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TRIETHANOLAMINE

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Triethanolamine is a strong irritant with low acute toxicity; toxic effects are due chiefly to its alkalinity. Degree of irritation is dependent on its concentration, exposure duration and site of exposure. Large oral doses in animals have produced minimal toxicity.
    B) TROLAMINE is a mixture comprised mainly of triethanolamine, in addition to various proportions of monoethanolamine and diethanolamine.

Specific Substances

    1) 2,2,2-Nitrilotriethanol
    2) Nitrilo-2,2',2"-triethanol
    3) Sterolamide
    4) TEA
    5) Triethanolamin
    6) Trihydroxytriethylamine
    7) Tris(hydroxyethyl)amine
    8) Triethylolamine
    9) Trolamine
    10) Molecular Formula: C6-H15-N-O3
    11) CAS 102-71-6
    1.2.1) MOLECULAR FORMULA
    1) C6-H15-N-O3

Available Forms Sources

    A) FORMS
    1) Triethanolamine is a hygroscopic, viscous liquid which has a slight odor of ammonia. It turns brown upon exposure to light and air (Budavari, 1996). It is miscible with water, methanol and acetone, and is soluble in chloroform, benzene and ether (S Sweetman , 1998; ACGIH, 1996; Budavari, 1996).
    2) Triethanolamine is an ethanolamine compound and a moderately strong base (Grant & Schuman, 1993).
    B) SOURCES
    1) Triethanolamine is produced by ammonolysis of ethylene oxide and then separated by distillation (Melnick & Thomaszewski, 1990; Budavari, 1996).
    C) USES
    1) As a pharmaceutical aid, it has been combined with fatty acids such as stearic and oleic acids and used as an emulsifier and as an alkalinizing agent. It has also been used for reducing dithranol-induced staining of the skin (S Sweetman , 1998; Budavari, 1996) (Benya & Harbison, 1994).
    2) Ear drops with triethanolamine polypeptide oleate-condensate 10% have been used for removal of ear wax. Triethanolamine has been combined with salicylic acid in topical preparations as an analgesic (S Sweetman , 1998).
    3) It is an intermediate used in the manufacture of household detergents, soaps, cosmetics, polishes, and waxes (Budavari, 1996). It is used with fatty acids as emulsifiers for creams, lotions, skin cleaners, and shampoos (Harbison, 1998; Melnick & Thomaszewski, 1990). It is also used in adhesives for food packaging (Zenz, 1994).
    4) Triethanolamine is also used as an antifoam agent, water repellant, corrosion inhibitor, softener, oil emulsifier, humectant, plasticizer, chelator, rubber accelerator, solvent (for casein, shellac, and dyes), and to increase the penetration of organic liquids into wood and paper. It is used in herbicides, cement additives, toilet goods, and cutting oils and as an intermediate in the manufacture of synthetic resins and surface active agents (Budavari, 1996).

Overview

Life Support

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

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) USES: It is an intermediate used in the manufacture of many commercial and household products. PHARMACEUTICAL: As a pharmaceutical aid, it has been combined with fatty acids such as stearic and oleic acids and used as an emulsifier and as an alkalinizing agent. It has also been used for reducing dithranol-induced staining of the skin. PERSONAL CARE: It is used with fatty acids as emulsifiers for creams, lotions, skin cleaners, and shampoos. HOUSEHOLD: It is used in the manufacture of household detergents, soaps, cosmetics, polishes, and waxes.
    B) TOXICOLOGY: Triethanolamine is produced by ammonolysis of ethylene oxide and then separated by distillation. It is a hygroscopic, viscous liquid which has a slight odor of ammonia, and turns brown upon exposure to light and air.
    C) ROUTE OF EXPOSURE: Primarily via the skin, with some exposure occurring from inhalation of vapor and aerosols.
    D) WITH POISONING/EXPOSURE
    1) OVERDOSE: Limited human data following acute or chronic exposure.
    2) ACUTE EXPOSURE: Triethanolamine is found in many occupational and consumer products; therefore there is considerable opportunity for exposure. It is anticipated to have low acute toxicity, with effects mainly resulting from its alkalinity (pH 9 to 11 in water). Significant caustic injury is not expected from this substance. Triethanolamine is a skin and eye irritant. The degree of irritancy depends upon triethanolamine concentration, exposure duration, and site. INHALATION: Irritant gases (nitrogen oxides, sulfur dioxide) and carbon monoxide can be produced when triethanolamine is heated to decomposition.
    a) ANIMAL DATA: Large doses of triethanolamine produced minimal toxicity when administered orally to laboratory animals.
    3) CHRONIC EXPOSURE: Based on data from animal studies, triethanolamine is anticipated to have low chronic toxicity under typical human exposure conditions. Key concerns are possible sensitization, irritation, and potential carcinogenicity. Human reports of dermal sensitization or asthma have been confounded by exposure to other chemicals or to ethanolamines and other chemicals at high temperatures.
    a) ANIMAL DATA: Experimental animal studies have been negative for dermal and respiratory sensitization. The carcinogenic potential of triethanolamine is uncertain due to conflicting or equivocal study results. Nephrotoxicity (primary effect), hepatic congestion, and demyelination of peripheral and sciatic nerve fibers have been reported in laboratory animals following long-term oral administration of triethanolamine. Skin irritation and ulceration have been reported following repeated, subchronic, and chronic topical exposure in laboratory animals, but triethanolamine has failed to produce sensitization following dermal application.
    0.2.20) REPRODUCTIVE
    A) At the time of this review, no reproductive studies were found for triethanolamine in humans.
    B) The only reproductive study found for triethanolamine concluded that it was embryotoxic in chickens.
    0.2.21) CARCINOGENICITY
    A) At the time of this review, no studies were found on the carcinogenic potential of triethanolamine in humans.

