Contact Us    Contact Us     |     Feedback
MOBILE VIEW  | 

ANTIMONY

Export To Excel

Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Antimony is used primarily in lead alloys, especially in type metal and batteries. It is also used in bullets and bearing metal, fireworks, thermoelectric piles, and in the semiconductor industry (ITI, 1995; Budavari, 1996). Pentavalent antimony is used in the treatment of leishmaniasis.
    B) Antimony resembles arsenic, both biologically and chemically. It belongs to the same periodic group as arsenic.

Specific Substances

    1) Al-Kohl
    2) Antimony regulus
    3) Stibium
    4) Antimony black
    5) Kohhel
    6) Kohol
    7) Cohol
    8) CAS 7440-36-0
    1.2.1) MOLECULAR FORMULA
    1) Sb

Available Forms Sources

    A) FORMS
    1) Antimony has a bluish tinge, and is either coarsely laminated or has a granular structure (HSDB , 2002).
    2) Antimony has a hexagonal (rhombohedral) crystal structure (HSDB , 2002).
    3) Antimony is available as a stable metal as well as two allotropes: yellow crystals and amorphous black modifications (Lewis, 2001).
    4) There are two naturally occurring isotopes of antimony, 121 (57.25%) and 123 (42.75%). There are also several artificial radioactive isotopes (112-120; 122; 124-135). Isotopes 122 and 124 are used as radioactive tracers (Budavari, 2000). Isotopes are fission products of plutonium (HSDB , 2002).
    5) Antimony is available as cast cakes, ingots, broken pieces, granules, shot and single crystals (HSDB , 2002).
    6) Common antimony compounds include: antimony trioxide; antimony trisulfide; antimony trichloride; antimony pentoxide; antimony pentasulfide; and antimony pentachloride (Hathaway et al, 1996).
    7) There are over 90 antimony-containing minerals. Pure antimony is extremely rare (IRPTC, 1984).
    B) SOURCES
    1) Antimony occurs naturally, with commercial ores containing between 5% and 60% antimony. The antimony content of the ore determines the method of recovery. Low grade ores (5%-25%) are volatilized as oxides; mid grade (25%-40%) are smelted in a blast furnace; and high grade (45%-60%) are treated by iron precipitation or liquidated. Antimony recovery from some ores takes place by leaching and electrowinning (HSDB , 2002).
    2) The estimated world production of antimony is 65,500 metric tons. Smelting and refining of ores, especially lead ores, yields antimony-bearing wastes. "Antimony is obtained by roasting stibnite (Sb2S3) in air to form senarmontite (SbSO3). The metal is subsequently recovered by reducing the oxide with carbon or by heating trivalent sulfide to obtain the antimony tetroxide and then reducing it with carbon" (Clayton & Clayton, 1994).
    3) Reports concerning antimony prior to 1960 involved ores that contained appreciable amounts of sulfur, arsenic, lead, copper and selenium. The suggested order of toxicity (in descending order) is metallic antimony, trisulfide, pentasulfide, trioxide, pentoxide (Finkel, 1983).
    C) USES
    1) Antimony is widely used in the production of alloys to impart increased hardness, mechanical strength, corrosion resistance, and a low coefficient of friction. Some of these alloys include: babbitt, pewter, white metal, hard lead, Britannia metal and bearing metal (used in bearing shells), printing-type metal. It is also used in storage battery plates, collapsible tubes and foil, cable sheathing, solder, ornamental castings, and ammunition (Budavari, 2000; Lewis, 2001; Sittig, 1991). Antimony is also used for thermoelectric piles, blackening iron, coating metals, and is used in semiconductor technology, roofing materials, and radiation protection (Ashford, 1994; Budavari, 2000; Lewis, 2001). Antimony has low thermal conductivity (Lewis, 2001).
    2) Pure antimony compounds can be used as abrasives, pigments, flameproofing compounds, plasticizers, and catalysts in organic synthesis; they are also used in the manufacture of tartar emetic, paints, lacquers, glass, pottery, enamels, glazes, pharmaceuticals, pyrotechnics, matches, and explosives. In addition, they are used in dyeing, for blueing steel, and in coloring aluminum, pewter, and zinc (NIOSH , 2002; Sittig, 1991).

Overview

Life Support

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

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) Antimony is irritating to the eyes, skin, and mucous membranes. Antimony's principle toxic properties mimic those of arsenic, and signs and symptoms of exposure may include abdominal cramps, nausea, vomiting, watery diarrhea which may be bloody, and a metallic taste. Exposure to the dust and fumes may cause gingivitis, rhinitis, chest tightness, shortness of breath, bronchitis, pulmonary edema, headache, and dizziness.
    B) Signs and symptoms of chronic exposure may include ECG changes, laryngitis, tracheitis, bronchitis, pneumonitis, pneumoconiosis, ulceration of the nasal septum and larynx, and contact allergy to metal. Skin contact with antimony compounds can cause papules and pustules around sweat and sebaceous glands. QT prolongation and T wave changes have been reported on ECG.
    C) Acute oral exposures are unusual as there are few oral preparations. Antimony compounds are poorly absorbed from the gastrointestinal tract. Antimony shows slow renal excretion following parenteral injection. Most exposures are of a chronic occupational nature.
    1) Trivalent and pentavalent antimony compounds have also been used as anthelmintic and antiprotozoal drug treatments. Tartar emetic (antimony potassium tartrate) and antimony sodium tartrate were used to treat schistosomiasis infections (liver fluke). PRAZIQUANTEL, a less toxic oral agent, and other drugs have replaced these trivalent antimony compounds. Antimony sodium tartrate was also used as an emetic and expectorant.
    2) MEGLUMINE ANTIMONIATE (Glucantime(R)) and SODIUM STIBOGLUCONATE (sodium antimony gluconate, Pentostam(R)) are pentavalent antimony compounds used for the treatment of leishmaniasis, a protozoan parasitic disease transmitted by the bite of infected sandflies. Meglumine antimoniate is a drug of choice for cutaneous, mucocutaneous, and visceral leishmaniasis; the drug is not available in the US. Sodium stibogluconate is only available in the United States from the Centers for Disease Control (CDC), Atlanta, Georgia.
    D) STIBINE - Avoid conditions in which nascent hydrogen will react with antimony to form extremely toxic stibine (SbH3). Effects of stibine exposure include nausea, vomiting, headache, hemolysis, hematuria, abdominal pain, and death.
    E) EXPERIMENTAL ANIMALS - Acute antimony poisoning in experimental animals is characterized by marked weight loss, hair loss, dry scaly skin, eosinophilia, and myocardial failure. Exposure to antimony salts may result in irritation of skin and mucous membranes. Chronic exposure has resulted in extensive pneumonitis; fatty degeneration of the liver; hypertrophy of splenic follicles; and decreased polymorphonuclear leukocyte, eosinophil, and white blood cell counts.
    0.2.4) HEENT
    A) Conjunctivitis may be seen after exposure to antimony salts as may pharyngitis, laryngitis, rhinitis and nose bleed.
    B) Nasal perforation from occupational exposure has been reported.
    0.2.5) CARDIOVASCULAR
    A) QT prolongation and T wave changes have been reported with therapeutic use. Thrombophlebitis is common after IV use, but has also been reported when poisoning is by the oral route.
    B) Animals have shown myocardial failure after being fatally poisoned by antimony. The sulfide salts are much more prone to produce this effect.
    0.2.6) RESPIRATORY
    A) Antimony salts are known to be mucous membrane irritants, and may cause pulmonary irritation. Metal fume fever has also been reported with this agent.
    0.2.8) GASTROINTESTINAL
    A) Vomiting, diarrhea and stomatitis have all been reported after exposure to antimony and its salts.
    0.2.9) HEPATIC
    A) Hepatic transaminases have been increased after sodium stibogluconate infusion.
    0.2.13) HEMATOLOGIC
    A) Eosinophilia has been seen in acutely and fatally poisoned animals. There are reports of leukopenia or leukocytosis occurring in the treatment of Leishmaniasis with antimony compounds.
    0.2.14) DERMATOLOGIC
    A) Hair loss, dry skin and antimony spots have all been seen after exposure to antimony. Dermatitis is rare following exposure to metallic antimony.
    0.2.20) REPRODUCTIVE
    A) Antimony has been found to cause premature births and spontaneous abortions in women, along with growth retardation in children. Russian studies have suggested that workers exposed to antimony have shown sexual dysfunction in males and increased incidence of gynecological problems in females.
    B) Male rats have shown reduced quantities of spermatogenic epithelial cells and inability to fertilize healthy females. Female rats have shown altered reproductive function and sex life.

