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CADMIUM STEARATE

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Cadmium stearate is a white powder solid, used as a lubricant and stabilizer in plastics. It is the most acutely toxic of the heavy metal stearates.

Specific Substances

    A) No Synonyms were found in group or single elements
    1.2.1) MOLECULAR FORMULA
    1) C36-H70-O4.Cd

Available Forms Sources

    A) FORMS
    1) Cadmium stearate is a white powder solid which has negligible water solubility (HSDB , 1993).
    B) SOURCES
    1) It is a soap formed from cadmium chloride and sodium stearate.
    2) Cadmium stearate is the most acutely toxic of the heavy metal stearates (Tarasenko et al, 1976). The CADMIUM OXIDE degradation product may be inhaled in fumes from burned or heat-cut materials containing cadmium stearate.
    3) The clinical effects are compiled from the properties of cadmium compounds in general. Because it can liberate cadmium chloride (HSDB , 1993) or cadmium oxide, cadmium stearate can potentially cause any or all of the toxic effects of cadmium compounds. Effects which have been documented specifically for cadmium stearate are noted.
    C) USES
    1) Cadmium stearate is used as a lubricant and stabilizer in plastics (HSDB , 1993).

Overview

Life Support

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

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) Cadmium stearate can liberate cadmium oxide upon heating or burning, and is capable of causing acute or chronic cadmium poisoning. All of the clinical effects discussed below have not necessarily been documented to occur with cadmium stearate. Acute toxicity most notably occurs after cadmium ingestion or inhalation of cadmium fumes. Poisoning from inhalation is relatively rare but dangerous, having a mortality rate of about 15 percent. Initial signs/symptoms of cadmium poisoning resemble initial symptoms of the flu. Chronic exposure to cadmium compounds can cause cumulative toxicity, with the kidney and skeleton being the critical organs.
    0.2.4) HEENT
    A) Transient eye irritation, salivation, and dry mouth can occur with cadmium compounds. Edema of the face, throat, and neck have occurred with a large oral exposure.
    0.2.6) RESPIRATORY
    A) Cough, dyspnea, and tightness in the chest be delayed in onset after exposure. A flu-like condition similar to metal fume fever (cadmium pneumonitis) may develop. Severe and potentially fatal pulmonary edema may develop. Death may occur within one week. Nonlethal exposures may cause residual effects of pulmonary fibrosis.
    0.2.7) NEUROLOGIC
    A) Inhalation of cadmium fumes can cause cadmium fume fever with headache, vertigo, and shivering. Systemic effects from inhalation may include hallucinations or distorted perceptions.
    0.2.8) GASTROINTESTINAL
    A) Nausea, vomiting, and abdominal and substernal pain occur following acute oral ingestion. Salivation or dry mouth have been reported. Ileus has been noted in experimental animals.
    0.2.9) HEPATIC
    A) Abnormal liver function has occurred, probably secondary to kidney damage.
    0.2.10) GENITOURINARY
    A) Testicular necrosis has occurred within hours of a single exposure to cadmium in animals.
    0.2.14) DERMATOLOGIC
    A) Dermal uptake of cadmium stearate has been demonstrated in several animal species, but not in man.
    0.2.19) IMMUNOLOGIC
    A) Immunosuppression has been shown in experimental animals.
    0.2.20) REPRODUCTIVE
    A) Low birth weights have been reported in one occupational study. Embryo- and fetotoxicity have been reported in rats and mice. Cadmium is a suspected male reproductive hazard.
    0.2.21) CARCINOGENICITY
    A) No studies were found for cadmium stearate. Cadmium and its salts are suspected human carcinogens for prostate and lung cancer.
    0.2.22) OTHER
    A) Zinc and selenium antagonize the toxicity of cadmium. Cumulative toxicity is likely.

Laboratory Monitoring

    A) Blood cadmium levels are transient reflecting cadmium body burden only several months after termination of chronic exposure. Urine cadmium levels appear to be a better measurement of body burden (Kowal et al, 1979).

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) GASTRIC LAVAGE: Consider after ingestion of a potentially life-threatening amount of poison if it can be performed soon after ingestion (generally within 1 hour). Protect airway by placement in the head down left lateral decubitus position or by endotracheal intubation. Control any seizures first.
    1) CONTRAINDICATIONS: Loss of airway protective reflexes or decreased level of consciousness in unintubated patients; following ingestion of corrosives; hydrocarbons (high aspiration potential); patients at risk of hemorrhage or gastrointestinal perforation; and trivial or non-toxic ingestion.
    B) Activated charcoal has no proven benefit in cadmium poisoning.
    C) CHELATION - has NOT been shown to be efficacious in cadmium poisoning, and may increase the risk of renal injury.
    D) NOTE: See treatment of oral exposure in the main body of this document for complete information.
    0.4.3) INHALATION EXPOSURE
    A) INHALATION: Move patient to fresh air. Monitor for respiratory distress. If cough or difficulty breathing develops, evaluate for respiratory tract irritation, bronchitis, or pneumonitis. Administer oxygen and assist ventilation as required. Treat bronchospasm with an inhaled beta2-adrenergic agonist. Consider systemic corticosteroids in patients with significant bronchospasm.
    B) TREATMENT - Severe pulmonary edema may ensue.
    1) ACUTE LUNG INJURY: Maintain ventilation and oxygenation and evaluate with frequent arterial blood gases and/or pulse oximetry monitoring. Early use of PEEP and mechanical ventilation may be needed.
    C) NOTE: See treatment of inhalation exposure in the main body of this document for complete information.
    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.
    B) NOTE: See treatment of eye exposure in the main body of this document for complete information.
    0.4.5) DERMAL EXPOSURE
    A) OVERVIEW
    1) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
    2) NOTE: See treatment of dermal exposure in the main body of this document for complete information.