Laboratory Monitoring

    A) Generally, routine laboratory studies are not indicated following most dermal exposures.
    B) Conduct liver and renal function tests and monitor urinary output in cases involving significant exposure.
    C) If the patient has been exposed to triethanolamine heated to decomposition, there is a risk of inhalational exposure to nitrogen oxides, carbon monoxide, and carbon dioxide. Monitor for respiratory irritation, pneumonitis, pulmonary edema, hypoxia, and elevated carboxyhemoglobin levels.
    D) Monitor arterial blood gases and chest x-ray in symptomatic patients (ie, dyspnea, tachypnea, wheezing, retractions, persistent coughing, cyanosis).
    E) Dermal patch testing, bronchial provocation testing, and pulmonary function tests may be useful to identify individuals who have been sensitized to triethanolamine, although sensitization and associated adverse effects are rare.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) MANAGEMENT OF TOXICITY
    1) Limited human exposure data. Treatment is symptomatic and supportive. Monitor respiratory effort following an inhalation exposure.
    B) DECONTAMINATION
    1) PREHOSPITAL: Do NOT induce vomiting in cases of triethanolamine ingestion. Due to possible irritating effects, emesis should not be induced following ingestion. Dilution may be sufficient for ingestions of small quantities of triethanolamine, particularly if the solution is of very low triethanolamine concentration. Dilute with water. DERMAL: Remove contaminated clothing following and rinse exposed skin with water. INHALATION: Move patients to fresh air. Assess respiratory effort; monitor pulse oximetry.
    2) HOSPITAL: ACTIVATED CHARCOAL: There is no information concerning the usefulness of activated charcoal; it may be administered at the physician's discretion in individual cases. INHALATION: Assess respiratory effort and treat symptomatically following an inhalation exposure.
    C) AIRWAY MANAGEMENT
    1) Airway management is unlikely to be necessary following a mild to moderate inhalation exposure. Irritant gases (nitrogen oxides, sulfur dioxide) and carbon monoxide can be produced when triethanolamine is heated to decomposition. Respiratory tract irritation, pneumonitis, pulmonary edema, and hypoxia can occur with significant exposure to these gases. In the event of inhalation exposure, move patient to fresh air. Assess airway and ensure adequate ventilation.
    D) ANTIDOTE
    1) There is no known antidote for triethanolamine.
    E) ENHANCED ELIMINATION
    1) Enhanced elimination is unlikely to be necessary following exposure to triethanolamine.
    F) PATIENT DISPOSITION
    1) HOME CRITERIA: Triethanolamine is combined with other chemicals to produce numerous household/cosmetic products; it may be difficult to determine if the effects observed are directly related to triethanolamine. However, significant exposure is unlikely to occur. Patients (adults or children) with a dermal household exposure that develop mild skin irritation can be managed at home. If a patient has been exposed to concentrated triethanolamine, they may need to observed in a healthcare facility. In the event of an oral ingestion of a household product containing triethanolamine, patients may need to be observed in a healthcare facility depending on the other ingredients and the possible irritating effects of triethanolamine.
    2) OBSERVATION CRITERIA: Patients can be discharged as soon as symptoms have been treated and can be managed at home as needed. In the unlikely event that a patient has been exposed to triethanolamine heated to decomposition, there is a risk of inhalational exposure to nitrogen oxides (irritants), carbon monoxide, and carbon dioxide. Monitor for hypoxia and respiratory irritation, ranging from mild respiratory irritation to delayed pulmonary edema which can be delayed up to 72 hours after exposure.
    3) ADMISSION CRITERIA: In patients that show signs of exposure to triethanolamine heated to decomposition, admit any individuals with stridor, chest retractions, dysphagia, cyanosis, choking, circumoral burns, excessive salivation (drooling) or any other signs or symptoms of aspiration and/or severe oral irritation/corrosion. Patients with a history of smoking or underlying respiratory disease (ie, asthma) may be at greater risk.
    4) CONSULT CRITERIA: Consult a poison control center or a medical toxicologist for assistance in managing patients with severe toxicity (ie, respiratory insufficiency or depression) or in whom the diagnosis is not clear.
    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) TOXIC DOSE: The actual lethal and toxic dose in humans are unknown. Mild to moderate eye or skin irritation are the primary effects anticipated from direct triethanolamine contact. Triethanolamine, ethanolamine, and diethanolamine are considered safe in cosmetic formulations which are briefly used followed by thorough rinsing from the skin surface. The concentration of these 3 ethanolamines in cosmetics should not exceed 5% if the products are intended for prolonged skin contact. INGESTION: The estimated fatal ORAL dose of triethanolamine in humans is 50 g; however, how this data was determined was not provided. DERMAL: Mild dermal irritation resulted from intermittent application of 15 mg of triethanolamine to human skin for 3 days. ANIMAL DATA: Based on experimental animal data, acute oral toxicity is considered low.

Clinical Effects

Summary Of Exposure

    A) USES: It is an intermediate used in the manufacture of many commercial and household products. PHARMACEUTICAL: As a pharmaceutical aid, it has been combined with fatty acids such as stearic and oleic acids and used as an emulsifier and as an alkalinizing agent. It has also been used for reducing dithranol-induced staining of the skin. PERSONAL CARE: It is used with fatty acids as emulsifiers for creams, lotions, skin cleaners, and shampoos. HOUSEHOLD: It is used in the manufacture of household detergents, soaps, cosmetics, polishes, and waxes.
    B) TOXICOLOGY: Triethanolamine is produced by ammonolysis of ethylene oxide and then separated by distillation. It is a hygroscopic, viscous liquid which has a slight odor of ammonia, and turns brown upon exposure to light and air.
    C) ROUTE OF EXPOSURE: Primarily via the skin, with some exposure occurring from inhalation of vapor and aerosols.
    D) WITH POISONING/EXPOSURE
    1) OVERDOSE: Limited human data following acute or chronic exposure.
    2) ACUTE EXPOSURE: Triethanolamine is found in many occupational and consumer products; therefore there is considerable opportunity for exposure. It is anticipated to have low acute toxicity, with effects mainly resulting from its alkalinity (pH 9 to 11 in water). Significant caustic injury is not expected from this substance. Triethanolamine is a skin and eye irritant. The degree of irritancy depends upon triethanolamine concentration, exposure duration, and site. INHALATION: Irritant gases (nitrogen oxides, sulfur dioxide) and carbon monoxide can be produced when triethanolamine is heated to decomposition.
    a) ANIMAL DATA: Large doses of triethanolamine produced minimal toxicity when administered orally to laboratory animals.
    3) CHRONIC EXPOSURE: Based on data from animal studies, triethanolamine is anticipated to have low chronic toxicity under typical human exposure conditions. Key concerns are possible sensitization, irritation, and potential carcinogenicity. Human reports of dermal sensitization or asthma have been confounded by exposure to other chemicals or to ethanolamines and other chemicals at high temperatures.
    a) ANIMAL DATA: Experimental animal studies have been negative for dermal and respiratory sensitization. The carcinogenic potential of triethanolamine is uncertain due to conflicting or equivocal study results. Nephrotoxicity (primary effect), hepatic congestion, and demyelination of peripheral and sciatic nerve fibers have been reported in laboratory animals following long-term oral administration of triethanolamine. Skin irritation and ulceration have been reported following repeated, subchronic, and chronic topical exposure in laboratory animals, but triethanolamine has failed to produce sensitization following dermal application.