Laboratory Monitoring

    A) Obtain whole blood antimony concentration after poisoning with trivalent antimony. Serum concentration of antimony in normal subjects is approximately 3 mcg/L.
    B) Obtain 24 hours urine antimony concentration after exposure to pentavalent or trivalent antimony. A normal urinary level is approximately 0.8 mcg/L.
    C) Some antimony salts may cause liver toxicity. Monitor liver enzymes if patients have had significant exposures.
    D) Obtain an ECG in patients with significant poisoning.
    E) Hair concentrations of antimony rise with treatment with antimony compounds.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) 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.
    B) Chelation may be useful in severe cases. DMSA, D-penicillamine, DMPS and BAL have been advocated.
    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.
    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).

Range Of Toxicity

    A) An estimated toxic amount of the organic antimony tartar emetic (non elemental antimony) is 0.1 to 1 grams.
    B) Workers exposed to air having about 3 mg of antimony per cubic meter had urinary levels ranging from 0.8 to 9.6 mg/L.

Clinical Effects

Summary Of Exposure

    A) Antimony is irritating to the eyes, skin, and mucous membranes. Antimony's principle toxic properties mimic those of arsenic, and signs and symptoms of exposure may include abdominal cramps, nausea, vomiting, watery diarrhea which may be bloody, and a metallic taste. Exposure to the dust and fumes may cause gingivitis, rhinitis, chest tightness, shortness of breath, bronchitis, pulmonary edema, headache, and dizziness.
    B) Signs and symptoms of chronic exposure may include ECG changes, laryngitis, tracheitis, bronchitis, pneumonitis, pneumoconiosis, ulceration of the nasal septum and larynx, and contact allergy to metal. Skin contact with antimony compounds can cause papules and pustules around sweat and sebaceous glands. QT prolongation and T wave changes have been reported on ECG.
    C) Acute oral exposures are unusual as there are few oral preparations. Antimony compounds are poorly absorbed from the gastrointestinal tract. Antimony shows slow renal excretion following parenteral injection. Most exposures are of a chronic occupational nature.
    1) Trivalent and pentavalent antimony compounds have also been used as anthelmintic and antiprotozoal drug treatments. Tartar emetic (antimony potassium tartrate) and antimony sodium tartrate were used to treat schistosomiasis infections (liver fluke). PRAZIQUANTEL, a less toxic oral agent, and other drugs have replaced these trivalent antimony compounds. Antimony sodium tartrate was also used as an emetic and expectorant.
    2) MEGLUMINE ANTIMONIATE (Glucantime(R)) and SODIUM STIBOGLUCONATE (sodium antimony gluconate, Pentostam(R)) are pentavalent antimony compounds used for the treatment of leishmaniasis, a protozoan parasitic disease transmitted by the bite of infected sandflies. Meglumine antimoniate is a drug of choice for cutaneous, mucocutaneous, and visceral leishmaniasis; the drug is not available in the US. Sodium stibogluconate is only available in the United States from the Centers for Disease Control (CDC), Atlanta, Georgia.
    D) STIBINE - Avoid conditions in which nascent hydrogen will react with antimony to form extremely toxic stibine (SbH3). Effects of stibine exposure include nausea, vomiting, headache, hemolysis, hematuria, abdominal pain, and death.
    E) EXPERIMENTAL ANIMALS - Acute antimony poisoning in experimental animals is characterized by marked weight loss, hair loss, dry scaly skin, eosinophilia, and myocardial failure. Exposure to antimony salts may result in irritation of skin and mucous membranes. Chronic exposure has resulted in extensive pneumonitis; fatty degeneration of the liver; hypertrophy of splenic follicles; and decreased polymorphonuclear leukocyte, eosinophil, and white blood cell counts.

Heent

    3.4.1) SUMMARY
    A) Conjunctivitis may be seen after exposure to antimony salts as may pharyngitis, laryngitis, rhinitis and nose bleed.
    B) Nasal perforation from occupational exposure has been reported.
    3.4.3) EYES
    A) CONJUNCTIVITIS may be seen after exposure to antimony salts (Bingham et al, 2001; Friberg, 1979).
    3.4.5) NOSE
    A) Antimony exposure may cause inflammation of the lining of the mouth, nose and throat (Harbison, 1998). Rhinitis and nose bleeds were seen in smelter workers exposed to antimony in concentrations of 4.7 to 11.8 mg/m(3) (Renes, 1953).
    B) NASAL PERFORATION has been reported from occupational exposure (McCallum, 1989; Budavari, 1996).
    C) EPISTAXIS has been reported in patients developing antimony dermatitis (White et al, 1993).
    3.4.6) THROAT
    A) PHARYNGITIS as well as laryngitis may be seen after exposure to antimony vapor (Bingham et al, 2001; Friberg, 1979).