Range Of Toxicity

    A) Acute ingestion of as little as 10 mg of inorganic cadmium has caused severe symptoms. Severe pulmonary toxicity (pulmonary edema) may ensue following inhalation of cadmium fumes. Significant dermal absorption seldom occurs.

Clinical Effects

Summary Of Exposure

    A) Cadmium stearate can liberate cadmium oxide upon heating or burning, and is capable of causing acute or chronic cadmium poisoning. All of the clinical effects discussed below have not necessarily been documented to occur with cadmium stearate. Acute toxicity most notably occurs after cadmium ingestion or inhalation of cadmium fumes. Poisoning from inhalation is relatively rare but dangerous, having a mortality rate of about 15 percent. Initial signs/symptoms of cadmium poisoning resemble initial symptoms of the flu. Chronic exposure to cadmium compounds can cause cumulative toxicity, with the kidney and skeleton being the critical organs.

Heent

    3.4.1) SUMMARY
    A) Transient eye irritation, salivation, and dry mouth can occur with cadmium compounds. Edema of the face, throat, and neck have occurred with a large oral exposure.
    3.4.3) EYES
    A) IRRITATION - Smarting of the eyes may occur upon exposure to the fume of cadmium compounds, but no permanent eye injuries have been reported (Grant, 1986).
    3.4.5) NOSE
    A) Loss of sense of smell occurs after years of exposure to very high cadmium concentrations (ILO, 1998).
    3.4.6) THROAT
    A) SALIVATION - Both salivation and dry mouth have been reported as well as a metallic taste (Sittig, 1991).
    B) EDEMA - Facial, pharyngeal and neck edema developed rapidly after a large dose oral ingestion that proved fatal (Buckler et al, 1986).
    C) YELLOW TEETH - Yellow rings in the teeth have been reported in chronic cadmium poisoning in early epidemiological studies; confirmation has not been forthcoming in more recent studies, however (Clayton & Clayton, 1981; Sittig, 1991; ILO, 1998).

Respiratory

    3.6.1) SUMMARY
    A) Cough, dyspnea, and tightness in the chest be delayed in onset after exposure. A flu-like condition similar to metal fume fever (cadmium pneumonitis) may develop. Severe and potentially fatal pulmonary edema may develop. Death may occur within one week. Nonlethal exposures may cause residual effects of pulmonary fibrosis.
    3.6.2) CLINICAL EFFECTS
    A) COUGH
    1) Following acute inhalation, the lung is the target organ, although symptoms may not appear for up to 12 hours (Beton et al, 1966). A cough, dyspnea, bronchitis, and pneumonitis have all been noted in acute poisonings (Tibbits & Milroy, 1980).
    B) METAL FEVER
    1) CADMIUM FUME FEVER - A flu-like condition similar to metal fume fever may develop (Clayton & Clayton, 1981; Finkel, 1983; ILO, 1998).
    C) ACUTE LUNG INJURY
    1) Respiratory toxicity may progress, over 1 to 4 days, to pulmonary edema which may persist for months. Death may occur within one week. Nonlethal exposures may cause residual effects of pulmonary fibrosis, or respiratory pneumonitis with persistent restrictive ventilatory defect (Barnhart & Rosenstock, 1984; Clayton & Clayton, 1981).
    3.6.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) RESPIRATORY DISORDER
    a) A single intratracheal dose of 10 mg cadmium stearate produced ulceration, pneumonia, hemorrhage, pneumosclerosis, and broncholithiasis after two months; emphysema, dilation of the large bronchi, accumulation of lymphocytes, diffuse pneumosclerosis, and small hemorrhagic areas were seen after four to six months (p 117).

Neurologic

    3.7.1) SUMMARY
    A) Inhalation of cadmium fumes can cause cadmium fume fever with headache, vertigo, and shivering. Systemic effects from inhalation may include hallucinations or distorted perceptions.
    3.7.2) CLINICAL EFFECTS
    A) HEADACHE
    1) Headache may occur as a constitutional symptom from cadmium fume fever.
    B) HALLUCINATIONS
    1) Systemic effects from inhalation may include hallucinations or distorted perceptions (Lewis, 1996).

Gastrointestinal

    3.8.1) SUMMARY
    A) Nausea, vomiting, and abdominal and substernal pain occur following acute oral ingestion. Salivation or dry mouth have been reported. Ileus has been noted in experimental animals.
    3.8.2) CLINICAL EFFECTS
    A) GASTROENTERITIS
    1) Following acute oral ingestion, the target organ is the gastrointestinal tract. Acute poisoning produces severe nausea, vomiting, diarrhea, abdominal and substernal pains, and gastroenteritis (Taylor et al, 1984; Sittig, 1991; ILO, 1998).
    B) DRUG-INDUCED ILEUS
    1) Laboratory studies in mice indicate a paralyzing effect of cadmium on peristalsis leading to retention of cadmium and increased absorption following ingestion (Andersen et al, 1986).

Hepatic

    3.9.1) SUMMARY
    A) Abnormal liver function has occurred, probably secondary to kidney damage.

Genitourinary

    3.10.1) SUMMARY
    A) Testicular necrosis has occurred within hours of a single exposure to cadmium in animals.
    3.10.2) CLINICAL EFFECTS
    A) DISORDER OF TESTIS
    1) Testicular necrosis resulting in creatinuria has been seen in cadmium poisoned experimental animals (Gray et al, 1986; ILO, 1998).

Dermatologic

    3.14.1) SUMMARY
    A) Dermal uptake of cadmium stearate has been demonstrated in several animal species, but not in man.
    3.14.2) CLINICAL EFFECTS
    A) POISONING
    1) Cadmium stearate was easily absorbed through the intact skin of mice, rats, guinea pigs, and rabbits (Schmidt & Gohlke, 1971).