Heent

    3.4.3) EYES
    A) Human injury has not been reported (Hathaway et al, 1996). Mild to moderate eye irritation may occur following direct contact with concentrated triethanolamine, based on limited experimental animal data (Grant & Schuman, 1993).
    1) Griffith et al (1980) reported that administration of 0.1 mL of 98% triethanolamine to the rabbit eye caused negligible irritation (mean Draize score of zero in repeated studies) which cleared within 24 hours; 0.3 mL produced mild irritation (mean Draize scores of 0 or 1 in repeated studies) which cleared within 1 day, and 0.1 mL produced mild irritation (mean Draize scores of 0, 1 or 2 in repeated studies) which resolved within 3 days. Using the Federal Hazardous Substances Act and proposed National Academy of Sciences criteria for ocular irritancy, triethanolamine was presumed to be nonhazardous (innocuous/nonirritant) following accidental eye contact.
    2) Moderate, transient injury 24 hours after instillation of triethanolamine into rabbit eyes was reported by Carpenter & Smyth (1946). Triethanolamine was ranked 5 on an injury grade scale of 1 to 10, with 10 representing chemicals which caused severe eye injury. The scoring system is not equivalent to the Draize method. The study is limited by several factors, such as absence of data specifically concerning triethanolamine administration and responses, and possible impurity of test compounds.
    3) A study which compared eye irritation caused by ethanolamines rated triethanolamine irritation as minimal, while irritation was considered maximum for ethanolamine and severe for diethanolamine (Melnick & Thomaszewski, 1990).
    3.4.6) THROAT
    A) Ingestion of several ounces of undiluted or unneutralized triethanolamine may result in alkali burns of the mouth, pharynx and esophagus (HSDB , 2001).

Respiratory

    3.6.2) CLINICAL EFFECTS
    A) IRRITATION SYMPTOM
    1) WITH POISONING/EXPOSURE
    a) Due to its low vapor pressure (less than 0.01 torr), triethanolamine vapor inhalation is not likely to be a significant route of exposure in industry (Benya & Harbison, 1994).
    b) Inhalation of highly concentrated triethanolamine mists or spray are anticipated by some to produce respiratory tract irritation in certain individuals, such as those sensitive to pulmonary irritants (Amerex Corp, 1998). However, reports of significant respiratory irritation in humans exposed solely to triethanolamine mists or spray have not been found in the published, peer-reviewed literature or computerized toxicological databases such as MEDLINE.
    c) Irritant gases (nitrogen oxides), carbon dioxide, and carbon monoxide (asphyxiant) can be produced when triethanolamine is heated to decomposition (Radian Corporation, 1991). Respiratory tract irritation, pneumonitis, pulmonary edema, and hypoxia can occur with significant exposure to these gases.
    B) BRONCHOSPASM
    1) WITH POISONING/EXPOSURE
    a) Savonius et al (1994) reported occupational asthma in 3 workers who had been exposed to triethanolamines at temperatures higher than the ambient air. Two of the workers were past or current cigarette smokers and all workers had been exposed to triethanolamine or monoethanolamine for 8 or more years. Skin tests were positive only in one worker (test agent not reported) but bronchial provocation testing was positive to cutting fluids or detergent which had been heated to above room temperature.
    1) Signs and symptoms included work-related cough, dyspnea, chest tightness, and wheezing, with 21% to 24% decreases in peak expiratory flow. It was suggested that the exposure to the ethanolamines at temperatures above room temperature was a critical factor and that significant inhalational exposure to ethanolamines is unlikely when ethanolamines are used at room temperature (Savonius et al, 1994).

Neurologic

    3.7.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) NEUROPATHY PERIPHERAL
    a) Lightly scattered degeneration of the myelin sheath of sciatic and peripheral nerve fibers were found in mice and guinea pigs fed 800 to 1600 mg/kg of triethanolamine 5 days per week, for up to 6 months (Kindsvatter, 1940; Grant & Schuman, 1993; ACGIH, 1996).

Hepatic

    3.9.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) HEPATOCELLULAR DAMAGE
    a) Hepatic congestion and fatty changes were found in experimental animals orally administered large doses (800 to 1600 mg/kg) of triethanolamine, 5 days per week, for 3 to 6 months (Kindsvatter, 1940; ACGIH, 1996). Knaak et al (1997) have reported hepatic lesions in rat studies consisting of cloudy swelling and occasional fatty changes.
    b) A National Toxicology Program (NTP) draft technical review reported that male (triethanolamine dose: 2000 mg/kg) and female B6C3F1 mice (triethanolamine dose: 300 mg/kg), but not rats, had significantly greater incidence of hepatic eosinophilic foci as compared to controls (NTP , 1994). Triethanolamine was topically administered 5 days per week, for 2 years (NTP , 1998).

