurium, Escherichia coli, Drosophila spermatozoa and spermatids, and Neurospora crassa assays (Nilsson et al, 1991; Vogel & Nivard, 1998).
    B) Human data on mutagenicity is inconclusive although propylene oxide causes DNA strand breaks in human diploid fibroblasts in vitro. The mean chromosome aberration rate in workers with more than 20 years exposure to propylene oxides was significantly increased compared to controls (HSDB , 2001).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) If respiratory tract irritation or respiratory depression is evident, monitor arterial blood gases, chest x-ray, and pulmonary function tests.
    B) Monitoring pulse oximetry is recommended for patients with respiratory tract signs or symptoms.
    C) This agent may cause hepatotoxicity. Monitor liver function tests in patients with significant exposure.
    4.1.2) SERUM/BLOOD
    A) BLOOD/SERUM CHEMISTRY
    1) This agent may cause hepatotoxicity. Monitor liver function tests in patients with significant exposure.
    4.1.4) OTHER
    A) OTHER
    1) MONITORING
    a) If respiratory tract irritation or respiratory depression is evident, monitor arterial blood gases, chest x-ray, and pulmonary function tests.
    b) Monitoring pulse oximetry is recommended for patients with respiratory tract signs or symptoms.

Radiographic Studies

    A) CHEST RADIOGRAPH
    1) If respiratory tract irritation is present, monitor chest x-ray.

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Monitoring

    A) If respiratory tract irritation or respiratory depression is evident, monitor arterial blood gases, chest x-ray, and pulmonary function tests.
    B) Monitoring pulse oximetry is recommended for patients with respiratory tract signs or symptoms.
    C) This agent may cause hepatotoxicity. Monitor liver function tests in patients with significant exposure.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) EMESIS/ NOT RECOMMENDED
    1) Emesis is not recommended due to the irritant nature of this agent.
    B) DILUTION
    1) 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).
    C) ACTIVATED CHARCOAL
    1) PREHOSPITAL ACTIVATED CHARCOAL ADMINISTRATION
    a) Consider prehospital administration of activated charcoal as an aqueous slurry in patients with a potentially toxic ingestion who are awake and able to protect their airway. Activated charcoal is most effective when administered within one hour of ingestion. Administration in the prehospital setting has the potential to significantly decrease the time from toxin ingestion to activated charcoal administration, although it has not been shown to affect outcome (Alaspaa et al, 2005; Thakore & Murphy, 2002; Spiller & Rogers, 2002).
    1) In patients who are at risk for the abrupt onset of seizures or mental status depression, activated charcoal should not be administered in the prehospital setting, due to the risk of aspiration in the event of spontaneous emesis.
    2) The addition of flavoring agents (cola drinks, chocolate milk, cherry syrup) to activated charcoal improves the palatability for children and may facilitate successful administration (Guenther Skokan et al, 2001; Dagnone et al, 2002).
    2) CHARCOAL DOSE
    a) Use a minimum of 240 milliliters of water per 30 grams charcoal (FDA, 1985). Optimum dose not established; usual dose is 25 to 100 grams in adults and adolescents; 25 to 50 grams in children aged 1 to 12 years (or 0.5 to 1 gram/kilogram body weight) ; and 0.5 to 1 gram/kilogram in infants up to 1 year old (Chyka et al, 2005).
    1) Routine use of a cathartic with activated charcoal is NOT recommended as there is no evidence that cathartics reduce drug absorption and cathartics are known to cause adverse effects such as nausea, vomiting, abdominal cramps, electrolyte imbalances and occasionally hypotension (None Listed, 2004).
    b) ADVERSE EFFECTS/CONTRAINDICATIONS
    1) Complications: emesis, aspiration (Chyka et al, 2005). Aspiration may be complicated by acute respiratory failure, ARDS, bronchiolitis obliterans or chronic lung disease (Golej et al, 2001; Graff et al, 2002; Pollack et al, 1981; Harris & Filandrinos, 1993; Elliot et al, 1989; Rau et al, 1988; Golej et al, 2001; Graff et al, 2002). Refer to the ACTIVATED CHARCOAL/TREATMENT management for further information.
    2) Contraindications: unprotected airway (increases risk/severity of aspiration) , nonfunctioning gastrointestinal tract, uncontrolled vomiting, and ingestion of most hydrocarbons (Chyka et al, 2005).
    6.5.2) PREVENTION OF ABSORPTION
    A) EMESIS
    1) Is not recommended due to the irritant nature of this agent.
    B) DILUTION
    1) 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).
    C) GASTRIC LAVAGE
    1) INDICATIONS: Consider gastric lavage with a large-bore orogastric tube (ADULT: 36 to 40 French or 30 English gauge tube {external diameter 12 to 13.3 mm}; CHILD: 24 to 28 French {diameter 7.8 to 9.3 mm}) after a potentially life threatening ingestion if it can be performed soon after ingestion (generally within 60 minutes).
    a) Consider lavage more than 60 minutes after ingestion of sustained-release formulations and substances known to form bezoars or concretions.
    2) PRECAUTIONS:
    a) SEIZURE CONTROL: Is mandatory prior to gastric lavage.
    b) AIRWAY PROTECTION: Place patients in the head down left lateral decubitus position, with suction available. Patients with depressed mental status should be intubated with a cuffed endotracheal tube prior to lavage.
    3) LAVAGE FLUID:
    a) Use small aliquots of liquid. Lavage with 200 to 300 milliliters warm tap water (preferably 38 degrees Celsius) or saline per wash (in older children or adults) and 10 milliliters/kilogram body weight of normal saline in young children(Vale et al, 2004) and repeat until lavage return is clear.
    b) The volume of lavage return should approximate amount of fluid given to avoid fluid-electrolyte imbalance.
    c) CAUTION: Water should be avoided in young children because of the risk of electrolyte imbalance and water intoxication. Warm fluids avoid the risk of hypothermia in very young children and the elderly.
    4) COMPLICATIONS:
    a) Complications of gastric lavage have included: aspiration pneumonia, hypoxia, hypercapnia, mechanical injury to the throat, esophagus, or stomach, fluid and electrolyte imbalance (Vale, 1997). Combative patients may be at greater risk for complications (Caravati et al, 2001).
    b) Gastric lavage can cause significant morbidity; it should NOT be performed routinely in all poisoned patients (Vale, 1997).
    5) CONTRAINDICATIONS:
    a) Loss of airway protective reflexes or decreased level of consciousness if patient is not intubated, following ingestion of corrosive substances, hydrocarbons (high aspiration potential), patients at risk of hemorrhage or gastrointestinal perforation, or trivial or non-toxic ingestion.
    D) ACTIVATED CHARCOAL
    1) CHARCOAL ADMINISTRATION
    a) Consider administration of activated charcoal after a potentially toxic ingestion (Chyka et al, 2005). Administer charcoal as an aqueous slurry; most effective when administered within one hour of ingestion.
    2) CHARCOAL DOSE
    a) Use a minimum of 240 milliliters of water per 30 grams charcoal (FDA, 1985). Optimum dose not established; usual dose is 25 to 100 grams in adults and adolescents; 25 to 50 grams in children aged 1 to 12 years (or 0.5 to 1 gram/kilogram body weight) ; and 0.5 to 1 gram/kilogram in infants up to 1 year old (Chyka et al, 2005).
    1) Routine use of a cathartic with activated charcoal is NOT recommended as there is no evidence that cathartics reduce drug absorption and cathartics are known to cause adverse effects such as nausea, vomiting, abdominal cramps, electrolyte imbalances and occasionally hypotension (None Listed, 2004).
    b) ADVERSE EFFECTS/CONTRAINDICATIONS
    1) Complications: emesis, aspiration (Chyka et al, 2005). Aspiration may be complicated by acute respiratory failure, ARDS, bronchiolitis obliterans or chronic lung disease (Golej et al, 2001; Graff et al, 2002; Pollack et al, 1981; Harris & Filandrinos, 1993; Elliot et al, 1989; Rau et al, 1988; Golej et al, 2001; Graff et al, 2002). Refer to the ACTIVATED CHARCOAL/TREATMENT management for further information.
    2) Contraindications: unprotected airway (increases risk/severity of aspiration) , nonfunctioning gastrointestinal tract, uncontrolled vomiting, and ingestion of most hydrocarbons (Chyka et al, 2005).
    6.5.3) TREATMENT
    A) IRRITATION SYMPTOM
    1) Observe patients with ingestion carefully for the possible development of esophageal or gastrointestinal tract irritation or burns. If signs or symptoms of esophageal irritation or burns are present, consider endoscopy to determine the extent of injury.
    B) ACUTE LUNG INJURY
    1) ONSET: Onset of acute lung injury after toxic exposure may be delayed up to 24 to 72 hours after exposure in some cases.
    2) NON-PHARMACOLOGIC TREATMENT: The treatment of acute lung injury is primarily supportive (Cataletto, 2012). Maintain adequate ventilation and oxygenation with frequent monitoring of arterial blood gases and/or pulse oximetry. If a high FIO2 is required to maintain adequate oxygenation, mechanical ventilation and positive-end-expiratory pressure (PEEP) may be required; ventilation with small tidal volumes (6 mL/kg) is preferred if ARDS develops (Haas, 2011; Stolbach & Hoffman, 2011).
    a) To minimize barotrauma and other complications, use the lowest amount of PEEP possible while maintaining adequate oxygenation. Use of smaller tidal volumes (6 mL/kg) and lower plateau pressures (30 cm water or less) has been associated with decreased mortality and more rapid weaning from mechanical ventilation in patients with ARDS (Brower et al, 2000). More treatment information may be obtained from ARDS Clinical Network website, NIH NHLBI ARDS Clinical Network Mechanical Ventilation Protocol Summary, http://www.ardsnet.org/node/77791 (NHLBI ARDS Network, 2008)
    3) FLUIDS: Crystalloid solutions must be administered judiciously. Pulmonary artery monitoring may help. In general the pulmonary artery wedge pressure should be kept relatively low while still maintaining adequate cardiac output, blood pressure and urine output (Stolbach & Hoffman, 2011).
    4) ANTIBIOTICS: Indicated only when there is evidence of infection (Artigas et al, 1998).
    5) EXPERIMENTAL THERAPY: Partial liquid ventilation has shown promise in preliminary studies (Kollef & Schuster, 1995).
    6) CALFACTANT: In a multicenter, randomized, blinded trial, endotracheal instillation of 2 doses of 80 mL/m(2) calfactant (35 mg/mL of phospholipid suspension in saline) in infants, children, and adolescents with acute lung injury resulted in acute improvement in oxygenation and lower mortality; however, no significant decrease in the course of respiratory failure measured by duration of ventilator therapy, intensive care unit, or hospital stay was noted. Adverse effects (transient hypoxia and hypotension) were more frequent in calfactant patients, but these effects were mild and did not require withdrawal from the study (Wilson et al, 2005).
    7) However, in a multicenter, randomized, controlled, and masked trial, endotracheal instillation of up to 3 doses of calfactant (30 mg) in adults only with acute lung injury/ARDS due to direct lung injury was not associated with improved oxygenation and longer term benefits compared to the placebo group. It was also associated with significant increases in hypoxia and hypotension (Willson et al, 2015).
    C) SUPPORT
    1) There is no specific antidote. Treatment is symptomatic and supportive.