Cardiovascular

    3.5.1) SUMMARY
    A) QT prolongation and T wave changes have been reported with therapeutic use. Thrombophlebitis is common after IV use, but has also been reported when poisoning is by the oral route.
    B) Animals have shown myocardial failure after being fatally poisoned by antimony. The sulfide salts are much more prone to produce this effect.
    3.5.2) CLINICAL EFFECTS
    A) THROMBOPHLEBITIS
    1) Thrombophlebitis is common after IV use, but has even been reported when poisoning is by the oral route (Lauwers et al, 1990).
    B) ELECTROCARDIOGRAM ABNORMAL
    1) Prolongation of the QT interval and T wave changes have been reported after therapeutic use of meglumine antimonate for treatment of visceral Leishmaniasis (de Lalla et al, 1993).
    3.5.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) CARDIAC FAILURE
    a) Myocardial failure was the cause of death in animals acutely and fatally poisoned with antimony (Bradley & Fredrick, 1941). Sulfide salts have the most pronounced myocardial effect (ACGIH, 1986; Friberg, 1979).
    2) CARDIOMYOPATHY
    a) Decreased myocardial contractile force and decreased coronary vasomotor tone has been seen in the isolated canine heart (Winship, 1987).

Respiratory

    3.6.1) SUMMARY
    A) Antimony salts are known to be mucous membrane irritants, and may cause pulmonary irritation. Metal fume fever has also been reported with this agent.
    3.6.2) CLINICAL EFFECTS
    A) COUGH
    1) Various antimony dusts can cause pulmonary irritation and cough (Bingham et al, 2001). The extent of damage is often due to the elements bound to the antimony. Metallic antimony and the oxides are less irritating than are the halide salts (Friberg, 1979).
    B) METAL FEVER
    1) Antimony compounds have caused metal fume fever (Finkel, 1983).

Gastrointestinal

    3.8.1) SUMMARY
    A) Vomiting, diarrhea and stomatitis have all been reported after exposure to antimony and its salts.
    3.8.2) CLINICAL EFFECTS
    A) NAUSEA AND VOMITING
    1) Nausea and vomiting are effects of antimony poisoning by any route of entry. With parenteral administration it is delayed (IRPTC, 1984). Gastrointestinal irritation with mucosal inflammation is particularly prevalent in the distal large intestine (IRPTC, 1984). In older drinking vessels, antimony may have been used to bind enamel to metal. Acid drinks may dissolve the antimony and cause nausea, vomiting and diarrhea (Verrin, 1963).
    2) Profuse vomiting and diarrhea and severe abdominal pain were reported in a 19-year-old man who ingested 500 mg of tartar emetic (antimony potassium tartrate) as part of chemical aversion therapy for alcohol dependence. The patient recovered following administration of antiemetics and IV fluids (Tarabar et al, 2004).
    B) TASTE SENSE ALTERED
    1) Antimony causes a metallic taste (Harbison, 1998; Bailly et al, 1991).
    C) DIARRHEA
    1) Diarrhea may be seen after antimony exposure (Harbison, 1998; Lauwers et al, 1990).
    2) Profuse vomiting and diarrhea were reported in a 19-year-old man who ingested 500 mg of tartar emetic (antimony potassium tartrate) as part of chemical aversion therapy for alcohol dependence. The patient recovered following administration of antiemetics and IV fluids (Tarabar et al, 2004).
    D) INFLAMMATORY DISEASE OF MUCOUS MEMBRANE
    1) Sores in the mouth and sore throat may be seen after antimony exposure and helps differentiate antimony from lead poisoning (Harbison, 1998).
    E) PANCREATITIS
    1) CASE REPORT - Abdominal pain and elevated serum amylase and lipase levels with marked diffuse pancreatic edema on abdominal CT developed in a 24-year- old woman after therapeutic use of meglumine antimonate for treatment of visceral Leishmaniasis (de Lalla et al, 1993).
    2) CASE REPORT - A 32-year-old male with AIDS was accidentally given 10 times the prescribed dosage of sodium stibogluconate (6.5 grams instead of 0.65 grams) for treatment of visceral leishmaniasis and, 48 hours later, developed elevated serum amylase and lipase levels. There were no other clinical signs or indications from an abdominal CT scan of pancreatitis. The patient did develop appendicitis three days post-ingestion, however, a causal relationship could not be established (Reymond & Desmeules, 1998). The pancreatic enzyme levels gradually normalized and the patient recovered uneventfully following an appendectomy.
    3) CASE SERIES - Serum amylase and lipase levels were elevated prospectively in 16 of 17 consecutive patients receiving pentavalent antimony for leishmaniasis. Twelve of the seventeen developed pancreatitis. Pancreatitis resolved with therapy termination. Recurrent pancreatitis was seen in six patients with restart of treatment. Pancreatitis developed in 11 of 32 additional patients under treatment with either sodium stibogluconate or meglumine antimoniate (Gasser et al, 1994).

Hepatic

    3.9.1) SUMMARY
    A) Hepatic transaminases have been increased after sodium stibogluconate infusion.
    3.9.2) CLINICAL EFFECTS
    A) LIVER ENZYMES ABNORMAL
    1) CASE REPORT - A 27-year-old female with acquired cutaneous leishmaniasis received 10 times the daily dose of sodium stibogluconate (Pentostam): 8500 mg (143 mg/kg) instead of 850 mg. Other than her report of malaise during the four-hour infusion, no other clinical abnormalities were observed. AST increased briefly to 2.4 times the upper limit of normal (Herwaldt et al, 1992).
    3.9.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) HEPATIC ENZYMES INCREASED
    a) In RATS intramuscular administration of sodium stibogluconate and meglumine antimonate caused increases in serum transaminase levels (AlKhawajah et al, 1993).

Genitourinary

    3.10.2) CLINICAL EFFECTS
    A) ABNORMAL SEXUAL FUNCTION
    1) Cases of sexual dysfunction have been mentioned among male workers exposed to antimony at their work place. Female antimony workers showed an increased incidence of gynecologic diseases. Most of the articles concerning reproductive changes have been in the Russian literature.
    B) SERUM CREATININE RAISED
    1) WITH POISONING/EXPOSURE
    a) CASE REPORT - Profuse vomiting and diarrhea and severe abdominal pain were reported in a 19-year-old man who intentionally ingested 500 mg of tartar emetic (antimony potassium tartrate) as chemical aversion therapy for alcohol dependence. Initial laboratory analyses showed a potassium level of 6.1 mEq/L and an elevated serum creatinine level of 2.4 mg/dL. With supportive care, the patient became asymptomatic and his serum creatinine level nomalized to 1.1 mg/dL (Tarabar et al, 2004).
    3.10.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) RENAL FUNCTION ABNORMAL
    a) In RATS intramuscular administration of sodium stibogluconate and meglumine antimonate caused increases in BUN and creatinine level and trace albuminuria (AlKhawajah et al, 1993).

