A retired man became ill after working 3 hr in his basement workshop.

He had been using a commercial paint and varnish remover to strip a piece of furniture. The product contained methylene chloride. On admission to hospital he also brought the can of paint and varnish remover with him.

 Chest pain and discomfort

The physician found that the victim had experienced an anterior wall myocardial infarction.

The patient returned home 2 weeks later and resumed his project. Shortly, he experienced severe chest pains and was readmitted. This time his diagnosis stated severe myocardial infarction complicated by cardiogenic shock. Six months after recovery, the man again attempted to complete his task. He entered his workshop and, although he worked slowly and without unnecessary effort soon collapsed and died.

This case illustrates that a physician failed to recognize the potential harm of a product containing methylene chloride. The physician noted the name of the ingredient in product; the label did indicate that the product should be used only in a well-ventilated area.

However,he did not understand that methylene chloride is metabolized to carbon monoxide and therefore he did not associate the victims symptoms with the use of the product.
The resulting carboxyhemoglobin placed considerable stress on the victims cardiovascular system, with each subsequent exposure caused increased damage.

Diagnosis is based on a history of exposure and clinical presentation. 1. Carboxyhemoglobin levels in blood Normal value: Nonsmoker: >3% Smoker: >9% 2. Expired air and blood or urine levels of methylene chloride may be obtained.

A. Specific drugs and antidotes. Administer 100% Oxygen. B. Supportive measures 1. Maintain an open airway and assist ventilation if necessary 2. Administer supplemental oxygen, and treat pulmonary oedema if occurred. The victim could have been warned not to use these products again, especially in a closed environment. his life may have been spared.