Inhalation Exposure

    6.7.1) DECONTAMINATION
    A) Move patient from the toxic environment to fresh air. Monitor for respiratory distress. If cough or difficulty in breathing develops, evaluate for hypoxia, respiratory tract irritation, bronchitis, or pneumonitis.
    B) OBSERVATION: Carefully observe patients with inhalation exposure for the development of any systemic signs or symptoms and administer symptomatic treatment as necessary.
    C) INITIAL TREATMENT: Administer 100% humidified supplemental oxygen, perform endotracheal intubation and provide assisted ventilation as required. Administer inhaled beta-2 adrenergic agonists, if bronchospasm develops. Consider systemic corticosteroids in patients with significant bronchospasm (National Heart,Lung,and Blood Institute, 2007). Exposed skin and eyes should be flushed with copious amounts of water.
    6.7.2) TREATMENT
    A) IRRITATION SYMPTOM
    1) Respiratory tract irritation, if severe, can progress to noncardiogenic pulmonary edema which may be delayed in onset up to 24 to 72 hours after exposure in some cases.
    2) There are no controlled studies indicating that early administration of corticosteroids can prevent the development of noncardiogenic pulmonary edema in patients with inhalation exposure to respiratory irritant substances, and long-term use may cause adverse effects (Boysen & Modell, 1989).
    a) However, based on anecdotal experience, some clinicians do recommend early administration of corticosteroids (such as methylprednisolone 1 gram intravenously as a single dose) in an attempt to prevent the later development of pulmonary edema.
    1) Anecdotal experience with dimethyl sulfate inhalation showed possible benefit of methylprednisolone in the TREATMENT of noncardiogenic pulmonary edema (Ip et al, 1989).
    3) Anecdotal experience also indicated that systemic corticosteroids may have possible efficacy in the TREATMENT of drug-induced noncardiogenic pulmonary edema (Zitnik & Cooper, 1990; Stentoft, 1990; Chudnofsky & Otten, 1989) or noncardiogenic pulmonary edema developing after cardiopulmonary bypass (Maggart & Stewart, 1987).
    4) It is not clear from the published literature that administration of systemic corticosteroids early following inhalation exposure to respiratory irritant substances can PREVENT the development of noncardiogenic pulmonary edema. The decision to administer or withhold corticosteroids in this setting must currently be made on clinical grounds.
    B) ACUTE LUNG INJURY
    1) ONSET: Onset of acute lung injury after toxic exposure may be delayed up to 24 to 72 hours after exposure in some cases.
    2) NON-PHARMACOLOGIC TREATMENT: The treatment of acute lung injury is primarily supportive (Cataletto, 2012). Maintain adequate ventilation and oxygenation with frequent monitoring of arterial blood gases and/or pulse oximetry. If a high FIO2 is required to maintain adequate oxygenation, mechanical ventilation and positive-end-expiratory pressure (PEEP) may be required; ventilation with small tidal volumes (6 mL/kg) is preferred if ARDS develops (Haas, 2011; Stolbach & Hoffman, 2011).
    a) To minimize barotrauma and other complications, use the lowest amount of PEEP possible while maintaining adequate oxygenation. Use of smaller tidal volumes (6 mL/kg) and lower plateau pressures (30 cm water or less) has been associated with decreased mortality and more rapid weaning from mechanical ventilation in patients with ARDS (Brower et al, 2000). More treatment information may be obtained from ARDS Clinical Network website, NIH NHLBI ARDS Clinical Network Mechanical Ventilation Protocol Summary, http://www.ardsnet.org/node/77791 (NHLBI ARDS Network, 2008)
    3) FLUIDS: Crystalloid solutions must be administered judiciously. Pulmonary artery monitoring may help. In general the pulmonary artery wedge pressure should be kept relatively low while still maintaining adequate cardiac output, blood pressure and urine output (Stolbach & Hoffman, 2011).
    4) ANTIBIOTICS: Indicated only when there is evidence of infection (Artigas et al, 1998).
    5) EXPERIMENTAL THERAPY: Partial liquid ventilation has shown promise in preliminary studies (Kollef & Schuster, 1995).
    6) CALFACTANT: In a multicenter, randomized, blinded trial, endotracheal instillation of 2 doses of 80 mL/m(2) calfactant (35 mg/mL of phospholipid suspension in saline) in infants, children, and adolescents with acute lung injury resulted in acute improvement in oxygenation and lower mortality; however, no significant decrease in the course of respiratory failure measured by duration of ventilator therapy, intensive care unit, or hospital stay was noted. Adverse effects (transient hypoxia and hypotension) were more frequent in calfactant patients, but these effects were mild and did not require withdrawal from the study (Wilson et al, 2005).
    7) However, in a multicenter, randomized, controlled, and masked trial, endotracheal instillation of up to 3 doses of calfactant (30 mg) in adults only with acute lung injury/ARDS due to direct lung injury was not associated with improved oxygenation and longer term benefits compared to the placebo group. It was also associated with significant increases in hypoxia and hypotension (Willson et al, 2015).
    C) Treatment should include recommendations listed in the ORAL EXPOSURE section when appropriate.