Hematologic

    3.13.1) SUMMARY
    A) Eosinophilia has been seen in acutely and fatally poisoned animals. There are reports of leukopenia or leukocytosis occurring in the treatment of Leishmaniasis with antimony compounds.
    3.13.2) CLINICAL EFFECTS
    A) LEUKOPENIA
    1) Leukopenia has been reported following treatment of Leishmaniasis with antimony compounds (Herwaldt et al, 1992; Hicsonmez et al, 1988).
    3.13.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) EOSINOPHILIA
    a) Animals acutely and fatally poisoned with antimony developed eosinophilia (Bradley & Fredrick, 1941).
    2) LEUKOCYTOSIS
    a) In RATS intramuscular administration of sodium stibogluconate and meglumine antimonate caused leukocytosis and decreased hemoglobin and hematocrit (AlKhawajah et al, 1993).

Dermatologic

    3.14.1) SUMMARY
    A) Hair loss, dry skin and antimony spots have all been seen after exposure to antimony. Dermatitis is rare following exposure to metallic antimony.
    3.14.2) CLINICAL EFFECTS
    A) MACULOPAPULAR ERUPTION
    1) Antimony spots have been seen after industrial exposure. These spots are a rash consisting of papules and pustules surrounding sweat and sebaceous glands. They are primarily found on forearms, thighs and areas where clothing is tight. It is more common in hot weather. Papular eruptions may progress to vesicles and pustules.
    B) DERMATITIS
    1) Dermatitis may develop following exposure to metallic antimony (Stokinger, 1981; Harbison, 1998; White et al, 1993).
    2) A memory effect was reported for metal dermatitis by Menne & Nieboer (1989). This effect was thought to be the cause of repeated flare-ups. The metal ion may attach to specific proteins and form an antigen.
    3.14.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) ALOPECIA
    a) Animals acutely and fatally poisoned with antimony developed hair loss (Bradley & Fredrick, 1941).
    2) SKIN DRY
    a) Dry skin with a scaly appearance was seen in animals acutely and fatally poisoned with antimony (Bradley & Fredrick, 1941).

Reproductive

    3.20.1) SUMMARY
    A) Antimony has been found to cause premature births and spontaneous abortions in women, along with growth retardation in children. Russian studies have suggested that workers exposed to antimony have shown sexual dysfunction in males and increased incidence of gynecological problems in females.
    B) Male rats have shown reduced quantities of spermatogenic epithelial cells and inability to fertilize healthy females. Female rats have shown altered reproductive function and sex life.
    3.20.2) TERATOGENICITY
    A) HUMANS
    1) BIRTH PREMATURE
    a) In a study of women exposed to dusts containing metallic antimony, antimony trioxide, and antimony pentasulfide, results showed an excess incidence of premature births and spontaneous abortions and that their childrens' growth may have been retarded (IARC, 1988).
    2) SUDDEN INFANT DEATH SYNDROME
    a) It has been suggested that the microbial generation of toxic gases from antimony-based additives used as fire retardants in crib mattresses could be associated with the development of sudden infant death syndrome (SIDS) (Richardson, 1990; Taylor, 1995); however, other studies have shown no statistical difference between post-mortem hepatic and serum antimony concentrations in infants who have died from SIDS and in infants who have died from other causes (Cullen et al, 2000; Boex et al, 1998).
    3.20.3) EFFECTS IN PREGNANCY
    A) HUMANS
    1) Antimony trioxide may interfere with embryonic or fetal development in humans, but the data are inconclusive (Leonard & Gerger, 1996). Women working in antimony processing had increased miscarriages, premature births, gynecological disease and developmental delay in their children (Belyayeva, 1967; Bingham et al, 2001). Antimony crosses the placenta (Clayton & Clayton, 1994).
    2) No pregnancy data was found in a review article on women treated with antimony compounds for leishmaniasis (Leonard & Gerger, 1996).
    B) ANIMAL STUDIES
    1) Rabbits fed doses of metallic antimony from 5 to 55 mg every other day for 30, 60, and 90 days had an increased number of abortions (HSDB , 2002). Although the number of abortions was increased in rabbits, oral antimony did not affect length of gestation or size of litter and was not teratogenic in rats (as antimony trichloride), even at levels producing maternal toxicity (Rossi et al, 1987).
    2) Antimony potassium tartrate produced no adverse effects in lambs when administered to pregnant ewes on a daily basis (James et al, 1966).

Carcinogenicity

    3.21.1) IARC CATEGORY
    A) IARC Carcinogenicity Ratings for CAS7440-36-0 (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) Not Listed
    3.21.3) HUMAN STUDIES
    A) CARCINOMA
    1) The ACGIH has classified antimony trioxide production as a suspected human carcinogen (A2) (ACGIH, 1991).
    3.21.4) ANIMAL STUDIES
    A) PULMONARY CARCINOMA
    1) Inhalation of antimony produced lung tumors in the rat; there is a possible link between occupational exposure to antimony and lung cancer (Friberg et al, 1986).
    B) LACK OF EFFECT
    1) No carcinogenic effect of antimony trioxide was found in rats chronically exposed by inhalation (Newton et al, 1994).

Genotoxicity

    A) Mutagenicity and cytotoxicity were seen in a Salmonella mutagenicity bioassay study, but it is noted that over 70% of the samples were contaminated with bacteria and fungi. Trivalent antimony has induced DNA damage in bacteria.

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) Obtain whole blood antimony concentration after poisoning with trivalent antimony. Serum concentration of antimony in normal subjects is approximately 3 mcg/L.
    B) Obtain 24 hours urine antimony concentration after exposure to pentavalent or trivalent antimony. A normal urinary level is approximately 0.8 mcg/L.
    C) Some antimony salts may cause liver toxicity. Monitor liver enzymes if patients have had significant exposures.
    D) Obtain an ECG in patients with significant poisoning.
    E) Hair concentrations of antimony rise with treatment with antimony compounds.
    4.1.2) SERUM/BLOOD
    A) BLOOD/SERUM CHEMISTRY
    1) Measure whole blood antimony concentration after poisoning with trivalent antimony (Shannon, 1998). Serum concentration of antimony in "normal" subjects is 3 mcg/L (Friberg, 1979).
    4.1.3) URINE
    A) URINARY LEVELS
    1) Obtain 24 hour urine antimony concentration after poisoning with pentavalent or trivalent antimony (Shannon, 1998). Levels of 1 mg/L may indicate a potentially harmful antimony exposure (Elkins, 1959). A "normal" subject may have a level of 0.8 mcg/L (Friberg, 1979).
    2) In one study the increase in urinary antimony concentration during a shift correlated with airborne concentrations better than did the absolute postshift urine concentration (Bailly et al, 1991). It was suggested that an airborne concentration of antimony of 500 micrograms/meter(3) corresponds to an increase in urinary antimony of 35 micrograms/g creatinine.
    4.1.4) OTHER
    A) OTHER
    1) HAIR
    a) Hair concentrations rise with treatment with antimony compounds (Dorea et al, 1987).
    2) GASTRIC
    a) May be measured in bile and gastric fluids, especially within 24 hours after an acute ingestion (Bailly et al, 1991).
    3) ECG
    a) Obtain an ECG after significant poisoning.