Genitourinary

    3.10.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) NEPHROPATHY TOXIC
    a) Kindsvatter (1940) reported renal swelling and congestion in some animals administered large oral doses (800 to 1600 mg/kg) of triethanolamine, 5 days per week, for 3 to 6 months (ACGIH, 1996). Knaak et al (1997) have reported cloudy swelling of the convoluted tubules and loop of Henle in experimental rat studies.
    b) Dose-related nephrotoxicity also occurred in male and female rats following 2 years of triethanolamine administered as a 1% or 2% concentration in the drinking water (Maekawa et al, 1986; ACGIH, 1996). Kidney effects included increased weight, enlargement, presence of granular surfaces, pallor, mineralization of the renal papilla, pyelonephritis, and nodular hyperplasia of the pelvic mucosa.
    c) A draft National Toxicology Program (NTP) technical report has also identified increased renal weight as an effect of triethanolamine in rats and mice to whose skin triethanolamine was repeatedly applied 5 days per week for a period of 13 weeks or 2 years (NTP , 1994). Triethanolamine (administered with acetone) doses ranged from 32 mg/kg to 2000 mg/kg, with 4000 mg/kg of neat triethanolamine (no acetone) being used in some studies. Renal effects were observed at lower doses in female than in male rats and mice.

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) SKIN IRRITATION
    1) WITH POISONING/EXPOSURE
    a) Triethanolamine can be irritating to the skin and mucous membranes following exposure to concentrations above 5% (HSDB , 2001; S Sweetman , 1998). Skin irritation or contact dermatitis has been reported in workers exposed to triethanolamine and other chemicals (Harbison, 1998; ACGIH, 1996).
    B) CONTACT DERMATITIS
    1) WITH POISONING/EXPOSURE
    a) Contact allergy to triethanolamine in a fluorescent marking pen used for patch testing has been reported in a woman (Hamilton & Zug, 1996). Contact dermatitis was reported in a patient following the use of ear drops containing triethanolamine polypeptide oleate-condensate (S Sweetman , 1998).
    b) Erythematous vesicular eruptions developed in a worker exposed to fiber glass, epoxy resins, and diaminodiphenylmethane. Positive patch tests to epoxy resin, diaminodiphenylmethane and triethanolamine were found; however, it was not known if the worker handled triethanolamine (Conde-Salazar et al, 1985). The purity of the triethanolamine used in the patch test was not reported.
    c) Allergic contact dermatitis occurred in a worker who was involved in cutting oil production (Shrank, 1985). Positive patch test responses to samples produced during initial stages of cutting oil manufacture were associated with the mixing of triethanolamine and caprylic acid, whereby triethanolamine caprylate was produced. Patch test response was negative to caprylic acid in ethanol (dilution not specified) and patch testing of triethanolamine alone was not reported. The author concluded that amine soaps are potential, but rare, allergens.
    d) A positive patch test response to triethanolamine was found in one of 6 workers who had evidence of allergic contact dermatitis to cutting fluids (Niklasson et al, 1993). The cutting fluids contained a fatty acid ester, EM-550, made of soya-oil, C21-dicarboxylic acids, and the diethanolamine of C21-dicarboxylic acids.
    3.14.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) DERMATITIS
    a) Epidermal thickening with no other appreciable dermal or systemic effects developed in mice to which triethanolamine (0.14 to 2.3 g/kg of body weight) had been dermally applied 3 times per week for 13 weeks (DePass et al, 1995).
    2) LACK OF EFFECT
    a) Dermal application of up to 30% or greater than 99% pure triethanolamine failed to produce irritation in acutely exposed mice (NTP , 1994).
    3) IRRITATION
    a) Application of triethanolamine to rabbit skin for 72 hours produced moderate redness, edema, and necrosis (CTFA, 1959) (Hathaway et al, 1996). Skin irritation produced by triethanolamine was slight, as compared to moderate for diethanolamine and severe for ethanolamine (Melnick & Thomaszewski, 1990).

Endocrine

    3.16.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) OTHER NON-SPECIFIC
    a) When triethanolamine was applied topically to female rats for 13 weeks at 500, 1000 or 2000 mg/kg, dose-related hypertrophy of the pituitary gland pars intermedia was reported (NTP , 1994).
    b) Dose-related hypertrophy of the pituitary gland pars intermedia occurred in male rats administered 250 to 2000 mg/kg (NTP , 1994).

Immunologic

    3.19.2) CLINICAL EFFECTS
    A) ALLERGIC CONTACT DERMATITIS
    1) Contact allergy to triethanolamine in a fluorescent marking pen used for patch testing has been reported in a woman (Hamilton & Zug, 1996).
    2) Allergic contact dermatitis occurred in a worker who was involved in cutting oil production (Shrank, 1985). Positive patch test responses to samples produced during initial stages of cutting oil manufacture were associated with the mixing of triethanolamine and caprylic acid, whereby triethanolamine caprylate was produced.
    3.19.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) LACK OF EFFECT
    a) Female mice did not exhibit any statistically significant hypersensitivity responses to dermal triethanolamine challenge conducted 7 days after initial doses of 3%, 10% or 30% of greater than 99% pure triethanolamine was topically administered for 5 consecutive days (NTP , 1998). No evidence of sensitization was observed in guinea pigs (Life Science Research, 1975) (Hathaway et al, 1996).

Reproductive

    3.20.1) SUMMARY
    A) At the time of this review, no reproductive studies were found for triethanolamine in humans.
    B) The only reproductive study found for triethanolamine concluded that it was embryotoxic in chickens.
    3.20.2) TERATOGENICITY
    A) ANIMAL STUDIES
    1) The only reproductive study found for triethanolamine concluded that it was embryotoxic in chickens (Korhonen, 1983). The implications of this finding for human reproduction are not clear.