Eye Exposure

    6.8.1) DECONTAMINATION
    A) EYE IRRIGATION, ROUTINE: 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, an ophthalmologic examination should be performed (Peate, 2007; Naradzay & Barish, 2006).
    6.8.2) TREATMENT
    A) BURN
    1) Corneal burns in experimental animals and humans have been reversible with supportive care (Grant & Schuman, 1993; (McLaughlin, 1946).
    B) Treatment should include recommendations listed in the ORAL EXPOSURE section when appropriate.

Dermal Exposure

    6.9.1) DECONTAMINATION
    A) DECONTAMINATION: Remove contaminated clothing and wash exposed area thoroughly with soap and water for 10 to 15 minutes. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
    6.9.2) TREATMENT
    A) PULMONARY EDEMA
    1) ONSET: Onset of acute lung injury after toxic exposure may be delayed up to 24 to 72 hours after exposure in some cases.
    2) NON-PHARMACOLOGIC TREATMENT: The treatment of acute lung injury is primarily supportive (Cataletto, 2012). Maintain adequate ventilation and oxygenation with frequent monitoring of arterial blood gases and/or pulse oximetry. If a high FIO2 is required to maintain adequate oxygenation, mechanical ventilation and positive-end-expiratory pressure (PEEP) may be required; ventilation with small tidal volumes (6 mL/kg) is preferred if ARDS develops (Haas, 2011; Stolbach & Hoffman, 2011).
    a) To minimize barotrauma and other complications, use the lowest amount of PEEP possible while maintaining adequate oxygenation. Use of smaller tidal volumes (6 mL/kg) and lower plateau pressures (30 cm water or less) has been associated with decreased mortality and more rapid weaning from mechanical ventilation in patients with ARDS (Brower et al, 2000). More treatment information may be obtained from ARDS Clinical Network website, NIH NHLBI ARDS Clinical Network Mechanical Ventilation Protocol Summary, http://www.ardsnet.org/node/77791 (NHLBI ARDS Network, 2008)
    3) FLUIDS: Crystalloid solutions must be administered judiciously. Pulmonary artery monitoring may help. In general the pulmonary artery wedge pressure should be kept relatively low while still maintaining adequate cardiac output, blood pressure and urine output (Stolbach & Hoffman, 2011).
    4) ANTIBIOTICS: Indicated only when there is evidence of infection (Artigas et al, 1998).
    5) EXPERIMENTAL THERAPY: Partial liquid ventilation has shown promise in preliminary studies (Kollef & Schuster, 1995).
    6) CALFACTANT: In a multicenter, randomized, blinded trial, endotracheal instillation of 2 doses of 80 mL/m(2) calfactant (35 mg/mL of phospholipid suspension in saline) in infants, children, and adolescents with acute lung injury resulted in acute improvement in oxygenation and lower mortality; however, no significant decrease in the course of respiratory failure measured by duration of ventilator therapy, intensive care unit, or hospital stay was noted. Adverse effects (transient hypoxia and hypotension) were more frequent in calfactant patients, but these effects were mild and did not require withdrawal from the study (Wilson et al, 2005).
    7) However, in a multicenter, randomized, controlled, and masked trial, endotracheal instillation of up to 3 doses of calfactant (30 mg) in adults only with acute lung injury/ARDS due to direct lung injury was not associated with improved oxygenation and longer term benefits compared to the placebo group. It was also associated with significant increases in hypoxia and hypotension (Willson et al, 2015).
    B) SUPPORT
    1) There is no specific antidote. Treatment is symptomatic and supportive.
    C) IRRITATION SYMPTOM
    1) Treat dermal irritation or burns with standard topical therapy. Patients developing dermal hypersensitivity reactions may require treatment with systemic or topical corticosteroids or antihistamines.
    D) Treatment should include recommendations listed in the ORAL EXPOSURE section when appropriate.

Enhanced Elimination

    A) LACK OF DATA
    1) No studies have addressed the utilization of extracorporeal elimination techniques in poisoning with this agent.

Abstracts

Case Reports

    A) ADULT
    1) Gosselin et al (1984) reported on a case from the Russian literature where a worker was exposed to 1500 ppm for about 10 minutes. The initial symptoms were irritation of the eyes and respiratory tract, headache, general anthenia, and diarrhea. Within 2 hours, the patient became cyanotic, CNS depressed, and collapsed.
    2) Oxygen and antihistamines were given for "shock". The patient regained consciousness but remained weak, confused, and vomited. Shortly thereafter, blood pressure and pulse rate became normal and the patient was without symptoms in 24 hours (Beljaev et al, 1971).

Range Of Toxicity

Summary

    A) No specific lethal dose has been established.
    B) The odor threshold is 200 ppm. CNS depressant effects occur in experimental animals exposed to airborne concentrations of 4000 ppm.
    C) The oral LD50 in experimental animals is 690 to 1000 mg/kg; the LC50 is 1700 to 1800 ppm.

Minimum Lethal Exposure

    A) GENERAL/SUMMARY
    1) The minimum lethal human dose to this agent has not been delineated.
    B) ANIMAL DATA
    1) 400 ppm of propylene oxide is a lethal air concentration for rats (OHM/TADS , 2001).
    2) Dogs and guinea pigs died after a 4 hour exposure of propylene oxide at concentrations of 2480 and 4000 ppm, respectively (ACGIH, 1991).
    3) Rats died from an exposure of propylene oxide when gavaged as a 10% olive oil solution at 1.0 g/kg concentration (Bingham et al, 2001).
    4) 2 out of 10 rats died after an exposure of propylene oxide at 7200 ppm after 30 minutes. 5 out of 10 died after 1 hour (Bingham et al, 2001).
    5) The most sensitive laboratory species to acute lethal effects in order from the least sensitive to the most sensitive are guinea pig, rat, mouse, and dog (Bingham et al, 2001).
    6) There are reports of dogs dying after an exposure of propylene oxide at 2030 ppm for 4 hours (Hathaway et al, 1996).