Methods

    A) SPECTROSCOPY/SPECTROMETRY
    1) A spectrochemical method for analysis of antimony in biologic materials has been published by Kinser et al (1965). It has a lower limit of detection of 50 ppm in 2 mg of ash.

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Monitoring

    A) Obtain whole blood antimony concentration after poisoning with trivalent antimony. Serum concentration of antimony in normal subjects is approximately 3 mcg/L.
    B) Obtain 24 hours urine antimony concentration after exposure to pentavalent or trivalent antimony. A normal urinary level is approximately 0.8 mcg/L.
    C) Some antimony salts may cause liver toxicity. Monitor liver enzymes if patients have had significant exposures.
    D) Obtain an ECG in patients with significant poisoning.
    E) Hair concentrations of antimony rise with treatment with antimony compounds.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) ACTIVATED CHARCOAL
    1) It is not known whether activated charcoal adsorbs antimony. Consider prehospital administration of activated charcoal as an aqueous slurry in patients who are awake and able to protect their airway.
    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) GASTRIC LAVAGE
    1) There may be slow absorption and lavage may be effective even after several hours (Lauwers et al, 1990).
    2) 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.
    3) 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.
    4) 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.
    5) 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).
    6) 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.
    B) ACTIVATED CHARCOAL
    1) There are no reports of activated charcoal being used for exposure to antimony salts. Since a significant proportion of antimony excreted in bile undergoes enterohepatic circulation, and since there is little risk in using activated charcoal, we recommend it until further data are available.
    2) 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.
    3) 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) CHELATION THERAPY
    1) DMSA may be the most effective chelator available. D-penicillamine is less effective but may be useful (Basinger & Jones, 1981; Liang et al, 1957).
    2) BAL, given intramuscularly for 10 days has been recommended as treatment (Moeschlin, 1965).
    3) Unithiol, also called DMPS, has been used experimentally (IRPTC, 1984; Reynolds, 1982). Unithiol is a dimercaprol derivative, which is not available in the US. Doses used are 1 milliliter of a 5 percent solution per 10 kilograms of patients weight 3 to 4 times a day on day 1, 2 to 3 times on day two and 1 to 2 times on day 3 through 7. The drug is given intramuscularly. Children 5 to 10 years old have been given 1/3 to 1/2 of the adult dose (IRPTC, 1984).
    4) EDTA is not effective.
    B) SUPPORT
    1) There is no other specific treatment; patients should be treated symptomatically.

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) OXYGEN
    1) Administer 100% humidified supplemental oxygen with assisted ventilation as required to patients with respiratory tract irritation.
    B) 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).

Dermal Exposure

    6.9.1) DECONTAMINATION
    A) DERMAL DECONTAMINATION
    1) 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).

Abstracts

Case Reports

    A) ADULT
    1) A 24-year-old woman was admitted to a hospital within one hour of ingesting an unknown amount of trivalent antimony used as a veterinary product. Presenting symptoms included epigastralgia, dysphagia, and a metallic taste in the mouth. Otherwise, her clinical examination was normal.
    a) Gastric lavage was performed as well as forced diuresis, repeated gastric juice aspiration, bile collection, and antidotal therapy consisting of 200 mg dimercaprol three times per day for five days. Her clinical course was uneventful and routine biological tests remained in the normal range. On the sixth day she was discharged (Bailly et al, 1991).

Range Of Toxicity

Summary

    A) An estimated toxic amount of the organic antimony tartar emetic (non elemental antimony) is 0.1 to 1 grams.
    B) Workers exposed to air having about 3 mg of antimony per cubic meter had urinary levels ranging from 0.8 to 9.6 mg/L.

Minimum Lethal Exposure

    A) ADULT
    1) Acute poisoning due to antimony is rare, but death can result within several hours (Harbison, 1998).
    2) Authors of different studies have found the average lethal dose of high-purity metallic antimony to be between 10 and 11.2 mg/100 g (ILO , 1998).

Maximum Tolerated Exposure

    A) ADULT
    1) An oral reference dose (RfD) of 4x10(-4) mg/kg/day has been established by the EPA. This was based on a chronic oral bioassay in which 5 ppm of potassium antimony tartrate was administered to rats in their drinking water. In this study, only one species and one dose level were used, causing the confidence in this study to be low (EPA , 1991).
    2) WORKPLACE AIR - Concentrations of antimony in the air have ranged from 1 to 10 milligrams/cubic meter. Working zone concentrations have ranged from 4.7 to 10.2 milligrams/cubic meter in smelters (Friberg, 1979).
    3) Workers exposed to air having about 3 milligrams of antimony per cubic meter showed urinary values ranging from 0.8 to 9.6 milligrams/liter (Friberg, 1979).
    4) CASE REPORT - Profuse vomiting and diarrhea and severe abdominal pain were reported in a 19-year-old man who intentionally ingested 500 mg of tartar emetic (antimony potassium tartrate) as chemical aversion therapy for alcohol dependence. Initial laboratory analyses showed a potassium level of 6.1 mEq/L and an elevated serum creatinine level of 2.4 mg/dL. With supportive care, the patient became asymptomatic and his serum creatinine level nomalized to 1.1 mg/dL (Tarabar et al, 2004).
    5) An estimated toxic amount of the organic antimony tartar emetic (not elemental antimony) is 0.12 to 1 gram (IRPTC, 1984).

Serum Plasma Blood Concentrations

    7.5.2) TOXIC CONCENTRATIONS
    A) TOXIC CONCENTRATION LEVELS
    1) After an intentional ingestion of 500 mg of tartar emetic (antimony potassium tartrate) by a 19-year-old man, a 24-hour urine assay, performed several days post-ingestion, reported an antimony concentration of 1200 mcg/L (normal: < 10 mcg/L) (Tarabar et al, 2004).