Carcinogenicity

    3.21.1) IARC CATEGORY
    A) IARC Carcinogenicity Ratings for CAS102-71-6 (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004):
    1) IARC Classification
    a) Listed as: TEA (Triethanolamine)
    b) Carcinogen Rating: 3
    1) The agent (mixture or exposure circumstance) is not classifiable as to its carcinogenicity to humans. This category is used most commonly for agents, mixtures and exposure circumstances for which the evidence of carcinogenicity is inadequate in humans and inadequate or limited in experimental animals. Exceptionally, agents (mixtures) for which the evidence of carcinogenicity is inadequate in humans but sufficient in experimental animals may be placed in this category when there is strong evidence that the mechanism of carcinogenicity in experimental animals does not operate in humans. Agents, mixtures and exposure circumstances that do not fall into any other group are also placed in this category.
    2) IARC Classification
    a) Listed as: Triethanolamine
    b) Carcinogen Rating: 3
    1) The agent (mixture or exposure circumstance) is not classifiable as to its carcinogenicity to humans. This category is used most commonly for agents, mixtures and exposure circumstances for which the evidence of carcinogenicity is inadequate in humans and inadequate or limited in experimental animals. Exceptionally, agents (mixtures) for which the evidence of carcinogenicity is inadequate in humans but sufficient in experimental animals may be placed in this category when there is strong evidence that the mechanism of carcinogenicity in experimental animals does not operate in humans. Agents, mixtures and exposure circumstances that do not fall into any other group are also placed in this category.
    3.21.2) SUMMARY/HUMAN
    A) At the time of this review, no studies were found on the carcinogenic potential of triethanolamine in humans.
    3.21.4) ANIMAL STUDIES
    A) NEOPLASM
    1) Male and female mice which were fed triethanolamine (0.3% or 0.03% by weight) throughout their lifespan developed significantly higher numbers of tumors than controls (Hoshino & Tanooka, 1978). Female mice had 32% (p<0.01) more total incidence of malignant tumors, with tumors involving the lymphoid tissues predominating, than controls. Triethanolamine-treated male mice did not have the excessive lymphoid tissue tumors and did not have a dose-related increase in other tumors as compared to controls.
    2) Konishi et al (1992) have pointed out that the incidence of spontaneous tumors in the control mice in the study by Hoshino & Tanooka (1978) was unusually low, and the incidence of tumors in the triethanolamine-treated mice was similar to that which was found in other studies to spontaneous occur (Konishi et al, 1992; Hoshino & Tanooka, 1979).
    3) The National Toxicology Program's (NTP) draft technical reports of 2 year studies involving topical application of triethanolamine have found equivocal evidence of carcinogenesis in male rats, no evidence of carcinogenicity in female rats, equivocal evidence of carcinogenicity in male mice, and some evidence of carcinogenicity in female mice (NTP , 1994). A final version of the technical report is in press (NTP , 1998).
    4) Dermal application of triethanolamine 5 days per week for 103 weeks to male (doses: 200, 630, and 2000 mg/kg) and female mice (doses: 100, 300, and 1000 mg/kg) found significantly greater incidences of single and multiple hepatocellular adenomas in males than the incidences in control males. The combined incidence of hepatoblastoma, adenoma, and carcinoma in males dosed with 2000 mg/kg was also significantly greater than in controls. Complicating interpretation of these study results was the presence of Helicobacter hepaticus infection with in male mice. This infection can increase the incidence of hepatic neoplasms in mice (NTP , 1994; NTP , 1998).
    5) The combined incidence of hepatocellular adenomas and carcinomas in females in the 1000 mg/kg group was significantly greater than the control incidence. Hepatocellular carcinoma in female mice receiving 300 mg/kg was also significantly greater than in controls (NTP , 1994).
    6) Triethanolamine was carcinogenic in mice exposed by the oral route, producing thymic lymphomas (Clayton & Clayton, 1982).
    B) LACK OF EFFECT
    1) Oral administration for 104 weeks (greater than 2 years) of triethanolamine as a 1% or 2% concentration in the drinking water of rats was not considered carcinogenic, although there was a slight excess of hepatic tumors in males and of uterine endometrial sarcomas and renal-cell adenomas in females (Maekawa et al, 1986; ACGIH, 1996).
    2) Male and female mice fed triethanolamine in drinking water (1% to 2%) ad libitum for 82 weeks failed to develop dose-related or statistically significant increases of neoplasms as compared to controls (Konishi et al, 1992). Water consumption was similar in the controls and in the triethanolamine-ingesting mice. Male mice in the 1% and 2% triethanolamine groups consumed a total of 62.8 and 63.6 g/mouse, respectively, over the 82 week period. Female mice in the 1% and 2% triethanolamine groups consumed a total of 26.9 and 37.3 g/mouse, respectively over the 82 weeks.
    3) Dermal application of triethanolamine 5 days per week for 2 years to male (doses: 32, 63, 125 mg/kg) and female rats (doses: 63, 125 and 250 mg/kg) failed to produce skin neoplasms. The incidence of renal tubule adenoma in dosed male rats were slightly higher than the incidence in the controls. The incidence of renal tubule hyperplasia was similar in dosed and control males, but the severity of the hyperplasia in dosed males (32 and 125 mg/kg doses) was greater than that observed in controls (NTP , 1994; NTP , 1998).
    4) When given to rats by dermal exposure and/or in the drinking water, it did not cause cancer (Kostrodymova, 1976).

Genotoxicity

    A) Triethanolamine has been negative in in vitro tests for mutagenicity, chromosomal aberrations, and in Drosophila melanogaster for sex-linked recessive lethal mutations. No abnormalities were found in the erythrocytes of mice treated topically with triethanolamine.

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) Generally, routine laboratory studies are not indicated following most dermal exposures.
    B) Conduct liver and renal function tests and monitor urinary output in cases involving significant exposure.
    C) If the patient has been exposed to triethanolamine heated to decomposition, there is a risk of inhalational exposure to nitrogen oxides, carbon monoxide, and carbon dioxide. Monitor for respiratory irritation, pneumonitis, pulmonary edema, hypoxia, and elevated carboxyhemoglobin levels.
    D) Monitor arterial blood gases and chest x-ray in symptomatic patients (ie, dyspnea, tachypnea, wheezing, retractions, persistent coughing, cyanosis).
    E) Dermal patch testing, bronchial provocation testing, and pulmonary function tests may be useful to identify individuals who have been sensitized to triethanolamine, although sensitization and associated adverse effects are rare.
    4.1.2) SERUM/BLOOD
    A) BLOOD/SERUM CHEMISTRY
    1) Obtain arterial blood gases in symptomatic patients. Monitor BUN, creatinine, serum CPK, and liver function tests.
    2) Monitor carboxyhemoglobin levels if exposure to carbon monoxide as a by-product of triethanolamine decomposition is suspected.
    4.1.3) URINE
    A) URINALYSIS
    1) Monitor urinary output and urinalysis in significant exposures.
    2) Methods are available for measuring levels of triethanolamine and its metabolites in urine (Sollenbert, 1991); however, urinary values indicative of safe exposure or toxicity have not been established.
    4.1.4) OTHER
    A) OTHER
    1) PULMONARY FUNCTION TESTS
    a) Pulmonary function tests, dermal patch testing, and bronchial provocation testing may be useful to identify persons who have been sensitized to triethanolamine.