Immunologic

    3.19.1) SUMMARY
    A) Immunosuppression has been shown in experimental animals.
    3.19.2) CLINICAL EFFECTS
    A) DISORDER OF IMMUNE FUNCTION
    1) Acute cadmium chloride inhalation produced immunosuppression in mice (Krzystyniak et al, 1987).

Reproductive

    3.20.1) SUMMARY
    A) Low birth weights have been reported in one occupational study. Embryo- and fetotoxicity have been reported in rats and mice. Cadmium is a suspected male reproductive hazard.
    3.20.2) TERATOGENICITY
    A) BIRTH WEIGHT SUBNORMAL
    1) HUMANS
    a) Offspring of women receiving industrial exposure to 0.16 to 35 mg soluble cadmium salts/m(3) weighed less than controls (AMA, 1985; Schardein, 1985). These effects may be secondary to cadmium placental toxicity (Reproductive Toxicology, 1986).
    B) EMBRYOTOXICITY
    1) ANIMAL STUDIES
    a) Daily cadmium (chloride) 10 mg/kg orally, continuous 4 mg/dL in drinking water, or continuous inhalation of 0.6 mg/m(3) throughout gestation produced embryo- and fetotoxicity in rats and mice (AMA, 1985).
    3.20.3) EFFECTS IN PREGNANCY
    A) FERTILITY DECREASED FEMALE
    1) ANIMAL STUDIES
    a) Although no adverse effects have been reported on human female reproductive function, female rat reproductive function might be suppressed by 10 mg/kg cadmium chloride daily (AMA, 1985).
    3.20.4) EFFECTS DURING BREAST-FEEDING
    A) BREAST MILK
    1) HUMANS
    a) Human breast milk cadmium averaged less than 0.1 ng/g, although previously reported values were higher (Dabeka et al, 1986). Although breast milk averaged less than 0.1 mcg/kg the range of cadmium in milk and commercial infant formula was up to 1.2 mcg/L.

Carcinogenicity

    3.21.1) IARC CATEGORY
    A) IARC Carcinogenicity Ratings for CAS2223-93-0 (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) IARC Classification
    a) Listed as: Cadmium stearate
    b) Carcinogen Rating: 1
    1) The agent (mixture) is carcinogenic to humans. The exposure circumstance entails exposures that are carcinogenic to humans. This category is used when there is sufficient evidence of carcinogenicity in humans. Exceptionally, an agent (mixture) may be placed in this category when evidence of carcinogenicity in humans is less than sufficient but there is sufficient evidence of carcinogenicity in experimental animals and strong evidence in exposed humans that the agent (mixture) acts through a relevant mechanism of carcinogenicity.
    3.21.2) SUMMARY/HUMAN
    A) No studies were found for cadmium stearate. Cadmium and its salts are suspected human carcinogens for prostate and lung cancer.
    3.21.3) HUMAN STUDIES
    A) LACK OF INFORMATION
    1) No studies were found on the possible carcinogenic activity of cadmium stearate.
    B) CARCINOMA
    1) HUMANS
    a) The ACGIH has proposed to consider cadmium and its salts suspected human carcinogens (ACGIH, 1993). Cadmium workers exposed to 0.3 mg cadmium/m(3) may be at increased risk for lung and prostatic cancer (Elinder, 1986). However, other studies have failed to demonstrate an increase risk of prostatic cancer (Armstrong & Kazantzis, 1985) Armstrong & Karantzis, 1983; (Sorahan & Waterhouse, 1985).

Genotoxicity

    A) Cadmium stearate did not induce sister chromatid exchanges in human lymphocytes in vitro.

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) Blood cadmium levels are transient reflecting cadmium body burden only several months after termination of chronic exposure. Urine cadmium levels appear to be a better measurement of body burden (Kowal et al, 1979).
    4.1.2) SERUM/BLOOD
    A) BLOOD/SERUM CHEMISTRY
    1) The critical endpoint is total cadmium, not cadmium stearate specifically. Serum cadmium concentrations in healthy unexposed persons have ranged from 0.5 to 2 mcg/L; levels in smokers are higher. Asymptomatic exposed workers averaged 0.009 mg/L versus 0.004 mg/L in controls, and workers exposed to cadmium-containing hard solder ranged from <0.001 to 0.113 mg/L (Baselt, 1988).
    2) Cadmium levels in whole blood in normal unexposed, nonsmoking adults average 0.4 to 1.0 mcg/L. Smokers average 1.4 to 4.5 mcg/L (Friberg et al, 1985).
    3) Blood cadmium correlates well with urinary cadmium following chronic exposure (Verschoor et al, 1987).
    4) ABNORMAL LEVELS - Blood cadmium levels above 0.5 microgram/deciliter warrants careful investigation.
    4.1.3) URINE
    A) Urinary cadmium is normally below or around 1 mcg/L. Care must be taken to accurately measure urinary cadmium (Friberg et al, 1985). A 24 hour urine sample is preferable. Urinary cadmium levels reflect cadmium body burden.
    B) Chronic toxicity is associated with urinary excretion of cadmium levels of 20 micrograms cadmium/gram creatinine. Irreversible renal damage may occur at urinary cadmium concentrations above 5 mcg/g urinary creatinine (Verschoor et al, 1987).
    C) Proteinuria, evidenced by increased urinary low molecular weight proteins (eg, beta2-microglobulin in pH >5.6 urine) results from nephrotoxicity (Ellis et al, 1983; Shaik & Smith, 1984). This is the earliest evidence of cadmium-induced renal tubular dysfunction. It correlates with duration of exposure, cumulative exposure, and urinary cadmium (Elinder et al, 1985). The renal damage appears to be largely irreversible (Elinder et al, 1985). Decreased glomerular filtration rate occurs in severe cases.
    D) Elevated urinary metallothionein suggests exposure to cadmium or other metals (eg, Cu or Zn).
    4.1.4) OTHER
    A) OTHER
    1) Urine, blood, and hair cadmium are all elevated after prolonged exposure, but individual variability is large enough to make these useful only as indices of significant prolonged exposure in individuals. Direct in vivo measurement, using neutron activation analysis or x-ray fluorescence of liver and kidney cadmium are the best indicators of cadmium body burden and cumulative exposure (Morgan, 1979; Christoffersson et al, 1987). A renal cortical cadmium concentration of 200 mcg/g wet weight is often associated with renal dysfunction (Friberg et al, 1985).