Workplace Standards

    A) ACGIH TLV Values for CAS7440-36-0 (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) Antimony and compounds, as Sb
    a) TLV:
    1) TLV-TWA: 0.5 mg/m(3)
    2) TLV-STEL:
    3) TLV-Ceiling:
    b) Notations and Endnotes:
    1) Carcinogenicity Category: Not Listed
    2) Codes: Not Listed
    3) Definitions: Not Listed
    c) TLV Basis - Critical Effect(s): Skin and URT irr
    d) Molecular Weight: 121.75
    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 CAS7440-36-0 (National Institute for Occupational Safety and Health, 2007):
    1) Listed as: Antimony and compounds (as Sb)
    2) REL:
    a) TWA: 0.5 mg/m(3)
    b) STEL:
    c) Ceiling:
    d) Carcinogen Listing: (Not Listed) Not Listed
    e) Skin Designation: Not Listed
    f) Note(s): [*Note: The REL also applies to other antimony compounds (as Sb).]
    3) IDLH:
    a) IDLH: 50 mg Sb/m3
    b) Note(s): Not Listed

    C) Carcinogenicity Ratings for CAS7440-36-0 :
    1) ACGIH (American Conference of Governmental Industrial Hygienists, 2010): Not Listed ; Listed as: Antimony and compounds, as Sb
    2) EPA (U.S. Environmental Protection Agency, 2011): Not Assessed under the IRIS program. ; Listed as: Antimony
    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): Not Listed
    4) NIOSH (National Institute for Occupational Safety and Health, 2007): Not Listed ; Listed as: Antimony and compounds (as Sb)
    5) MAK (DFG, 2002): Not Listed
    6) NTP (U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project ): Not Listed

    D) OSHA PEL Values for CAS7440-36-0 (U.S. Occupational Safety, and Health Administration (OSHA), 2010):
    1) Listed as: Antimony and compounds (as Sb)
    2) Table Z-1 for Antimony and compounds (as Sb):
    a) 8-hour TWA:
    1) ppm:
    a) Parts of vapor or gas per million parts of contaminated air by volume at 25 degrees C and 760 torr.
    2) mg/m3: 0.5
    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) Budavari, 2000 HSDB, 2002 ITI, 1995 Lewis 2000 RTECS 2002
    1) LD50- (INTRAPERITONEAL)MOUSE:
    a) 90 mg/kg
    2) LD50- (INTRAPERITONEAL)RAT:
    a) 100 mg/kg
    3) LD50- (ORAL)RAT:
    a) 100 mg/kg (ITI, 1995)
    b) 7 g/kg
    4) TCLo- (INHALATION)HUMAN:
    a) 4700 mcg/m(3) for 20W (ITI, 1995)
    5) TCLo- (INHALATION)RAT:
    a) 50 mg/m(3) for 7H/52W - intermittent - carcinogenic; tumors of the respiratory system

Pharmacology Toxicology

Pharmacologic Mechanism

    A) Trivalent antimony compounds inhibit phosphofructokinase which regulates the main source of energy of schistosomes (Winship, 1987).
    B) Antimony is locally caustic.

Toxicologic Mechanism

    A) Some initial studies indicate that antimony may interfere with cellular metabolism by combination with sulfhydrl groups in respiratory enzymes (Chen, 1936).
    B) Antimony is locally caustic.

Physicochemical

Physical Characteristics

    A) Antimony exists as a silver-white, lustrous, hard, brittle metal with a scale-like crystalline structure. It may also exist as a dark gray, lustrous powder (HSDB, 2005; NIOSH, 2005; Budavari, 2000) .
    1) Besides the stable metal, there are two allotropes, yellow crystals and amorphous black modifications (Lewis, 2001).
    B) At 900 degrees C in presence of oxygen, antimony gives off fumes with garlic smell (HSDB , 1999).
    C) In dry air, antimony is not tarnished, but in moist air, it tarnishes very slowly (Budavari, 2000).
    D) The gaseous form of antimony hydride is known as stibine (Bingham et al, 2001).
    E) At room temperature, antimony is stable. When antimony is heated, it will burn brilliantly and give off dense white fumes of antimony oxide. This has a garlic-like odor (ILO , 1998).