Maximum Tolerated Exposure

    A) ADULT
    1) Propylene oxide is moderately acutely toxic. Jacobson et al (1956) estimated that (based on single exposure data) propylene oxide is 0.5 to 0.3 times as toxic as ethylene oxide. Dilute solutions may cause irritation and necrosis of the skin following direct contact, and the vapors are irritating to the eyes and respiratory tract (Clayton & Clayton, 1993).
    2) While no significant excess of mortality was found in workers occupationally exposed to propylene oxide, corneal burns have resulted from vapor exposure and contact dermatitis has resulted from direct liquid contact. A reduced capacity to repair DNA damage was associated with exposure for 1 to 20 years to 8-hour airborne TWA exposures of 0.6 to 12 ppm and STEL concentrations as high as 1000 ppm (ACGIH, 1991; Clayton & Clayton, 1993).
    3) While individuals exposed to propylene oxide at a concentration of 1500 ppm for 30-170 described the odor as strong, the irritation effects were not intolerable (Bingham et al, 2001).
    4) A case of a single human exposure to 1500 mg/L of propylene oxide for 10 minutes caused lung irritation, diarrhea, and headache. After 2 hours the patient became cyanotic and collapsed. After treatment, the pulse rate and blood pressure returned to normal and he recovered the following day (HSDB , 2001).
    5) Human experimental data from the 1940's describe "eye irritation after about 2 weeks of steady operation" at exposures measuring between 350-900 ppm over two 30-minute exposure periods (Bingham et al, 2001).
    B) ANIMAL DATA
    1) Various experimental animal species were given 79 or more 7-hour exposures to 457 ppm. Only eye and respiratory irritation was noted in most species. A higher death rate was noted in rats who developed pneumonia. Exposure to 200 ppm daily produced no symptoms in this study (Rowe et al, 1956).
    2) CD-1 female mice, infected by streptococcus aerosols, inhaled 20 ppm of propylene oxide for 5 days for 3 hours each day. There were no adverse effects or change in respiratory tract (ACGIH, 1991).
    3) Monkey and rabbits were exposed to 457 ppm of propylene oxide for over 218 days for 7 hours/day 154 times and showed no adverse effects (ACGIH, 1991; Bingham et al, 2001; Grant, 1993; Hathaway et al, 1996).
    4) No ill effects were noted in several species of laboratory animals exposed to repeated daily concentrations at 100 ppm and 200 ppm of propylene oxide, except guinea pigs. After 6 months at 200 ppm, they were found to have a slight increase in lung weight (ACGIH, 1991).
    5) Rats survived an exposure of propylene oxide at 7200 ppm for 0.25 hours (Bingham et al, 2001).
    6) Rats showed no evidence of toxicity after inhalation exposures at 4000 ppm for 30 minutes; 2000 ppm for 2 hours; or 1000 ppm for 7 hours (Bingham et al, 2001).
    7) In a National Toxicology Program inhalation study, no ill effects were noted in mice or rats exposed to 500 ppm for 6 hours/day, 5 day/week, for 13 weeks (Bingham et al, 2001).
    8) 18 doses were spread out over 4 weeks at 0.2 g/kg of propylene oxide as a 10% solution in olive oil, did not produce ill effects in rats. A decrease in body weight, gastric irritation, and slight liver damage occurred when the dose was increased to 0.3 g/kg (Bingham et al, 2001).
    9) Four out of six rats died after a single exposure at 4000 ppm propylene oxide (HSDB , 2001).

Workplace Standards

    A) ACGIH TLV Values for CAS75-56-9 (American Conference of Governmental Industrial Hygienists, 2010):
    1) Editor's Note: The listed values are recommendations or guidelines developed by ACGIH(R) to assist in the control of health hazards. They should only be used, interpreted and applied by individuals trained in industrial hygiene. Before applying these values, it is imperative to read the introduction to each section in the current TLVs(R) and BEI(R) Book and become familiar with the constraints and limitations to their use. Always consult the Documentation of the TLVs(R) and BEIs(R) before applying these recommendations and guidelines.
    a) Adopted Value
    1) Propylene oxide
    a) TLV:
    1) TLV-TWA: 2 ppm
    2) TLV-STEL:
    3) TLV-Ceiling:
    b) Notations and Endnotes:
    1) Carcinogenicity Category: A3
    2) Codes: SEN
    3) Definitions:
    a) A3: Confirmed Animal Carcinogen with Unknown Relevance to Humans: The agent is carcinogenic in experimental animals at a relatively high dose, by route(s) of administration, at site(s), of histologic type(s), or by mechanism(s) that may not be relevant to worker exposure. Available epidemiologic studies do not confirm an increased risk of cancer in exposed humans. Available evidence does not suggest that the agent is likely to cause cancer in humans except under uncommon or unlikely routes or levels of exposure.
    b) SEN: The designation SEN refers to the potential for an agent to produce sensitization, as confirmed by human or animal data. The notation does not imply that this is the critical effect or that this is the sole basis for the TLV. Although, for those TLVs that are based on sensitization, the TLV is meant to protect workers from induction of this effect, but cannot protect workers who have already become sensitized. The notation should be used to assist in identifying sensitization hazards and reducing respiratory, dermal, and conjunctival exposures to sensitizing agents in the workplace. Please see "Definitions and Notations" (in TLV booklet) for full definition.
    c) TLV Basis - Critical Effect(s): Eye and URT irr
    d) Molecular Weight: 58.08
    1) For gases and vapors, to convert the TLV from ppm to mg/m(3):
    a) [(TLV in ppm)(gram molecular weight of substance)]/24.45
    2) For gases and vapors, to convert the TLV from mg/m(3) to ppm:
    a) [(TLV in mg/m(3))(24.45)]/gram molecular weight of substance
    e) Additional information:

    B) NIOSH REL and IDLH Values for CAS75-56-9 (National Institute for Occupational Safety and Health, 2007):
    1) Listed as: Propylene oxide
    2) REL:
    a) TWA:
    b) STEL:
    c) Ceiling:
    d) Carcinogen Listing: (Ca) NIOSH considers this substance to be a potential occupational carcinogen (See Appendix A in the NIOSH Pocket Guide to Chemical Hazards).
    e) Skin Designation: Not Listed
    f) Note(s): See Appendix A
    3) IDLH:
    a) IDLH: 400 ppm
    b) Note(s): Ca
    1) Ca: NIOSH considers this substance to be a potential occupational carcinogen (See Appendix A).

    C) Carcinogenicity Ratings for CAS75-56-9 :
    1) ACGIH (American Conference of Governmental Industrial Hygienists, 2010): A3 ; Listed as: Propylene oxide
    a) A3 :Confirmed Animal Carcinogen with Unknown Relevance to Humans: The agent is carcinogenic in experimental animals at a relatively high dose, by route(s) of administration, at site(s), of histologic type(s), or by mechanism(s) that may not be relevant to worker exposure. Available epidemiologic studies do not confirm an increased risk of cancer in exposed humans. Available evidence does not suggest that the agent is likely to cause cancer in humans except under uncommon or unlikely routes or levels of exposure.
    2) EPA (U.S. Environmental Protection Agency, 2011): B2 ; Listed as: Propylene oxide
    a) B2 : Probable human carcinogen - based on sufficient evidence of carcinogenicity in animals.
    3) 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): 2B ; Listed as: Propylene oxide
    a) 2B : The agent (mixture) is possibly carcinogenic to humans. The exposure circumstance entails exposures that are possibly carcinogenic to humans. This category is used for agents, mixtures and exposure circumstances for which there is limited evidence of carcinogenicity in humans and less than sufficient evidence of carcinogenicity in experimental animals. It may also be used when there is inadequate evidence of carcinogenicity in humans but there is sufficient evidence of carcinogenicity in experimental animals. In some instances, an agent, mixture or exposure circumstance for which there is inadequate evidence of carcinogenicity in humans but limited evidence of carcinogenicity in experimental animals together with supporting evidence from other relevant data may be placed in this group.
    4) NIOSH (National Institute for Occupational Safety and Health, 2007): Ca ; Listed as: Propylene oxide
    a) Ca : NIOSH considers this substance to be a potential occupational carcinogen (See Appendix A in the NIOSH Pocket Guide to Chemical Hazards).
    5) MAK (DFG, 2002): Category 2 ; Listed as: Propylene oxide
    a) Category 2 : Substances that are considered to be carcinogenic for man because sufficient data from long-term animal studies or limited evidence from animal studies substantiated by evidence from epidemiological studies indicate that they can make a significant contribution to cancer risk. Limited data from animal studies can be supported by evidence that the substance causes cancer by a mode of action that is relevant to man and by results of in vitro tests and short-term animal studies.
    6) NTP (U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project ): Not Listed

    D) OSHA PEL Values for CAS75-56-9 (U.S. Occupational Safety, and Health Administration (OSHA), 2010):
    1) Listed as: Propylene oxide
    2) Table Z-1 for Propylene oxide:
    a) 8-hour TWA:
    1) ppm: 100
    a) Parts of vapor or gas per million parts of contaminated air by volume at 25 degrees C and 760 torr.
    2) mg/m3: 240
    a) Milligrams of substances per cubic meter of air. When entry is in this column only, the value is exact; when listed with a ppm entry, it is approximate.
    3) Ceiling Value:
    4) Skin Designation: No
    5) Notation(s): Not Listed