Radiographic Studies

    A) RADIOGRAPHIC-OTHER
    1) In chronic poisoning, skeletal x-ray findings are characteristic of osteomalacia and may show multiple fractures.

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Monitoring

    A) Blood cadmium levels are transient reflecting cadmium body burden only several months after termination of chronic exposure. Urine cadmium levels appear to be a better measurement of body burden (Kowal et al, 1979).

Oral Exposure

    6.5.2) PREVENTION OF ABSORPTION
    A) GASTRIC LAVAGE
    1) INDICATIONS: Consider gastric lavage with a large-bore orogastric tube (ADULT: 36 to 40 French or 30 English gauge tube {external diameter 12 to 13.3 mm}; CHILD: 24 to 28 French {diameter 7.8 to 9.3 mm}) after a potentially life threatening ingestion if it can be performed soon after ingestion (generally within 60 minutes).
    a) Consider lavage more than 60 minutes after ingestion of sustained-release formulations and substances known to form bezoars or concretions.
    2) PRECAUTIONS:
    a) SEIZURE CONTROL: Is mandatory prior to gastric lavage.
    b) AIRWAY PROTECTION: Place patients in the head down left lateral decubitus position, with suction available. Patients with depressed mental status should be intubated with a cuffed endotracheal tube prior to lavage.
    3) LAVAGE FLUID:
    a) Use small aliquots of liquid. Lavage with 200 to 300 milliliters warm tap water (preferably 38 degrees Celsius) or saline per wash (in older children or adults) and 10 milliliters/kilogram body weight of normal saline in young children(Vale et al, 2004) and repeat until lavage return is clear.
    b) The volume of lavage return should approximate amount of fluid given to avoid fluid-electrolyte imbalance.
    c) CAUTION: Water should be avoided in young children because of the risk of electrolyte imbalance and water intoxication. Warm fluids avoid the risk of hypothermia in very young children and the elderly.
    4) COMPLICATIONS:
    a) Complications of gastric lavage have included: aspiration pneumonia, hypoxia, hypercapnia, mechanical injury to the throat, esophagus, or stomach, fluid and electrolyte imbalance (Vale, 1997). Combative patients may be at greater risk for complications (Caravati et al, 2001).
    b) Gastric lavage can cause significant morbidity; it should NOT be performed routinely in all poisoned patients (Vale, 1997).
    5) CONTRAINDICATIONS:
    a) Loss of airway protective reflexes or decreased level of consciousness if patient is not intubated, following ingestion of corrosive substances, hydrocarbons (high aspiration potential), patients at risk of hemorrhage or gastrointestinal perforation, or trivial or non-toxic ingestion.
    B) ACTIVATED CHARCOAL
    1) Activated charcoal has no proven benefit in cadmium poisoning.
    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) EFFICACY - May be used after acute exposure but has not been shown to be of definite benefit. The effectiveness of chelation therapy decreases markedly with time after exposure. Chelation is not recommended to treat chronic cadmium poisoning.
    2) DOSE - Administer CaNa2 EDTA 75 milligrams/kilogram/24 hours deep intramuscular or slow intravenous infusion, given in 3 to 6 divided doses for up to 5 days. May be repeated for a second course after a minimum of 2 days drug holiday; each course should not exceed a total of 500 milligrams/kilogram body weight.
    3) CHELATION/NEPHROTOXICITY - All complexing agents may increase the risk of cadmium-induced renal damage. BAL, EDTA, and penicillamine should not be used with cadmium since the complex formed is nephrotoxic (Friberg, 1956; Klaassen et al, 1984).
    B) EXPERIMENTAL THERAPY
    1) DTPA/DTPA CALCIUM - DTPA (Chel 330) and DTPA Ca (CaNa2 pentetate; calcium Chel 330) seem to be more effective than EDTA. They are not approved for human use in the US (Andersen, 1984).
    2) DIETHYLDITHIOCARBAMATE - Increases cadmium distribution into tissue, decreases elimination, and increases lethality in animals (Nielsen et al, 1986).
    3) B COMPLEX VITAMINS - Vitamin B complex during cadmium exposure reduced toxicity in rats by unknown mechanisms (Tandon et al, 1984).
    4) VITAMIN D - Chronic cadmium poisoning appears to respond to large doses of vitamin D in the presence of adequate dietary calcium and phosphorus (Braunwald et al, 1987). Calcitriol has been used pragmatically to treat chronic cadmium toxicity; vitamin D deficiency has been postulated as a predisposing factor for the development of chronic cadmium toxicity and its associated osteoporosis (Angle et al, 1989).