Molecular Weight

    A) 121.75

Other

    A) ODOR THRESHOLD
    1) Stibine gas is odorless (Bingham et al, 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) ACGIH: Documentation of the Threshold Limit Values and Biological Exposure Indices, 5th ed, Am Conference of Govt Ind Hyg, Inc, Cincinnati, OH, 1986.
    14) ACGIH: Documentation of the Threshold Limit Values and Biological Exposure Indices, 6th ed, Am Conference of Govt Ind Hyg, Inc, Cincinnati, OH, 1991, pp 73-75.
    15) AIHA: 2006 Emergency Response Planning Guidelines and Workplace Environmental Exposure Level Guides Handbook, American Industrial Hygiene Association, Fairfax, VA, 2006.
    16) ATSDR: Toxicological Profile for Antimony and Compounds, Agency for Toxic Substances and Disease Registry, US Dept of Health and Human Services, Atlanta, GA, 1992.
    17) 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.
    18) Alkofahi AS, Abdelaziz AA, & Mahmoud II: Cytotoxicity and mutagenicity of 'Al-Kohl', an eye cosmetic commonly used in Jordan. J Clin Pharm Ther 1989; 14:443-450.
    19) 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.
    20) Ashford R: Ashford's Dictionary of Industrial Chemicals, Wavelength Publications Ltd, London, England, 1994.
    21) Bailly R, Lauwerys R, & Buchet JP: Experimental and human studies on antimony metabolism: their relevance for the biological monitoring of workers exposed to inorganic antimony. Br J Ind Med 1991; 48:93-97.
    22) Basinger MA & Jones MM: Structural requirements for chelate antidotal efficacy in acute antimony(III) intoxication. Res Commun Chem Pathol Pharmacol 1981; 32:355-358.
    23) Belyayeva AP: Gig Tr Prof Zabol 1967; 11:32-37.
    24) Bingham E, Cohrssen B, & Powell CH: Patty's Toxicology, Vol 2. 5th ed, John Wiley & Sons, New York, NY, 2001.
    25) Boex TJ, Padgham C, & Nurse PA: Antimony and sudden infant death syndrome (letter). Lancet 1998; 351:1102-1103.
    26) Bradley WR & Fredrick WG: Ind Med (Ind Hyg Sec) 1941; 2:15.
    27) Budavari S: The Merck Index, 12th ed, Merck & Co, Inc, Whitehouse Station, NJ, 1996, pp 117-118.
    28) Budavari S: The Merck Index, 12th ed. on CD-ROM. Version 12:3a. Chapman & Hall/CRCnetBASE. Whitehouse Station, NJ. 2000.
    29) Burgess JL, Kirk M, Borron SW, et al: Emergency department hazardous materials protocol for contaminated patients. Ann Emerg Med 1999; 34(2):205-212.
    30) Caravati EM, Knight HH, & Linscott MS: Esophageal laceration and charcoal mediastinum complicating gastric lavage. J Emerg Med 2001; 20:273-276.
    31) Chemsoft(R) : Electronic EPA, NIOSH, & OSHA Methods(TM). Windowchem(TM) Software. Fairfield, CA. 2000.
    32) Chen G: J Infect Dis 1936; 76:152.
    33) Chulay JD, Fleckenstein L, & Smith DH: Pharmacokinetics of antimony during treatment of visceral leishmaniasis with sodium stibogluconate or meglumine antimoniate. Trans R Soc Trop Med Hyg 1988; 82:69-72.
    34) Chyka PA, Seger D, Krenzelok EP, et al: Position paper: Single-dose activated charcoal. Clin Toxicol (Phila) 2005; 43(2):61-87.
    35) Clayton GD & Clayton FE: Patty's Industrial Hygiene and Toxicology, Vol 2C, Toxicology, 4th ed, John Wiley & Sons, New York, NY, 1994, pp 1902-1913.
    36) Cullen A, Kiberd B, & Devaney D: Concentrations of antimony in infants dying from SIDS and infants from other causes. Arch Dis Child 2000; 82:244-247.
    37) 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.
    38) 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.
    39) Dorea JG, Costa JML, & Hoizbecher J: Antimony accumulation in hair during treatment of Leishmaniasis. Clin Chem 1987; 33:2081-2082.
    40) Dragun J: The Soil Chemistry of Hazardous Materials, Hazardous Materials Control Research Institute, Silver Spring, MD, 1988.
    41) EPA : Integrated Risk Information System (IRIS), Full IRIS Summary for Antimony (CASRN 7440-36-0). US Environmental Protection Agency. Greenbelt, MD. 1991. Available from URL: www.epa.gov/iris/subst/0006.htm. As accessed Accessed May 13, 2002.
    42) 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/.
    43) 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.
    44) Elkins HB: The Chemistry of Industrial Toxicology, 2nd ed, John Wiley, New York, NY, 1959.
    45) Elliot CG, Colby TV, & Kelly TM: Charcoal lung. Bronchiolitis obliterans after aspiration of activated charcoal. Chest 1989; 96:672-674.
    46) FDA: Poison treatment drug product for over-the-counter human use; tentative final monograph. FDA: Fed Register 1985; 50:2244-2262.
    47) Finkel AJ: Hamilton & Hardy's Industrial Toxicology, John Wright PSG Inc, Boston, MA, 1983.
    48) Friberg L: Handbook on the Toxicology of Metals, Elsevier/North-Holland Biomedical Press, Amsterdam, The Netherlands, 1979.
    49) Gasser RA Jr, Magill AJ, & Oster CN: Pancreatitis induced by pentavalent antimonial agents during treatment of leishmaniasis. Clin Infect Dis 1994; 18:83-90.
    50) Gebel T, Christensen S, & Dunkelberg H: Comparative and environmental genotoxicity of antimony and arsenic. Anticancer Res 1997; 17:2603-2607.
    51) Golej J, Boigner H, Burda G, et al: Severe respiratory failure following charcoal application in a toddler. Resuscitation 2001; 49:315-318.
    52) Graff GR, Stark J, & Berkenbosch JW: Chronic lung disease after activated charcoal aspiration. Pediatrics 2002; 109:959-961.
    53) 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.
    54) Gurnani N, Sharma A, & Talukder G: Comparison of clastogenic effects of antimony and bismuth as trioxides on mice invivo. Biol Tr Elem Res 1993; 37:281-292.
    55) HSDB : Hazardous Substances Data Bank. National Library of Medicine. Bethesda, MD (Internet Version). Edition expires 1999; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    56) HSDB : Hazardous Substances Data Bank. National Library of Medicine. Bethesda, MD (Internet Version). Edition expires 2005; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    57) HSDB : Hazardous Substances Data Bank. National Library of Medicine. Bethesda, MD (Internet Version). Edition expires 8/31/2002; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    58) Harbison RD: Hamilton & Hardy's Industrial Toxicology, 5th ed, Mosby-Year Books, St. Louis, MO, 1998.
    59) Harris CR & Filandrinos D: Accidental administration of activated charcoal into the lung: aspiration by proxy. Ann Emerg Med 1993; 22:1470-1473.
    60) Hathaway GJ, Proctor NH, & Hughes JP: Chemical Hazards of the Workplace, 4th ed, Van Nostrand Reinhold Company, New York, NY, 1996.
    61) Herwaldt BL, Kaye ET, & Lepore TJ: Sodium stibogluconate (Pentostam) overdose during treatment of American cutaneous leishmaniasis. J Infect Dis 1992; 165:968-971.
    62) Hicsonmez G, Jama H, & Ozsoylu S: Severe leucopenia during treatment of visceral leishmaniasis. Trans R Soc Trop Med Hyg 1988; 82:417.
    63) 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.
    64) 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.
    65) 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.
    66) 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.
    67) 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.
    68) IARC: IARC monographs on the evaluation of carcinogenic risks to humans, 47, International Agency for Research on Cancer, World Health Organization, Geneva, Switzerland, 1988, pp 291-305.
    69) 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.
    70) ICAO: Technical Instructions for the Safe Transport of Dangerous Goods by Air, 2003-2004. International Civil Aviation Organization, Montreal, Quebec, Canada, 2002.
    71) ILO : Encyclopedia of Occupational Health and Safety, 4th ed. Vol 1-4. (CD ROM Version). International Labour Organization. Geneva, Switzerland. 1998.
    72) IRPTC: Antimony. In: Scientific Reviews of Soviet Literature on Toxicity and Hazards of Chemicals, United Nations Environmental Programme, Moscow, Russia, 1984.
    73) ITI: Toxic and Hazardous Industrial Chemicals Safety Manual, The International Technical Information Institute, Tokyo, Japan, 1995.
    74) 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.
    75) 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.
    76) James LF, Lazar VA, & Binns W: Effects of sublethal doses of certain minerals on pregnant ewes and fetal development. Am J Vet Res 1966; 27:132-135.
    77) Kuroda K, Endo G, & Okamoto A: Genotoxicity of beryllium, gallium and antimony in short-term assays. Mutat Res 1991; 264:163-170.
    78) Lauwers LF, Roelants A, & Rosseel PM: Oral antimony intoxications in man. Crit Care Med 1990; 18:324-326.
    79) Leonard A & Gerger GB: Mutagenicity, carcinogenicity and teratogenicity of antimony compounds. Mutat Res 1996; 366:1-8.
    80) Lewis RJ: Hawley's Condensed Chemical Dictionary, 14th ed, John Wiley & Sons, Inc, New York, NY, 2001.
    81) Lewis RJ: Sax's Dangerous Properties of Industrial Materials, 10th ed, Van Nostrand Reinhold Company, New York, NY, 2000.
    82) Liang Y, Chu C, & Tsen Y: Studies on antibilharzial drugs VI. The antidotal effects of sodium dimercaptosuccinate and BAL-glucoside against tartar emetic. Acta Physiol Sin 1957; 21:24.
    83) McCallum RI: The industrial toxicology of antimony: the Ernestine Henry Lecture 1987. J R Coll Physicians Lond 1989; 23:28-32.
    84) Moeschlin S: Poisoning: Diagnosis and Treatment, Grune & Stratton, New York, NY, 1965.
    85) NFPA: Fire Protection Guide to Hazardous Materials, 12th ed, National Fire Protection Association, Quincy, MA, 1997.
    86) NFPA: Fire Protection Guide to Hazardous Materials, 13th ed., National Fire Protection Association, Quincy, MA, 2002.
    87) NIOSH : Pocket Guide to Chemical Hazards. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires 1999; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    88) NIOSH : Pocket Guide to Chemical Hazards. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires 2002; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    89) NIOSH: Pocket Guide to Chemical Hazards. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires 2005; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    90) 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.