Toxicity Information

    7.7.1) TOXICITY VALUES
    A) References: ACGIH, 1991 Bingham et al, 2001 Budavari, 2000 CHRIS, 2001 HSDB, 2001 OHM/TADS, 2001 RTECS, 2001
    1) LD50- (INTRAPERITONEAL)MOUSE:
    a) 175 mg/kg
    2) LD50- (ORAL)MOUSE:
    a) 440 mg/kg -- ataxia, excitable, and respiratory stimulation
    3) LD50- (INTRAPERITONEAL)RAT:
    a) 150 mg/kg
    4) LD50- (ORAL)RAT:
    a) 380 mg/kg -- ataxia, excitable, and respiratory stimulation
    b) 1140 mg/kg (ACGIH, 1991; ITI, 1995; OHM/TADS, 2001)
    c) 1.14 g/kg (Budavari, 2000)
    d) 0.5-5 g/kg (grade 2) (CHRIS, 2001)
    5) TCLo- (INHALATION)HUMAN:
    a) Male, 1400 g/m(3) for 10M -- headache, depressed activity, and nausea or vomiting
    6) TCLo- (INHALATION)MOUSE:
    a) 400 ppm for 6H/2Y- intermittent -- sense organ tumors
    b) 487 ppm for 6H/2W-intermittent -- dyspnea and somnolence
    c) 125 ppm for 6H/13W- intermittent -- death
    7) TCLo- (INHALATION)RAT:
    a) 100 ppm for 7H at 2Y- intermittent -- endocrine tumors
    b) Female, 500 ppm for 7H at 7-16D of pregnancy -- fetotoxicity and musculoskeletal system abnormalities
    c) Female, 500 ppm for 7H at 1-16D of pregnancy -- craniofacial abnormalities
    d) Female, 500 ppm for 7H at 1-16D of pregnancy and 15D prior to mating -- affected litter size, pre-implantation mortality, and other effects on fertility
    e) 100 ppm for 7H/2Y-intermittent -- tumors
    f) 457 ppm for 7H/28W-intermittent -- fibrosis, affected sense organs, death
    g) 529 ppm for 6H/4W-intermittent -- changes to sense organs
    h) 25 mg/m(3) for 4H/26W- intermittent -- degenerative changes to brain coverings and vascular changes
    i) 997 ppm for 6H/2W-intermittent -- changes in heart weight, changes to trachea and bronchi, weight loss or decreased weight gain
    j) 1433 ppm for 6H/12D-intermittent -- dyspnea, hypermotility, diarrhea, and death

Pharmacology Toxicology

Toxicologic Mechanism

    A) Propylene oxide is a primary irritant, a mild CNS depressant, and a mild protoplasmic poison (ACGIH, 1991).
    B) It is an active alkylating agent, similar to, but less potent than, ethylene oxide (Kereluk, 1971; Vogel & Nivard, 1998).
    C) In some but not all experimental animal studies, propylene oxide is neurotoxic and causes distal axonal degeneration of myelinated fibers of the lumbosacral primary sensory neuron (Ohnishi & Murai, 1993; Setzer et al, 1996).

Physicochemical

Physical Characteristics

    A) Propylene oxide is a clear, colorless, volatile, reactive, highly flammable, reactive, irritant, moderately toxic, epoxide liquid with a sweet ether-like or alcohol odor. In foods, propylene oxide has no residual odor or taste. The liquid is lighter than water and dissolves quickly in water. At 15 degrees C and 1 ATM, propylene oxide is a liquid (AAR, 2000; (ACGIH, 1991; Ashford, 1994; Budavari, 1996; CHRIS , 2001; Lewis, 1998; Lewis, 2000; OHM/TADS , 2001; Bingham et al, 2001).
    B) The vapors are heavier than air and are flammable over a wide range of vapor-air concentrations. Above 94 degrees F propylene oxide is a gas (AAR, 2000; (NIOSH , 2001).
    C) Propylene oxide evaporates in warm weather and does not persist for long periods of time (OHM/TADS , 2001).
    D) Propylene oxide is noncorrosive to metals (HSDB , 2001).

Molecular Weight

    A) 58.08 (HSDB , 2001)

Other

    A) ODOR THRESHOLD
    1) 9.9 ppm (absolute perception limit) (Verschueren, 2001)
    2) 10 ppm; 24.7 mg/m(3) (Bingham et al, 2001; Harbison, 1998)
    3) 44 ppm (Bingham et al, 2001)
    4) 45 ppm (higher than the 20 ppm TWA) (Clayton & Clayton, 1993)
    5) 35 ppm (50% and 100% recognition) (ACGIH, 1991; Bingham et al, 2001; Verschueren, 2001)
    6) 44 ppm (ACGIH, 1991)
    7) 200 ppm (ACGIH, 1991; Bingham et al, 2001; CHRIS , 2001; Hathaway et al, 1996; OHM/TADS , 2001)
    8) 473 mg/m(3) (100% recognition) (Verschueren, 2001)
    9) 9.90X10+0 ppm (purity not specified) (HSDB , 2001)
    10) 3.50X10+1 ppm (purity not specified) (HSDB , 2001)
    11) Low: 24.7500 mg/m(3); High: 500.000 mg/m(3) (HSDB , 2001)