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) Monitor patient for respiratory distress. If a cough or difficulty in breathing develops, evaluate for respiratory tract irritation, bronchitis, and pneumonia.
    B) ACUTE LUNG INJURY
    1) MORTALITY - Inhalation of cadmium compounds can lead to potentially fatal pulmonary edema and pneumonitis. Poisoning from inhalation is relatively rare but dangerous, having a mortality rate of about 15 percent.
    2) ONSET: Onset of acute lung injury after toxic exposure may be delayed up to 24 to 72 hours after exposure in some cases.
    3) 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)
    4) 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).
    5) ANTIBIOTICS: Indicated only when there is evidence of infection (Artigas et al, 1998).
    6) EXPERIMENTAL THERAPY: Partial liquid ventilation has shown promise in preliminary studies (Kollef & Schuster, 1995).
    7) 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).
    8) 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) MONITORING OF PATIENT
    1) Toxicity has not been demonstrated by the ocular route for cadmium compounds. Persons with significant eye exposure should be carefully monitored for respiratory distress and other signs of inhalation exposure and treated as appropriate under the INHALATION EXPOSURE section where appropriate.
    2) Persons with significant eye exposure to cadmium compounds should be carefully monitored for signs of systemic toxicity, especially proteinuria characterized by elevated levels of low-molecular weight proteins such as beta-microglobulin, and/or oliguria. Persons with signs of systemic toxicity should be treated following recommendations under the ORAL EXPOSURE section where appropriate.
    B) Treatment should include recommendations listed in the ORAL EXPOSURE section when appropriate.

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).
    6.9.2) TREATMENT
    A) MONITORING OF PATIENT
    1) Toxicity has not been demonstrated by the dermal route for cadmium compounds. Persons with significant dermal exposure should be carefully monitored for respiratory distress and other signs of inhalation exposure and treated as appropriate under the INHALATION EXPOSURE section where appropriate.
    2) Persons with significant dermal exposure to cadmium compounds should be carefully monitored for signs of systemic toxicity, especially proteinuria characterized by elevated levels of low-molecular weight proteins such as beta-microglobulin, and/or oliguria. Persons with signs of systemic toxicity should be treated following recommendations under the ORAL EXPOSURE section where appropriate.
    B) Treatment should include recommendations listed in the ORAL EXPOSURE section when appropriate.

Enhanced Elimination

    A) EXTRACORPOREAL ELIMINATION
    1) Charcoal hemoperfusion is ineffective, due to high cadmium plasma protein and red blood cell binding.

Range Of Toxicity

Summary

    A) Acute ingestion of as little as 10 mg of inorganic cadmium has caused severe symptoms. Severe pulmonary toxicity (pulmonary edema) may ensue following inhalation of cadmium fumes. Significant dermal absorption seldom occurs.

Minimum Lethal Exposure

    A) ROUTE OF EXPOSURE
    1) Inhalation of as little as 4 mg cadmium may be fatal in adults. Several hundred milligrams may be fatal by the oral route (Baselt & Cravey, 1989).
    2) Exposure to probably less than 2500 min x mg/m(3) of cadmium oxide fumes or cadmium chloride aerosol is probably fatal (Friberg et al, 1985); 500 min x mg/m(3) is dangerous.
    3) Lethal oral doses of cadmium have ranged from 150 grams (Bernard & Lauwerys, 1984; Buckler et al, 1986).
    a) Following oral ingestion, death results from shock due to fluid loss or acute renal failure and cardiopulmonary depression.

Maximum Tolerated Exposure

    A) GENERAL/SUMMARY
    1) Acute ingestion of as little as 10 milligrams of inorganic cadmium has caused severe symptoms.
    2) Long term daily oral intake of more than 1 milligram of cadmium may result in severe bone disease (Friberg et al, 1985).
    B) OTHER
    1) BIOLOGICAL MONITORING LEVELS -
    a) Because there are other chemical and dietary sources of cadmium, analysis for cadmium in biological fluids of persons exposed to cadmium stearate would not necessarily correlate with exposure to this individual compound.
    b) The critical measure is total cadmium in urine or blood. Urinary levels are representative of total body burden, and blood levels are more indicative of recent exposure and/or acute poisoning (Kjellstrom, 1979).
    c) Workers in the manufacture of cadmium stearate, and in cadmium electroplating and hard soldering, had blood cadmium levels ranging from 1.0 to 23.7 mcg Cd/l blood (median 4.2 mcg/l), compared with levels of 0.3 to 4.1 mcg/l (median 1.6 mcg/l) in blood of unexposed persons (Kraus et al, 1988).
    d) Proteinuria, especially presence of low-molecular-weight proteins, is the earliest sign of kidney involvement in chronic cadmium toxicity (Clayton & Clayton, 1981; Finkel, 1983).
    e) Analysis of cadmium levels in hair may be useful for biological monitoring, but studies must be carefully controlled to take age and sex into account (Clayton & Clayton, 1981).
    C) CONCENTRATION LEVEL
    1) The average workroom concentration of respirable cadmium should be less than 0.01 mg Cd/m(3) (ILO, 1998).

Workplace Standards

    A) ACGIH TLV Values for CAS2223-93-0 (American Conference of Governmental Industrial Hygienists, 2010):
    1) Not Listed

    B) NIOSH REL and IDLH Values for CAS2223-93-0 (National Institute for Occupational Safety and Health, 2007):
    1) Not Listed

    C) Carcinogenicity Ratings for CAS2223-93-0 :
    1) ACGIH (American Conference of Governmental Industrial Hygienists, 2010): Not Listed
    2) EPA (U.S. Environmental Protection Agency, 2011): Not Listed
    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): 1 ; Listed as: Cadmium stearate
    a) 1 : The agent (mixture) is carcinogenic to humans. The exposure circumstance entails exposures that are carcinogenic to humans. This category is used when there is sufficient evidence of carcinogenicity in humans. Exceptionally, an agent (mixture) may be placed in this category when evidence of carcinogenicity in humans is less than sufficient but there is sufficient evidence of carcinogenicity in experimental animals and strong evidence in exposed humans that the agent (mixture) acts through a relevant mechanism of carcinogenicity.
    4) NIOSH (National Institute for Occupational Safety and Health, 2007): Not Listed
    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 CAS2223-93-0 (U.S. Occupational Safety, and Health Administration (OSHA), 2010):
    1) Not Listed