Radiographic Studies

    A) If respiratory irritation and/or hypoxia are present, monitor chest x-ray.

Methods

    A) CHROMATOGRAPHY
    1) Isotachophoresis has been used to detect triethanolamine and its metabolites in urine, and produces similar results as gas chromatography (Sollenberg, 1991).

Treatment

Monitoring

    A) Generally, routine laboratory studies are not indicated following most dermal exposures.
    B) Conduct liver and renal function tests and monitor urinary output in cases involving significant exposure.
    C) If the patient has been exposed to triethanolamine heated to decomposition, there is a risk of inhalational exposure to nitrogen oxides, carbon monoxide, and carbon dioxide. Monitor for respiratory irritation, pneumonitis, pulmonary edema, hypoxia, and elevated carboxyhemoglobin levels.
    D) Monitor arterial blood gases and chest x-ray in symptomatic patients (ie, dyspnea, tachypnea, wheezing, retractions, persistent coughing, cyanosis).
    E) Dermal patch testing, bronchial provocation testing, and pulmonary function tests may be useful to identify individuals who have been sensitized to triethanolamine, although sensitization and associated adverse effects are rare.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) DERMAL EXPOSURE
    1) Remove contaminated clothing.
    2) 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).
    3) Seek immediate medical attention if there are signs and/or symptoms of adverse effects, or if there is considerable dermal contact.
    B) EYE EXPOSURE
    1) Check the victim for contact lenses and remove them if present.
    2) 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).
    3) Seek medical attention.
    C) INHALATIONAL EXPOSURE
    1) 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.
    2) OBSERVATION: Carefully observe patients with inhalation exposure for the development of any systemic signs or symptoms and administer symptomatic treatment as necessary.
    3) 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.
    D) INGESTION EXPOSURE
    1) Do NOT induce vomiting, due to the potential irritating or corrosive effects of this chemical and the anticipated low toxicity by ingestion. If the victim is conscious and not seizing, give 1 or 2 glasses of water to dilute the chemical and immediately call a hospital or poison control center. Transport the victim to a hospital (Radian Corporation, 1991).
    2) If the victim is seizing or unconscious, do not give anything by mouth, ensure that the airway is open, and lay the victim on his/her side with the head lower than the body. DO NOT INDUCE VOMITING. Transport to the hospital (Radian Corporation, 1991).
    E) ACTIVATED CHARCOAL
    1) It is not known if activated charcoal is useful in triethanolamine ingestion.
    2) PREHOSPITAL ACTIVATED CHARCOAL ADMINISTRATION
    a) Consider prehospital administration of activated charcoal as an aqueous slurry in patients with a potentially toxic ingestion who are awake and able to protect their airway. Activated charcoal is most effective when administered within one hour of ingestion. Administration in the prehospital setting has the potential to significantly decrease the time from toxin ingestion to activated charcoal administration, although it has not been shown to affect outcome (Alaspaa et al, 2005; Thakore & Murphy, 2002; Spiller & Rogers, 2002).
    1) In patients who are at risk for the abrupt onset of seizures or mental status depression, activated charcoal should not be administered in the prehospital setting, due to the risk of aspiration in the event of spontaneous emesis.
    2) The addition of flavoring agents (cola drinks, chocolate milk, cherry syrup) to activated charcoal improves the palatability for children and may facilitate successful administration (Guenther Skokan et al, 2001; Dagnone et al, 2002).
    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).
    6.5.2) PREVENTION OF ABSORPTION
    A) SUMMARY
    1) Due to possible irritating effects, emesis should not be induced for ingestion of triethanolamine as a single chemical. Dilution may be sufficient for ingestions of small quantities of triethanolamine, particularly if the solution is of very low triethanolamine concentration.
    B) DILUTION
    1) DILUTION: If no respiratory compromise is present, administer milk or water as soon as possible after ingestion. Dilution may only be helpful if performed in the first seconds to minutes after ingestion. The ideal amount is unknown; no more than 8 ounces (240 mL) in adults and 4 ounces (120 mL) in children is recommended to minimize the risk of vomiting (Caravati, 2004).
    C) ACTIVATED CHARCOAL
    1) It is not known if activated charcoal is useful in triethanolamine ingestions. Measures may be performed at the physician's discretion.
    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) SUPPORT
    1) There is no known antidote for triethanolamine. Treatment is symptomatic. Support respiratory, cardiovascular and renal function.
    B) MONITORING OF PATIENT
    1) Generally, routine laboratory studies are not indicated following most dermal exposures.
    2) If the patient has been exposed to triethanolamine heated to decomposition, there is a risk of inhalational exposure to nitrogen oxides, carbon monoxide, and carbon dioxide.
    3) Monitor for respiratory irritation, pneumonitis, pulmonary edema, hypoxia, and elevated carboxyhemoglobin levels.
    4) Monitor arterial blood gases and chest x-ray in symptomatic patients (ie, dyspnea, tachypnea, wheezing, retractions, persistent coughing, cyanosis).
    5) Dermal patch testing, bronchial provocation testing, and pulmonary function tests may be useful to identify individuals who have been sensitized to triethanolamine, although sensitization and associated adverse effects are rare.
    C) DILUTION
    1) DILUTION: If no respiratory compromise is present, administer milk or water as soon as possible after ingestion. Dilution may only be helpful if performed in the first seconds to minutes after ingestion. The ideal amount is unknown; no more than 8 ounces (240 mL) in adults and 4 ounces (120 mL) in children is recommended to minimize the risk of vomiting (Caravati, 2004).