References

General Bibliography

    1) 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.
    2) 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.
    3) 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.
    4) 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.
    5) 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.
    6) 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.
    7) 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.
    8) 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.
    9) 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.
    10) 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.
    11) 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.
    12) 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.
    13) AAR: Emergency Handling of Hazardous Materials in Surface Transportation, Bureau of Explosives, Association of American Railroads, Washington, DC, 2000.
    14) ACGIH: Documentation of the Threshold Limit Values and Biological Exposure Indices, 6th ed, Am Conference of Govt Ind Hyg, Inc, Cincinnati, OH, 1991.
    15) AIHA: 2006 Emergency Response Planning Guidelines and Workplace Environmental Exposure Level Guides Handbook, American Industrial Hygiene Association, Fairfax, VA, 2006.
    16) 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.
    17) 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.
    18) Anon: Meeting of the IARC working group on some industrial chemicals. Scand J Work Environ Health 1994; 20:227-229.
    19) Ansell-Edmont: SpecWare Chemical Application and Recommendation Guide. Ansell-Edmont. Coshocton, OH. 2001. Available from URL: http://www.ansellpro.com/specware. As accessed 10/31/2001.
    20) 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.
    21) Ashford R: Ashford's Dictionary of Industrial Chemicals, Wavelength Publications Ltd, London, England, 1994.
    22) Bata Shoe Company: Industrial Footwear Catalog, Bata Shoe Company, Belcamp, MD, 1995.
    23) Beljaev VA, Politykin AJ, & Cernyseva LA: Acute poisoning by propylene oxide. Gig Truda Prof Zabal 1971; 15:48-49.
    24) Best Manufacturing: ChemRest Chemical Resistance Guide. Best Manufacturing. Menlo, GA. 2002. Available from URL: http://www.chemrest.com. As accessed 10/8/2002.
    25) Best Manufacturing: Degradation and Permeation Data. Best Manufacturing. Menlo, GA. 2004. Available from URL: http://www.chemrest.com/DomesticPrep2/. As accessed 04/09/2004.
    26) Bingham E, Cohrssen B, & Powell CH: Patty's Toxicology, Vol 6. 5th ed, John Wiley & Sons, New York, NY, 2001.
    27) Boss Manufacturing Company: Work Gloves, Boss Manufacturing Company, Kewanee, IL, 1998.
    28) Boysen PG & Modell JH: Pulmonary edema, in: Textbook of Critical Care Medicine, 2nd ed. Shoemaker WC, Ayres S, Grenvik A et al (Eds), WB Saunders Company, Philadelphia, PA, 1989, pp 515-518.
    29) 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.
    30) Budavari S: The Merck Index, 12th ed, Merck & Co, Inc, Whitehouse Station, NJ, 1996.
    31) Budavari S: The Merck Index, 12th ed. on CD-ROM. Version 12:3a. Chapman & Hall/CRCnetBASE. Whitehouse Station, NJ. 2000.
    32) Burgess JL, Kirk M, Borron SW, et al: Emergency department hazardous materials protocol for contaminated patients. Ann Emerg Med 1999; 34(2):205-212.
    33) CHRIS : CHRIS Hazardous Chemical Data. US Department of Transportation, US Coast Guard. Washington, DC (Internet Version). Edition expires 10/31/2001; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    34) Caravati EM, Knight HH, & Linscott MS: Esophageal laceration and charcoal mediastinum complicating gastric lavage. J Emerg Med 2001; 20:273-276.
    35) Caravati EM: Alkali. In: Dart RC, ed. Medical Toxicology, Lippincott Williams & Wilkins, Philadelphia, PA, 2004.
    36) 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.
    37) ChemFab Corporation: Chemical Permeation Guide Challenge Protective Clothing Fabrics, ChemFab Corporation, Merrimack, NH, 1993.
    38) Chudnofsky CR & Otten EJ: Acute pulmonary toxicity to nitrofurantoin. J Emerg Med 1989; 7:15-19.
    39) Chyka PA, Seger D, Krenzelok EP, et al: Position paper: Single-dose activated charcoal. Clin Toxicol (Phila) 2005; 43(2):61-87.
    40) Clayton GD & Clayton FE: Patty's Industrial Hygiene and Toxicology, Vol 2A, Toxicology, 3rd ed, John Wiley & Sons, New York, NY, 1981.
    41) Clayton GD & Clayton FE: Patty's Industrial Hygiene and Toxicology, Vol 2A, Toxicology, 4th ed, John Wiley & Sons, New York, NY, 1993.
    42) Comasec Safety, Inc.: Chemical Resistance to Permeation Chart. Comasec Safety, Inc.. Enfield, CT. 2003. Available from URL: http://www.comasec.com/webcomasec/english/catalogue/mtabgb.html. As accessed 4/28/2003.
    43) Comasec Safety, Inc.: Product Literature, Comasec Safety, Inc., Enfield, CT, 2003a.
    44) Couch R, Ehrenberg L, & Magnusson AL: In vivo dosimetry of ethylene oxide and propylene oxide in cynomolgus monkeys. Mutat Res 1996; 357:17-23.
    45) 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.
    46) 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.
    47) DuPont: DuPont Suit Smart: Interactive Tool for the Selection of Protective Apparel. DuPont. Wilmington, DE. 2002. Available from URL: http://personalprotection.dupont.com/protectiveapparel/suitsmart/smartsuit2/na_english.asp. As accessed 10/31/2002.
    48) DuPont: Permeation Guide for DuPont Tychem Protective Fabrics. DuPont. Wilmington, DE. 2003. Available from URL: http://personalprotection.dupont.com/en/pdf/tyvektychem/pgcomplete20030128.pdf. As accessed 4/26/2004.
    49) DuPont: Permeation Test Results. DuPont. Wilmington, DE. 2002a. Available from URL: http://www.tyvekprotectiveapprl.com/databases/default.htm. As accessed 7/31/2002.
    50) Dunkelberg H: Carcinogenicity of ethylene oxide and 1,2-propylene oxide upon intragastric administration of rats. Br J Cancer 1982; 46:924-933.
    51) 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/.
    52) 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.
    53) Eldridge SR, Bogdanffy MS, & Jokinen MP: Effects of propylene oxide on nasal epithelial cell proliferation in F344 rats. Fundam Appl Toxicol 1995; 27:25-32.
    54) Elliot CG, Colby TV, & Kelly TM: Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal. Chest 1989; 96:672-674.
    55) FDA: Poison treatment drug product for over-the-counter human use; tentative final monograph. FDA: Fed Register 1985; 50:2244-2262.
    56) Golej J, Boigner H, Burda G, et al: Severe respiratory failure following charcoal application in a toddler. Resuscitation 2001; 49:315-318.
    57) Gosselin RE, Smith RP, & Hodge HC: Clinical Toxicology of Commercial Products, 5th ed, Williams & Wilkins, Baltimore, MD, 1984.
    58) Graff GR, Stark J, & Berkenbosch JW: Chronic lung disease after activated charcoal aspiration. Pediatrics 2002; 109:959-961.
    59) Grant WM: Toxicology of the Eye, 4th ed, Charles C Thomas, Springfield, IL, 1993.
    60) Guardian Manufacturing Group: Guardian Gloves Test Results. Guardian Manufacturing Group. Willard, OH. 2001. Available from URL: http://www.guardian-mfg.com/guardianmfg.html. As accessed 12/11/2001.
    61) 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.
    62) HSDB : Hazardous Substances Data Bank. National Library of Medicine. Bethesda, MD (Internet Version). Edition expires 2001; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    63) 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.
    64) Haas CF: Mechanical ventilation with lung protective strategies: what works?. Crit Care Clin 2011; 27(3):469-486.
    65) Hackett PL, Brown MG, & Buschbom RL: Teratogenic study of ethylene and propylene oxide and n-butyl acetate. Contract No 210-80-0013, PB83-258-038, NIOSH, US Department of Health and Human Services, Cincinnati, OH, 1982.
    66) Harbison RD: Hamilton & Hardy's Industrial Toxicology, 5th ed, Mosby-Year Books, St. Louis, MO, 1998.
    67) Hardin BD, Niemeier RW, & Sikov MR: Reproductive- toxicologic assessment of the epoxides ethylene oxide, propylene oxide, butylene oxide, and styrene oxide. Scand J Work Environ Health 1983a; 9:94-102.
    68) Hardin BD: Mutat Res 1983b; 117:337-344.
    69) Harris CR & Filandrinos D: Accidental administration of activated charcoal into the lung: aspiration by proxy. Ann Emerg Med 1993; 22:1470-1473.
    70) Haseman JK & Hailey JR: An update of the National Toxicology Program database on nasal carcinogens. Mutat Res 1997; 380:3-11.
    71) Hathaway GJ, Proctor NH, & Hughes JP: Chemical Hazards of the Workplace, 3rd ed, Van Nostrand Reinhold Company, New York, NY, 1991.
    72) Hathaway GJ, Proctor NH, & Hughes JP: Chemical Hazards of the Workplace, 4th ed, Van Nostrand Reinhold Company, New York, NY, 1996.
    73) Hayes WC, Kirk HD, & Gushow TS: Effect of inhaled propylene oxide on reproductive parameters in Fischer 344 rats. Fundam Appl Toxicol 1988; 10:82-88.
    74) Howard PH: Handbook of Environmental Fate & Exposure Data for Organic Chemicals, Vol 1: Large Production and Priority Pollutants, Lewis Publishers, Chelsea, MI, 1989.
    75) 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.
    76) 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.
    77) 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.
    78) 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.
    79) 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.
    80) IARC: IARC Monographs on the evaluation of the carcinogenic risk of chemicals to man: Cadmium, Nickel, Some Epoxides, Miscellaneous Industrial Chemicals, and General Considerations on Volatile Anaesthetics, Vol II, International Agency for Research on Cancer, World Health Organization, Geneva, Switzerland, 1976.