    91) 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.
    92) 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.
    93) 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.
    94) Naradzay J & Barish RA: Approach to ophthalmologic emergencies. Med Clin North Am 2006; 90(2):305-328.
    95) 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.
    96) 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.
    97) 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.
    98) 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.
    99) 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.
    100) 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.
    101) 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.
    102) 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.
    103) 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.
    104) 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.
    105) 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.
    106) 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.
    107) 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.
    108) 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.
    109) 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.
    110) 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.
    111) 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.
    112) 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.
    113) 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.
    114) 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.
    115) 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.
    116) 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.
    117) 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.
    118) 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.
    119) 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.
    120) 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.
    121) 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.
    122) 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.
    123) 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.
    124) 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.
    125) 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.
    126) 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.
    127) 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.
    128) 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.
    129) 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.
    130) 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.
    131) 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.
    132) 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.
    133) 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.
    134) 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.
    135) 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.
    136) 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.
    137) 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.
    138) 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.
    139) 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.
    140) 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.
    141) 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.
    142) 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.
    143) 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.
    144) 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.
    145) 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.
    146) 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.
    147) 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.
    148) 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.
    149) 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.
    150) 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.
    151) 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.
    152) 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.
    153) 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.
    154) 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.
    155) 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.
    156) 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.
    157) 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.
    158) 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.
    159) 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.
    160) 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.
    161) 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.
    162) 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.
    163) 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.
    164) 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.
    165) 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.
    166) 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.
    167) 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.
    168) 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.
    169) 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.
    170) 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.
    171) National Research Council : Acute exposure guideline levels for selected airborne chemicals, 5, National Academies Press, Washington, DC, 2007.
    172) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 6, National Academies Press, Washington, DC, 2008.
    173) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 7, National Academies Press, Washington, DC, 2009.
    174) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 8, National Academies Press, Washington, DC, 2010.
    175) Newton PE, Bolte HF, & Daly IW: Subchronic and chronic inhalation toxicity of antimony trioxide in the rat. Fund Appl Toxicol 1994; 22:561-576.
    176) None Listed: Position paper: cathartics. J Toxicol Clin Toxicol 2004; 42(3):243-253.
    177) OHM/TADS : Oil and Hazardous Materials/Technical Assistance Data System. US Environmental Protection Agency. Washington, DC (Internet Version). Edition expires May/30/2002; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    178) OHM/TADS: Oil and Hazardous Materials Technical Assistance Data System. US Environmental Protection Agency. Washington, D.C. (Internet Version). Edition expires 2005; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    179) Peate WF: Work-related eye injuries and illnesses. Am Fam Physician 2007; 75(7):1017-1022.
    180) Pollack MM, Dunbar BS, & Holbrook PR: Aspiration of activated charcoal and gastric contents. Ann Emerg Med 1981; 10:528-529.
    181) RTECS : Registry of Toxic Effects of Chemical Substances. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires May/30/2002; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    182) Rau NR, Nagaraj MV, Prakash PS, et al: Fatal pulmonary aspiration of oral activated charcoal. Br Med J 1988; 297:918-919.
    183) Renes LE: Arch Ind Hyg 1953; 7:99-108.
    184) Reymond JM & Desmeules J: Sodium stibogluconate (Pentostan) overdose in a patient with acquired immunodeficiency syndrome. Ther Drug Monitor 1998; 20:714-716.
    185) Reynolds JEF: Martindale: The Extra Pharmacopoeia, 20th edition, The Pharmaceutical Press, London, UK, 1982.
    186) Richardson BA: Cot mattress biodeterioration and SIDS (letter). Lancet 1990; 335:670.
    187) Rossi F, Acampora R, & Vacca C: Teratog Carcinog Mutagen 1987; 7:491-496.
    188) Shannon M: The Toxicology of Other Heavy Metals in Clinical Management of Poisoning and Drug Overdose. Haddad LM, Shannon MW & Winchester JF, eds. W.B, Saunders Co, Philadelphia, PA, 1998.
    189) Sittig M: Handbook of Toxic and Hazardous Chemicals and Carcinogens, 3rd ed, Noyes Publications, Park Ridge, NJ, 1991.
    190) Spiller HA & Rogers GC: Evaluation of administration of activated charcoal in the home. Pediatrics 2002; 108:E100.
    191) Stokinger HE: Antimony.In: Clayton & Clayton (eds): Patty's Industrial Hygiene and Toxicology 3rd ed, Wiley-Interscience, New York, NY, 1981.
    192) Tarabar A, Khan Y, Nelson LS, et al: Antimony toxicity from the use of tartar emetic for the treatment of alcohol abuse. Vet Human Toxicol 2004; 46:331-333.
    193) Taylor A: Association between antimony and sudden infant death syndrome, Vth COMTOX Symposium on Toxicology and Clinical Chemistry of Metals, Vancouver, B.C. Canada, 1995.
    194) Thakore S & Murphy N: The potential role of prehospital administration of activated charcoal. Emerg Med J 2002; 19:63-65.
    195) 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.
    196) 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.
    197) 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-.
    198) 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.
    199) 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.
    200) 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.
    201) 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.
    202) 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-.
    203) U.S. Occupational Safety, and Health Administration (OSHA): Process safety management of highly hazardous chemicals. 29 CFR 2010 2010; 29(1910.119):348-.
    204) 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.
    205) Urben PG: Bretherick's Reactive Chemical Hazards Database, Version 3.0, Butterworth-Heinemann Ltd, Oxford, UK, 1999.
    206) Vale JA, Kulig K, American Academy of Clinical Toxicology, et al: Position paper: Gastric lavage. J Toxicol Clin Toxicol 2004; 42:933-943.
    207) 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.
    208) White GP, Mathias CGT, & Davin JS: Dermatitis in workers exposed to antimony in a melting process. JOM 1993; 35:392-395.
    209) Winship KA: Toxicity of antimony and its compounds. Adv Drug React Ac Pois Rev 1987; 2:67-90.
    210) de Lalla F, Pellizzer G, & Gradoni L: Acute pancreatitis assoicated with the administration of meglumine antimonate for the treatment of visceral leishmaniasis (letter). CID 1993; 16:730-731.