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

Eye Exposure

    6.8.1) DECONTAMINATION
    A) EYE IRRIGATION, ROUTINE: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, an ophthalmologic examination should be performed (Peate, 2007; Naradzay & Barish, 2006).
    6.8.2) TREATMENT
    A) ACUTE DISEASE OF EYE
    1) If irritation, pain, swelling, lacrimation or photophobia persist after 15 minutes of irrigation, an ophthalmologic examination should be performed.
    2) Ocular evaluation by a physician is recommended following exposure to highly concentrated triethanolamine.
    B) Treatment should include recommendations listed in the ORAL EXPOSURE section when appropriate.

Dermal Exposure

    6.9.1) DECONTAMINATION
    A) CLOTHING
    1) Remove contaminated clothing and place in vapor-tight, sealed bag.
    2) DECONTAMINATION: Remove contaminated clothing and wash exposed area thoroughly with soap and water for 10 to 15 minutes. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
    6.9.2) TREATMENT
    A) BURN
    1) APPLICATION
    a) These recommendations apply to patients with MINOR chemical burns (FIRST DEGREE; SECOND DEGREE: less than 15% body surface area in adults; less than 10% body surface area in children; THIRD DEGREE: less than 2% body surface area). Consultation with a clinician experienced in burn therapy or a burn unit should be obtained if larger area or more severe burns are present. Neutralizing agents should NOT be used.
    2) DEBRIDEMENT
    a) After initial flushing with large volumes of water to remove any residual chemical material, clean wounds with a mild disinfectant soap and water.
    b) DEVITALIZED SKIN: Loose, nonviable tissue should be removed by gentle cleansing with surgical soap or formal skin debridement (Moylan, 1980; Haynes, 1981). Intravenous analgesia may be required (Roberts, 1988).
    c) BLISTERS: Removal and debridement of closed blisters is controversial. Current consensus is that intact blisters prevent pain and dehydration, promote healing, and allow motion; therefore, blisters should be left intact until they rupture spontaneously or healing is well underway, unless they are extremely large or inhibit motion (Roberts, 1988; Carvajal & Stewart, 1987).
    3) TREATMENT
    a) TOPICAL ANTIBIOTICS: Prophylactic topical antibiotic therapy with silver sulfadiazine is recommended for all burns except superficial partial thickness (first-degree) burns (Roberts, 1988). For first-degree burns bacitracin may be used, but effectiveness is not documented (Roberts, 1988).
    b) SYSTEMIC ANTIBIOTICS: Systemic antibiotics are generally not indicated unless infection is present or the burn involves the hands, feet, or perineum.
    c) WOUND DRESSING:
    1) Depending on the site and area, the burn may be treated open (face, ears, or perineum) or covered with sterile nonstick porous gauze. The gauze dressing should be fluffy and thick enough to absorb all drainage.
    2) Alternatively, a petrolatum fine-mesh gauze dressing may be used alone on partial-thickness burns.
    d) DRESSING CHANGES:
    1) Daily dressing changes are indicated if a burn cream is used; changes every 3 to 4 days are adequate with a dry dressing.
    2) If dressing changes are to be done at home, the patient or caregiver should be instructed in proper techniques and given sufficient dressings and other necessary supplies.
    e) Analgesics such as acetaminophen with codeine may be used for pain relief if needed.
    4) TETANUS PROPHYLAXIS
    a) The patient's tetanus immunization status should be determined. Tetanus toxoid 0.5 milliliter intramuscularly or other indicated tetanus prophylaxis should be administered if required.
    B) SUPPORT
    1) Use of more protective gloves and clothing or cessation of exposure to the material may be considered if through testing it is determined that the individual has become sensitized to triethanolamine.
    C) Treatment should include recommendations listed in the ORAL EXPOSURE section when appropriate.

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.1) DISPOSITION/ORAL EXPOSURE
    6.3.1.1) ADMISSION CRITERIA/ORAL
    A) In patients that show signs of exposure to triethanolamine heated to decomposition, admit any individuals with stridor, chest retractions, dysphagia, cyanosis, choking, circumoral burns, excessive salivation (drooling) or any other signs or symptoms of aspiration and/or severe oral irritation/corrosion. Patients with a history of smoking or underlying respiratory disease (ie, asthma) may be at greater risk.
    6.3.1.2) HOME CRITERIA/ORAL
    A) Triethanolamine is combined with other chemicals to produce numerous household/cosmetic products; it may be difficult to determine if the effects observed are directly related to triethanolamine. However, significant exposure is unlikely to occur. Patients (adults or children) with a dermal household exposure that develop mild skin irritation can be managed at home. If a patient has been exposed to concentrated triethanolamine, they may need to observed in a healthcare facility. In the event of an oral ingestion of a household product containing triethanolamine, patients may need to be observed in a healthcare facility depending on the other ingredients and the possible irritating effects of triethanolamine.
    6.3.1.3) CONSULT CRITERIA/ORAL
    A) Consult a poison control center or a medical toxicologist for assistance in managing patients with severe toxicity (ie, respiratory insufficiency or depression) or in whom the diagnosis is not clear.
    6.3.1.5) OBSERVATION CRITERIA/ORAL
    A) Patients can be discharged as soon as symptoms have been treated and can be managed at home as needed. In the unlikely event that a patient has been exposed to triethanolamine heated to decomposition, there is a risk of inhalational exposure to nitrogen oxides (irritants), carbon monoxide, and carbon dioxide. Monitor for hypoxia and respiratory irritation, ranging from mild respiratory irritation to delayed pulmonary edema which can be delayed up to 72 hours after exposure.
    6.3.3) DISPOSITION/INHALATION EXPOSURE
    6.3.3.1) ADMISSION CRITERIA/INHALATION
    A) In patients that show signs of exposure to triethanolamine heated to decomposition, admit any individuals with stridor, chest retractions, dysphagia, cyanosis, choking, circumoral burns, excessive salivation (drooling) or any other signs or symptoms of aspiration and/or severe oral irritation/corrosion. Patients with a history of smoking or underlying respiratory disease (ie, asthma) may be at greater risk.
    6.3.3.5) OBSERVATION CRITERIA/INHALATION
    A) Monitor for respiratory distress. If cough or difficulty in breathing develops, evaluate for respiratory tract irritation, bronchitis, or pneumonitis.
    B) If the patient has been exposed to triethanolamine heated to decomposition, there is a risk of inhalational exposure to nitrogen oxides (irritants), carbon monoxide, and carbon dioxide. Monitor for hypoxia and respiratory irritation, ranging from mild respiratory irritation to pulmonary edema which can be delayed up to 72 hours after exposure.
    6.3.5) DISPOSITION/DERMAL EXPOSURE
    6.3.5.2) HOME CRITERIA/DERMAL
    A) Persons with extensive chemical burns should be admitted for symptomatic treatment and observation.
    B) As a precautionary measure, the physician may choose to admit individuals who have extensive body surface area contact with concentrated triethanolamine, as this chemical can be readily absorbed through the skin. Alternatively, asymptomatic individuals may be released after initial evaluation to be monitored at home, as long as there is sufficient supervision at home by another adult and adequate telephone contact with health professionals at a nearby health care facility.