Toxicity Information

    7.7.1) TOXICITY VALUES
    A) References: RTECS, 1998
    1) LD50- (INTRAPERITONEAL)MOUSE:
    a) 42100 mcg/kg
    2) LD50- (ORAL)MOUSE:
    a) 590 mg/kg
    3) LD50- (ORAL)RAT:
    a) 1125 mg/kg
    4) TCLo- (INHALATION)HUMAN:
    a) 1800 mcg/m(3) for 2Y
    b) 147 mg/m(3) for 35M

Physicochemical

Physical Characteristics

    A) Cadmium stearate is a white powder material, with a slight fatty odor (HSDB , 1990).

Molecular Weight

    A) 681.48 (Lewis, 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.
    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) AIHA: 2006 Emergency Response Planning Guidelines and Workplace Environmental Exposure Level Guides Handbook, American Industrial Hygiene Association, Fairfax, VA, 2006.
    14) AMA: Effects of toxic chemicals on the reproductive system, Council on Scientific Affairs, American Medical Association, Chicago, IL, 1985.
    15) 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.
    16) Andersen O, Nielsen JB, & Svendsen P: Oral cadmium toxicology. ACTA Pharmacol Toxicol 1986; 59(Suppl 7):44-47.
    17) Andersen O: Chelation of cadmium. Environ Health Perspect 1984; 54:249-266.
    18) Angle CR, Thomas DJ, & Swanson SA: Cadmium and bone toxicity: protective effect of 1,25(OH)2 vitamin D3 (Abstract). Vet Human Toxicol 1989; 31:351.
    19) Armstrong BG & Kazantzis G: Prostatic cancer and chronic respiratory and renal disease in British cadmium workers. Br J Ind Med 1985; 42:540-545.
    20) Artigas A, Bernard GR, Carlet J, et al: The American-European consensus conference on ARDS, part 2: ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling.. Am J Respir Crit Care Med 1998; 157:1332-1347.
    21) Barnhart S & Rosenstock L: Cadmium chemical pneumonitis. Chest 1984; 86:789-791.
    22) Baselt RC & Cravey RH: Disposition of Toxic Drugs and Chemicals in Man, 3rd ed, Year Book Medical Publishers, Chicago, IL, 1989, pp 116-118.
    23) Baselt RC: Biological Monitoring Methods for Industrial Chemicals, 2nd ed, PSG Publishing Company, Littleton, MA, 1988, pp 52-56.
    24) Bassendowska-Karska E & Zawadzkakos M: Cadmium sulfate does not induce sister chromatid exchanges in human lymphocytes in vitro. Toxicol Lett 1987; 37:173-175.
    25) Berman E: Determination of cadmium, thallium, and mercury in biological materials by atomic absorption. Atom Absorp Newsl 1967; 6:57-60.
    26) Bernard A & Lauwerys R: Cadmium in human population. Experientia 1984; 40:143-152.
    27) Beton DC, Andrews GS, & Davies HJ: Acute cadmium fume poisoning. Five cases with one death from renal necrosis. Br J Ind Med 1966; 23:292-301.
    28) Braunwald E, Isselbacher KJ, & Petersdorf RG: Harrison's Principles of Internal Medicine, 11th ed, McGraw-Hill Book Company, New York, NY, 1987.
    29) Brower RG, Matthay AM, & Morris A: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Eng J Med 2000; 342:1301-1308.
    30) Buckler HM, Smith WDF, & Rees WDW: Self poisoning with oral cadmium chloride. Br Med J 1986; 292:1559-1560.
    31) Burgess JL, Kirk M, Borron SW, et al: Emergency department hazardous materials protocol for contaminated patients. Ann Emerg Med 1999; 34(2):205-212.
    32) Caravati EM, Knight HH, & Linscott MS: Esophageal laceration and charcoal mediastinum complicating gastric lavage. J Emerg Med 2001; 20:273-276.
    33) Cataletto M: Respiratory Distress Syndrome, Acute(ARDS). In: Domino FJ, ed. The 5-Minute Clinical Consult 2012, 20th ed. Lippincott Williams & Wilkins, Philadelphia, PA, 2012.
    34) Christoffersson JO, Welinder H, & Spang G: Cadmium concentration in the kidney cortex of occupationally exposed workers measured in vivo using x-ray fluorescence analysis. Environ Res 1987; 42:489-499.
    35) Chyka PA, Seger D, Krenzelok EP, et al: Position paper: Single-dose activated charcoal. Clin Toxicol (Phila) 2005; 43(2):61-87.
    36) Clayton GD & Clayton FE: Patty's Industrial Hygiene and Toxicology, Vol 2A, Toxicology, 3rd ed, John Wiley & Sons, New York, NY, 1981, pp 1563-1583.
    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) Dabeka RW, Karpinski KF, & McKenzie AD: Survey of lead, cadmium and fluoride in human milk and correlation of levels with environmental and food factors. Food Chem Toxicol 1986; 9:913-921.
    39) Davison AG, Newman Taylor AJ, & Darbyshire J: Cadmium fume inhalation and emphysema. Lancet 1988; 1:663-667.
    40) EPA: EPA chemical profile on cadmium stearate, Environmental Protection Agency, Washington, DC, 1985.
    41) 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/.
    42) 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.
    43) Elinder CG, Elling C, & Lindberg E: Beta2-microglobulinuria among workers previously exposed to cadmium: follow-up and dose-response analysis. Am J Ind Med 1985; 8:553-564.
    44) Elinder CG: Health hazards from environmental or occupational exposure to cadmium. Arch Pharmacol Toxicol 1986; 59(Suppl 7):24-30.
    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 and Hardy's Industrial Toxicology, 4th ed, John Wright, PSG Inc, Boston, MA, 1983, pp 38-47-146.
    48) Friberg L, Elinder CG, & Kjellstrom T: Cadmium and Health: A Toxicological and Epidemiological Appraisal (Vol 1). Exposure, Dose and Metabolism (Vol 2). Effects and Response, CRC Press, Boca Raton, FL, 1985.
    49) Friberg L: Edathamil calcium-disodium in cadmium poisoning. Arch Ind Health 1956; 13:13-23.
    50) Golej J, Boigner H, Burda G, et al: Severe respiratory failure following charcoal application in a toddler. Resuscitation 2001; 49:315-318.
    51) Graff GR, Stark J, & Berkenbosch JW: Chronic lung disease after activated charcoal aspiration. Pediatrics 2002; 109:959-961.
    52) Grant WM: Toxicology of the Eye, 3rd ed, Charles C Thomas, Springfield, IL, 1986, pp 165.
    53) Gray JA, Nicholson JK, & Timbrell JA: Creatinuria as an early indicator of cadmium-induced testicular damage. Human Toxicol 1986; 5:402-403.
    54) HSDB : Hazardous Substances Data Bank. National Library of Medicine. Bethesda, MD (Internet Version). Edition expires 10/31/1998; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    55) HSDB : Hazardous Substances Data Bank. National Library of Medicine. Bethesda, MD (Internet Version). Edition expires 1990; 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 1993; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    57) Haas CF: Mechanical ventilation with lung protective strategies: what works?. Crit Care Clin 2011; 27(3):469-486.
    58) Hardy HL & Skinner JB: The possibility of chronic cadmium poisoning. J Ind Hyg Toxicol 1947; 29:321-324.