    81) 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.
    82) IARC: Monograph on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. Allyl Compounds, Aldehydes, Epoxides and Peroxides, Vol 36, International Agency for Research on Cancer, World Health Organization, Geneva, Switzerland, 1984.
    83) IARC: Monograph on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. Propylene Oxide, 36, International Agency for Research on Cancer, World Health Organization, Geneva, Switzerland, 1985, pp 227-243.
    84) ICAO: Technical Instructions for the Safe Transport of Dangerous Goods by Air, 2003-2004. International Civil Aviation Organization, Montreal, Quebec, Canada, 2002.
    85) ILC Dover, Inc.: Ready 1 The Chemturion Limited Use Chemical Protective Suit, ILC Dover, Inc., Frederica, DE, 1998.
    86) ILO : Encyclopedia of Occupational Health and Safety, 4th ed. Vol 1-4. (CD ROM Version). International Labour Organization. Geneva, Switzerland. 1998.
    87) ITI: Toxic and Hazardous Industrial Chemicals Safety Manual, The International Technical Information Institute, Tokyo, Japan, 1995.
    88) 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.
    89) 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.
    90) Ip M, Wong K-L, & Wong K-F: Lung injury in dimethyl sulfate poisoning. J Occup Med 1989; 31:141-143.
    91) Jacobson KH, Hackley E, & Feinsilver L: The toxicity of ethylene oxide and propylene oxide vapors. AMA Arch Ind Health 1956; 13:237.
    92) Kappler, Inc.: Suit Smart. Kappler, Inc.. Guntersville, AL. 2001. Available from URL: http://www.kappler.com/suitsmart/smartsuit2/na_english.asp?select=1. As accessed 7/10/2001.
    93) Kereluk K: Gaseous sterilization: methyl bromide, propylene oxide and ozone. Prog Ind Microbiol 1971; 10:117-124.
    94) Kimberly-Clark, Inc.: Chemical Test Results. Kimberly-Clark, Inc.. Atlanta, GA. 2002. Available from URL: http://www.kc-safety.com/tech_cres.html. As accessed 10/4/2002.
    95) Kimmel CA, LaBorde JB, & Hardin BD: Reproductive and developmental toxicology of selected epoxides, in: Kacew S & Reasor MJ (Eds).Toxicology and the Newborn, Elsevier, New York, NY, 1984, pp 271-287.
    96) Kjuric Z: Environ Mutagen 1986; 8:369-383.
    97) Kollef MH & Schuster DP: The acute respiratory distress syndrome. N Engl J Med 1995; 332:27-37.
    98) Kolman A & Dusinska M: Comparison of propylene oxide and epichlorohydrin effects in two transformation tests (C3H/10T1/2 and SHE cells). Toxicol Lett 1995; 81:213-221.
    99) Kuper CF, Reuzel PG, & Feron VJ: Chronic inhalation toxicity and carcinogenicity study of propylene oxide in Wistar rats. Food Chem Toxicol 1988; 26:159-167.
    100) LaCrosse-Rainfair: Safety Products, LaCrosse-Rainfair, Racine, WI, 1997.
    101) Lewis RJ: Hawley's Condensed Chemical Dictionary, 12th ed, Van Nostrand Reinhold Company, New York, NY, 1993.
    102) Lewis RJ: Hawley's Condensed Chemical Dictionary, 13th ed, John Wiley & Sons, Inc, New York, NY, 1997.
    103) Lewis RJ: Sax's Dangerous Properties of Industrial Materials, 10th ed, Van Nostrand Reinhold Company, New York, NY, 2000.
    104) Lewis RJ: Sax's Dangerous Properties of Industrial Materials, 8th ed, Van Nostrand Reinhold Company, New York, NY, 1992.
    105) Lewis RJ: Sax's Dangerous Properties of Industrial Materials, 9th ed, Van Nostrand Reinhold Company, New York, NY, 1996.
    106) Lewis: Lewis' Dictionary of Toxicology, Lewis Publisher, Boca Raton, FL, 1998.
    107) Lynch DW, Lewis TR, & Moorman WJ: Carcinogenic and toxicologic effects of inhaled ethylene oxide and propylene oxide in F344 rats. Toxicol Appl Pharmacol 1984; 76:69-84.
    108) Lynch DW, Lewis TR, & Moorman WJ: Sister-chromatid exchanges and chromosome aberrations in lymphocytes from monkeys exposed to ethylene oxide and propylene oxide by inhalation. Toxicol Appl Pharmacol 1984a; 76:85-95.
    109) MAPA Professional: Chemical Resistance Guide. MAPA North America. Columbia, TN. 2003. Available from URL: http://www.mapaglove.com/pro/ChemicalSearch.asp. As accessed 4/21/2003.
    110) MAPA Professional: Chemical Resistance Guide. MAPA North America. Columbia, TN. 2004. Available from URL: http://www.mapaglove.com/ProductSearch.cfm?id=1. As accessed 6/10/2004.
    111) Maggart M & Stewart S: The mechanisms and management of noncardiogenic pulmonary edema following cardiopulmonary bypass. Ann Thorac Surg 1987; 43:231-236.
    112) Mar-Mac Manufacturing, Inc: Product Literature, Protective Apparel, Mar-Mac Manufacturing, Inc., McBee, SC, 1995.
    113) Marigold Industrial: US Chemical Resistance Chart, on-line version. Marigold Industrial. Norcross, GA. 2003. Available from URL: www.marigoldindustrial.com/charts/uschart/uschart.html. As accessed 4/14/2003.
    114) McLaughlin RS: Chemical burns of the human cornea. Am J Ophthalmol 1946; 29:1355-1362.
    115) Memphis Glove Company: Permeation Guide. Memphis Glove Company. Memphis, TN. 2001. Available from URL: http://www.memphisglove.com/permeation.html. As accessed 7/2/2001.
    116) Montgomery Safety Products: Montgomery Safety Products Chemical Resistant Glove Guide, Montgomery Safety Products, Canton, OH, 1995.
    117) NFPA: Fire Protection Guide to Hazardous Materials, 11th ed, National Fire Protection Association, Quincy, MA, 1994.
    118) NFPA: Fire Protection Guide to Hazardous Materials, 12th ed, National Fire Protection Association, Quincy, MA, 1997.
    119) NFPA: Fire Protection Guide to Hazardous Materials, 13th ed., National Fire Protection Association, Quincy, MA, 2002.
    120) 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.
    121) NIOSH : Pocket Guide to Chemical Hazards. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires 2001; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    122) 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.
    123) 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.
    124) 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.
    125) 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.
    126) NTP: National Toxicology Program Chemical Repository, National Toxicology Progam, US Department of Human Health Services, National Institutes of Health, Research Triangle Park, NC, 2000.
    127) Naradzay J & Barish RA: Approach to ophthalmologic emergencies. Med Clin North Am 2006; 90(2):305-328.
    128) Nat-Wear: Protective Clothing, Hazards Chart. Nat-Wear. Miora, NY. 2001. Available from URL: http://www.natwear.com/hazchart1.htm. As accessed 7/12/2001.
    129) 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.
    130) 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.
    131) 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.
    132) 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.
    133) 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.
    134) 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.
    135) 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.
    136) 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.
    137) 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.
    138) 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.
    139) 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.
    140) 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.
    141) 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.
    142) 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.
    143) 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.
    144) 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.
    145) 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.
    146) 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.
    147) 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.
    148) 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.
    149) 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.
    150) 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.
    151) 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.
    152) 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.
    153) 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.
    154) 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.
    155) 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.
    156) 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.
    157) 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.
    158) 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.
    159) 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.
    160) 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.
    161) 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.
    162) 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.
    163) 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.
    164) 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.
    165) 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.
    166) 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.
    167) 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.
    168) 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.
    169) 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.
    170) 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.
    171) 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.
    172) 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.
    173) 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.
    174) 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.
    175) 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.
    176) 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.
    177) 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.
    178) 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.
    179) 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.