Range Of Toxicity

Summary

    A) TOXIC DOSE: The actual lethal and toxic dose in humans are unknown. Mild to moderate eye or skin irritation are the primary effects anticipated from direct triethanolamine contact. Triethanolamine, ethanolamine, and diethanolamine are considered safe in cosmetic formulations which are briefly used followed by thorough rinsing from the skin surface. The concentration of these 3 ethanolamines in cosmetics should not exceed 5% if the products are intended for prolonged skin contact. INGESTION: The estimated fatal ORAL dose of triethanolamine in humans is 50 g; however, how this data was determined was not provided. DERMAL: Mild dermal irritation resulted from intermittent application of 15 mg of triethanolamine to human skin for 3 days. ANIMAL DATA: Based on experimental animal data, acute oral toxicity is considered low.

Minimum Lethal Exposure

    A) SUMMARY
    1) ORAL: The estimated fatal dose of triethanolamine in humans is 50 g; however, how this data was determined was not provided (Driesbach & Robertson, 1987).

Maximum Tolerated Exposure

    A) SUMMARY
    1) ORAL: Triethanolamine is anticipated to be mildly toxic, if ingested (Lewis, 1996).
    2) DERMAL: Mild dermal irritation resulted from intermittent application of 15 mg of triethanolamine to human skin for 3 days (Lewis, 1996).

Workplace Standards

    A) ACGIH TLV Values for CAS102-71-6 (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) Triethanolamine
    a) TLV:
    1) TLV-TWA: 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): Eye and skin irr
    d) Molecular Weight: 149.22
    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) Under Study
    1) Triethanolamine
    a) TLV:
    1) TLV-TWA:
    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):
    d) Molecular Weight:
    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 CAS102-71-6 (National Institute for Occupational Safety and Health, 2007):
    1) Not Listed

    C) Carcinogenicity Ratings for CAS102-71-6 :
    1) ACGIH (American Conference of Governmental Industrial Hygienists, 2010): Not Listed ; Listed as: Triethanolamine
    2) ACGIH (American Conference of Governmental Industrial Hygienists, 2010): Not Listed ; Listed as: Triethanolamine
    3) EPA (U.S. Environmental Protection Agency, 2011): Not Listed
    4) 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): 3 ; Listed as: TEA (Triethanolamine)
    a) 3 : The agent (mixture or exposure circumstance) is not classifiable as to its carcinogenicity to humans. This category is used most commonly for agents, mixtures and exposure circumstances for which the evidence of carcinogenicity is inadequate in humans and inadequate or limited in experimental animals. Exceptionally, agents (mixtures) for which the evidence of carcinogenicity is inadequate in humans but sufficient in experimental animals may be placed in this category when there is strong evidence that the mechanism of carcinogenicity in experimental animals does not operate in humans. Agents, mixtures and exposure circumstances that do not fall into any other group are also placed in this category.
    5) 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): 3 ; Listed as: Triethanolamine
    a) 3 : The agent (mixture or exposure circumstance) is not classifiable as to its carcinogenicity to humans. This category is used most commonly for agents, mixtures and exposure circumstances for which the evidence of carcinogenicity is inadequate in humans and inadequate or limited in experimental animals. Exceptionally, agents (mixtures) for which the evidence of carcinogenicity is inadequate in humans but sufficient in experimental animals may be placed in this category when there is strong evidence that the mechanism of carcinogenicity in experimental animals does not operate in humans. Agents, mixtures and exposure circumstances that do not fall into any other group are also placed in this category.
    6) NIOSH (National Institute for Occupational Safety and Health, 2007): Not Listed
    7) MAK (DFG, 2002): Not Listed
    8) NTP (U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project ): Not Listed

    D) OSHA PEL Values for CAS102-71-6 (U.S. Occupational Safety, and Health Administration (OSHA), 2010):
    1) Not Listed

Toxicity Information

    7.7.1) TOXICITY VALUES
    A) References: Lewis, 1996; RTECS, 2001
    1) LD50- (INTRAPERITONEAL)MOUSE:
    a) 1450 mg/kg
    2) LD50- (ORAL)MOUSE:
    a) 7400 mg/kg
    3) LD50- (ORAL)RAT:
    a) 8680 mg/kg

Pharmacology Toxicology

Toxicologic Mechanism

    A) Acute effects of triethanolamine such as eye and skin irritation may be due to its alkalinity (Melnick & Thomaszewski, 1990).
    B) Although triethanolamine has not been labeled as a carcinogen, its carcinogenic potential is being evaluated because it is converted to the carcinogen N-nitrosodiethanolamine (NTP , 1994). Triethanolamine is nitrosated to N-nitrosodiethanolamine in the presence of nitrite or nitrogen oxides (Melnick & Thomaszewski, 1990).

Physicochemical

Physical Characteristics

    A) Hygroscopic, clear or pale yellow, viscous liquid which turns brown upon exposure to air and light, and has a slight ammoniacal odor (S Sweetman , 1998; HSDB , 2001; Budavari, 1996; Lewis, 1996).

Ph

    A) A 10% aqueous solution is strongly alkaline to litmus (S Sweetman , 1998).
    B) A 0.1 N aqueous solution has a pH of 10.5 (HSDB , 2001).

Molecular Weight

    A) 149.19 (Budavari, 1996)

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.
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