    59) Harris CR & Filandrinos D: Accidental administration of activated charcoal into the lung: aspiration by proxy. Ann Emerg Med 1993; 22:1470-1473.
    60) 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.
    61) 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.
    62) 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.
    63) 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.
    64) 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.
    65) 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.
    66) ICAO: Technical Instructions for the Safe Transport of Dangerous Goods by Air, 2003-2004. International Civil Aviation Organization, Montreal, Quebec, Canada, 2002.
    67) ILO: Encyclopaedia of Occupational Health and Safety, 4th ed. Vol 1-4, International Labour Organization, Geneva, Switzerland, 1998.
    68) 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.
    69) 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.
    70) Jamil K & Hussain S: Biotransfer of metals to the insect neochetina eichhornae via aquatic plants. Arch Environ Contam Toxicol 1992; 22:459-463.
    71) Kjellstrom T: Exposure and accumulation of cadmium in populations from Japan, the United States, and Sweden. Environ Health Persp 1979; 28:169-197.
    72) Klaassen CD, Amdur MO, & Doull J: Casarett and Doull's Toxicology, 3rd ed, Macmillan Publishing Co, New York, NY, 1986.
    73) Klaassen CD, Waalkes MP, & Catilena LR: Alteration of tissue disposition of cadmium by chelating agents. Environ Health Perspect 1984; 54:233-242.
    74) Kollef MH & Schuster DP: The acute respiratory distress syndrome. N Engl J Med 1995; 332:27-37.
    75) Kowal NE, Johnson DE, & Kraemer DF: Normal levels of cadmium in diet, urine, blood, and tissues of inhabitants of the United States. J Toxicol Environ Health 1979; 5:995-1014.
    76) Krzystyniak K, Fournier M, & Trottier B: Immunosuppression in mice after inhalation of cadmium aerosol. Toxicol Lett 1987; 38:1-12.
    77) Lewis RJ: Sax's Dangerous Properties of Industrial Materials, 9th ed, Van Nostrand Reinhold Company, New York, NY, 1996.
    78) Morgan WD: New ways of measuring cadmium in man. Nature 1979; 282:673-674.
    79) NFPA: Fire Protection Guide to Hazardous Materials, 13th ed., National Fire Protection Association, Quincy, MA, 2002.
    80) NHLBI ARDS Network: Mechanical ventilation protocol summary. Massachusetts General Hospital. Boston, MA. 2008. Available from URL: http://www.ardsnet.org/system/files/6mlcardsmall_2008update_final_JULY2008.pdf. As accessed 2013-08-07.
    81) 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.
    82) 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.
    83) 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.
    84) 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.
    85) Naradzay J & Barish RA: Approach to ophthalmologic emergencies. Med Clin North Am 2006; 90(2):305-328.
    86) 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.
    87) 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.
    88) 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.
    89) 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.
    90) 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.
    91) 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.
    92) 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.
    93) 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.
    94) 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.
    95) 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.
    96) 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.
    97) 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.
    98) 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.
    99) 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.
    100) 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.
    101) 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.
    102) 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.
    103) 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.
    104) 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.
    105) 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.
    106) 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.
    107) 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.
    108) 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.
    109) 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.
    110) 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.
    111) 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.
    112) 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.
    113) 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.
    114) 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.
    115) 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.
    116) 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.
    117) 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.
    118) 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.
    119) 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.
    120) 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.
    121) 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.
    122) 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.
    123) 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.
    124) 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.
    125) 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.
    126) 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.
    127) 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.
    128) 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.
    129) 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.
    130) 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.
    131) 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.
    132) 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.
    133) 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.
    134) 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.
    135) 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.
    136) 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.
    137) 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.
    138) 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.
    139) 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.
    140) 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.
    141) 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.
    142) 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.