    180) 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.
    181) 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.
    182) 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.
    183) 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.
    184) 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.
    185) 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.
    186) 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.
    187) 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.
    188) 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.
    189) 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.
    190) 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.
    191) 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.
    192) 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.
    193) 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.
    194) 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.
    195) 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.
    196) 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.
    197) 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.
    198) 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.
    199) 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.
    200) 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.
    201) 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.
    202) 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.
    203) 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.
    204) 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.
    205) National Research Council : Acute exposure guideline levels for selected airborne chemicals, 5, National Academies Press, Washington, DC, 2007.
    206) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 6, National Academies Press, Washington, DC, 2008.
    207) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 7, National Academies Press, Washington, DC, 2009.
    208) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 8, National Academies Press, Washington, DC, 2010.
    209) Neese Industries, Inc.: Fabric Properties Rating Chart. Neese Industries, Inc.. Gonzales, LA. 2003. Available from URL: http://www.neeseind.com/new/TechGroup.asp?Group=Fabric+Properties&Family=Technical. As accessed 4/15/2003.
    210) Nilsson R, Molholt B, & Sargent EV: Quantitative assessment of a human carcinogenic potency for propylene oxide. Regul Toxicol Pharmacol 1991; 14:229-244.
    211) None Listed: Position paper: cathartics. J Toxicol Clin Toxicol 2004; 42(3):243-253.
    212) North: Chemical Resistance Comparison Chart - Protective Footwear . North Safety. Cranston, RI. 2002. Available from URL: http://www.linkpath.com/index2gisufrm.php?t=N-USA1. As accessed April 30, 2004.
    213) North: eZ Guide Interactive Software. North Safety. Cranston, RI. 2002a. Available from URL: http://www.northsafety.com/feature1.htm. As accessed 8/31/2002.
    214) OHM/TADS : Oil and Hazardous Materials/Technical Assistance Data System. US Environmental Protection Agency. Washington, DC (Internet Version). Edition expires 10/31/2001; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    215) OSHA: Personal Protective Equipment for General Industry. 59 FR 16334-16364, 59, Department of Labor, Occupational Safety and Health Administration, Washington, DC, 2000, pp 16334-16364.
    216) Ohnishi A & Murai Y: Polyneuropathy due to ethylene oxide, propylene oxide, and butylene oxide. Environ Res 1993; 60:242-247.
    217) Ohnishi A, Yamamoto T, & Hayashida Y: Propylene oxide causes central-peripheral distal axonopathy in rats. Arch Environ Health 1988; 43:353-356.
    218) Olsen GW, Lacy SE, & Bodner KM: Mortality from pancreatic and lymphopoietic cancer among workers in ethylene and propylene chlorohydrin production. Occup Environ Med 1997; 54:592-598.
    219) Omura M, Tanaka A, & Mori K: Dose-dependent testicular toxicity of propylene oxide in rats induced by repeated intraperitoneal injections. Fukuoka Igaku Zasshi 1994; 85:204-210.
    220) Peate WF: Work-related eye injuries and illnesses. Am Fam Physician 2007; 75(7):1017-1022.
    221) Playtex: Fits Tough Jobs Like a Glove, Playtex, Westport, CT, 1995.
    222) Plunkett ER: Handbook of Industrial Toxicology, Chemical Publishing Co, Inc, New York, NY, 1976.
    223) Pohanish RP & Greene SA: Rapid Guide to Chemical Incompatibilities, Van Nostrand Reinhold Company, New York, NY, 1997.
    224) Pollack MM, Dunbar BS, & Holbrook PR: Aspiration of activated charcoal and gastric contents. Ann Emerg Med 1981; 10:528-529.
    225) RTECS : Registry of Toxic Effects of Chemical Substances. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires 2001; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    226) Rau NR, Nagaraj MV, Prakash PS, et al: Fatal pulmonary aspiration of oral activated charcoal. Br Med J 1988; 297:918-919.
    227) Renne RA, Giddens WE, & Boorman GA: Nasal cavity neoplasia in F344/N rats and (C57BL/6XC3H) F1 mice inhaling propylene oxide for up to 2 years. J Natl Cancer Inst 1986; 77:573-582.
    228) Rios-Blanco MN, Plna K, & Faller T: Propylene oxide: mutagenesis, carcinogenesis, and molecular dose. Mutat Res 1997; 380:179-197.
    229) River City: Protective Wear Product Literature, River City, Memphis, TN, 1995.
    230) Rowe VK, Hollingsworth RL, & Oyen F: Toxicity of propylene oxide determined on experimental animals. Arch Ind Health 1956; 13:228-236.
    231) Safety 4: North Safety Products: Chemical Protection Guide. North Safety. Cranston, RI. 2002. Available from URL: http://www.safety4.com/guide/set_guide.htm. As accessed 8/14/2002.
    232) Segerback D, Plna K, & Faller T: Tissue distribution of DNA adducts in male Fischer rats exposed to 500 ppm of propylene oxide: quantitative analysis of 7-(2-hydroxypropyl)guanine by 32P-postlabelling. 1998; 115:229-246.
    233) Servus: Norcross Safety Products, Servus Rubber, Servus, Rock Island, IL, 1995.
    234) Setzer JV, Brightwell WS, & Russo JM: Neurophysiological and neuropathological evaluation of primates exposed to ethylene oxide and propylene oxide. Toxicol Ind Health 1996; 12:667-682.
    235) Sittig M: Handbook of Toxic and Hazardous Chemicals and Carcinogens, 3rd ed, Vol 1-2, Noyes Publications, Park Ridge, NJ, 1991.
    236) Spiller HA & Rogers GC: Evaluation of administration of activated charcoal in the home. Pediatrics 2002; 108:E100.
    237) Sprinz H: NIOSH, Cincinnati, OH, 1982, pp 9.
    238) Standard Safety Equipment: Product Literature, Standard Safety Equipment, McHenry, IL, 1995.
    239) Steinkraus V & Hausen BM: Contact allergy to propylene oxide. Contact Derm 1994; 31:120.
    240) Stentoft J: The toxicity of cytarabine. Drug Saf 1990; 5:7-27.
    241) 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.
    242) Thakore S & Murphy N: The potential role of prehospital administration of activated charcoal. Emerg Med J 2002; 19:63-65.
    243) Tingley: Chemical Degradation for Footwear and Clothing. Tingley. South Plainfield, NJ. 2002. Available from URL: http://www.tingleyrubber.com/tingley/Guide_ChemDeg.pdf. As accessed 10/16/2002.
    244) Trelleborg-Viking, Inc.: Chemical and Biological Tests (database). Trelleborg-Viking, Inc.. Portsmouth, NH. 2002. Available from URL: http://www.trelleborg.com/protective/. As accessed 10/18/2002.
    245) Trelleborg-Viking, Inc.: Trellchem Chemical Protective Suits, Interactive manual & Chemical Database. Trelleborg-Viking, Inc.. Portsmouth, NH. 2001.
    246) 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.
    247) 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.
    248) 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-.
    249) 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.
    250) 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.
    251) 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.
    252) 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.
    253) 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-.
    254) U.S. Occupational Safety, and Health Administration (OSHA): Process safety management of highly hazardous chemicals. 29 CFR 2010 2010; 29(1910.119):348-.
    255) 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.
    256) Urben PG: Bretherick's Reactive Chemical Hazards Database, Version 3.0, Butterworth-Heinemann Ltd, Oxford, UK, 2000.
    257) Vale JA, Kulig K, American Academy of Clinical Toxicology, et al: Position paper: Gastric lavage. J Toxicol Clin Toxicol 2004; 42:933-943.
    258) Vale JA: Position Statement: gastric lavage. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 1997; 35:711-719.
    259) Van Ketel WG: Contact Dermatitis 1979; 5:191-192.
    260) Verschueren K: Handbook of Environmental Data on Organic Chemicals. 4th ed. CD-ROM version. Wiley-Interscience. Hoboken, NJ. 2001.
    261) Vogel EW & Nivard MJ: Genotoxic effects of inhaled ethylene oxide, propylene oxide and butylene oxide on germ cells: sensitivity of genetic endpoints in relation to dose and repair status. Mutat Res 1998; 405:259-271.
    262) Wells Lamont Industrial: Chemical Resistant Glove Application Chart. Wells Lamont Industrial. Morton Grove, IL. 2002. Available from URL: http://www.wellslamontindustry.com. As accessed 10/31/2002.
    263) Willson DF, Truwit JD, Conaway MR, et al: The adult calfactant in acute respiratory distress syndrome (CARDS) trial. Chest 2015; 148(2):356-364.
    264) 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.
    265) Workrite: Chemical Splash Protection Garments, Technical Data and Application Guide, W.L. Gore Material Chemical Resistance Guide, Workrite, Oxnard, CA, 1997.
    266) Zitnik RJ & Cooper JA: Pulmonary disease due to antirheumatic agents. Clin Chest Med 1990; 11:139-150.