    143) 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.
    144) 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.
    145) 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.
    146) 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.
    147) 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.
    148) 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.
    149) 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.
    150) 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.
    151) 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.
    152) 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.
    153) 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.
    154) 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.
    155) 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.
    156) 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.
    157) 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.
    158) 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.
    159) 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.
    160) 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.
    161) 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.
    162) National Research Council : Acute exposure guideline levels for selected airborne chemicals, 5, National Academies Press, Washington, DC, 2007.
    163) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 6, National Academies Press, Washington, DC, 2008.
    164) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 7, National Academies Press, Washington, DC, 2009.
    165) National Research Council: Acute exposure guideline levels for selected airborne chemicals, 8, National Academies Press, Washington, DC, 2010.
    166) Nielsen JB, Andersen O, & Svendsen P: Effect of DDC on acute oral Cd toxicity. ACTA Pharmacol Toxicol 1986; 59(Suppl 7):490-493.
    167) None Listed: Position paper: cathartics. J Toxicol Clin Toxicol 2004; 42(3):243-253.
    168) Peate WF: Work-related eye injuries and illnesses. Am Fam Physician 2007; 75(7):1017-1022.
    169) Perry EF, Koirtyohann SR, & Perry HM Jr: Determination of cadmium in blood and urine by graphite furnace atomic absorption spectrophotometry. Clin Chem 1975; 21:626-629.
    170) Pollack MM, Dunbar BS, & Holbrook PR: Aspiration of activated charcoal and gastric contents. Ann Emerg Med 1981; 10:528-529.
    171) RTECS : Registry of Toxic Effects of Chemical Substances. National Institute for Occupational Safety and Health. Cincinnati, OH (Internet Version). Edition expires 1990; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    172) Rau NR, Nagaraj MV, Prakash PS, et al: Fatal pulmonary aspiration of oral activated charcoal. Br Med J 1988; 297:918-919.
    173) Reproductive Toxicology: A medical letter: The developmental toxicity of cadmium. Reproductive Toxicology Center 1986; 5:9-12.
    174) Sax NI & Lewis RJ: Dangerous Properties of Industrial Materials, 7th ed, Van Nostrand Reinhold Company, New York, NY, 1989, pp 2600-2601.
    175) Schardein JL: Chemically Induced Birth Defects, Marcel Dekker, Inc, New York, NY, 1985, pp 572-574.
    176) Schmidt P & Gohlke R: Animal experimental investigations on the toxicity of cadmium stearate. Z Gesamte Hyg Grenzgeb 1971; 17:827.
    177) Shabalina LP: Effects of cadmium compounds on the testicular tissue of animals. Gig Tr Prof Zabol 1971; 15:51.
    178) Shabalina LP: Industrial hygiene in the production and use of cadmium stearate. Gig Sanit 1968; 33:187-192.
    179) Shabalina LP: The action of the dust of cadmium compounds on the respiratory organs; part of the hygienic estimation of chemical factors of the environment. 1966.
    180) Shaikh ZA & Smith LM: Biological indicators of cadmium exposure and toxicity. Experientia 1984; 40:36-43.
    181) Sittig M: Handbook of Toxic and Hazardous Chemicals and Carcinogens, 2nd ed, Noyes Publications, Park Ridge, NJ, 1985, pp 169-172.
    182) Sittig M: Handbook of Toxic and Hazardous Chemicals and Carcinogens, 3rd ed, Noyes Publications, Park Ridge, NJ, 1991, pp 306-307.
    183) Sorahan T & Waterhouse JAH: Cancer of prostate among nickel cadmium battery workers (Letter). Lancet 1985; 1:459-460.
    184) Stolbach A & Hoffman RS: Respiratory Principles. In: Nelson LS, Hoffman RS, Lewin NA, et al, eds. Goldfrank's Toxicologic Emergencies, 9th ed. McGraw Hill Medical, New York, NY, 2011.
    185) Suzuki S: Ind Health (Japan) 1965; 3:73.
    186) Takebayashi S, Harada T, & Kamura S: Cadmium-induced osteopathy: clinical and autopsy findings of four patients. Bone Pathol Appl Pathol 1987; 5:190-197.
    187) Tandon SK, Flora SJS, & Behari JR: Vitamin B complex in treatment of cadmium intoxication. Ann Clin Lab Sci 1984; 14:487-492.
    188) Tarasenko NY, Shabalina LP, & Spiridonova VS: Comparative toxicity of metal stearates. Internat Arch Occup Environ Health 1976; 37:179-192.
    189) Taylor A, Jackson MA, & Patil D: Poisoning with cadmium fumes after smelting lead. Br Med J 1984; 288:1270-1271.
    190) Tibbits PA & Milroy WC: Pulmonary edema induced by exposure to cadmium oxide fume: case report. Milit Med 1980; 145:435-437.
    191) 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.
    192) 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.
    193) 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-.
    194) 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.
    195) 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.
    196) 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.
    197) 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.
    198) 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-.
    199) U.S. Occupational Safety, and Health Administration (OSHA): Process safety management of highly hazardous chemicals. 29 CFR 2010 2010; 29(1910.119):348-.
    200) 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.
    201) Vale JA, Kulig K, American Academy of Clinical Toxicology, et al: Position paper: Gastric lavage. J Toxicol Clin Toxicol 2004; 42:933-943.
    202) 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.
    203) Verschoor M, Herber R, & van Hemmen J: Renal function of workers with low-level cadmium exposure. Scand J Work Environ Health 1987; 13:232-238.
    204) Willson DF, Truwit JD, Conaway MR, et al: The adult calfactant in acute respiratory distress syndrome (CARDS) trial. Chest 2015; 148(2):356-364.
    205) Wilson DF, Thomas NJ, Markovitz BP, et al: Effect of exogenous surfactant (calfactant) in pediatric acute lung injury. A randomized controlled trial. JAMA 2005; 293:470-476.