How Should Patients Exposed to PCBs Be Treated and Managed?

Learning Objective

Upon completion of this section, you will be able to

  • Describe the principal treatment strategy for managing PCB poisoning and
  • Describe the measures for preventing occupational and environmental exposure to PCBs.

No specific treatment exists for PCB accumulation. Patients should avoid further PCB exposure and also avoid other hepatotoxic substances, including ethanol.

Acute Exposure

Treat acute skin and eye PCB exposure immediately by flushing with copious amounts of water. However, post-contamination washing cannot ensure removal of all contamination [Wester et al. 1983].

Remove contaminated clothing and discard properly.

Carefully observe patients with inhalation exposure for any systemic signs or symptoms of toxicity and administer treatment as necessary. No specific measures are available to reduce respiratory tract absorption.

In the rare event of ingestion of PCBs, emesis would be contraindicated because of the high risk of aspiration. The value of administering activated charcoal after ingestion is unknown. Unless a patient has an intact or protected airway, administering charcoal is contraindicated [Alaspaa et al. 2005; Chyka et al. 2005].

Exposed persons should have periodic follow-up examinations with particular attention to hepatic function and dermal lesions.

Key Points
  • No antidote exists for PCB exposure; therefore, treatment is supportive.
Chronic Exposure

No specific treatment is available for chronic PCB toxicity. Because no known methods exist for reducing the reserves of PCBs in adipose tissues, purging the body of PCBs should not be attempted.

Initial treatment of chloracne is based on

  • Cessation of PCB exposure,
  • Good skin hygiene, and
  • Dermatologic measures commonly used for acne vulgaris.

Given the difficulty in treating chloracne, the patient should be referred to a dermatologist.

If chronic exposure has occurred due to consuming contaminated fish or game, the patient should be informed that PCBs tend to accumulate in the body with continued exposure, and counseled about the importance of minimizing further exposure.

In areas with a known PCB problem, state and local public health or natural resources departments typically issue advisories. These advisories specify the waters or hunting areas where PCB-contaminated fish and game likely are, and list the species and size of fish or game that are of concern. Such advisories might completely ban consumption, or might recommend limits on the frequency with which certain species are to be consumed. To minimize the risk for further exposure, sport and subsistence fishers are encouraged to familiarize themselves with and observe advisory recommendations [ATSDR 2000].

Patients should be monitored for increased hepatic enzymes. Because PCBs are hepatotoxins, history of exposure to other potentially hepatotoxic agents should be obtained. To minimize the risk of hepatic damage, patients should be encouraged to avoid exposure to other hepatotoxins, including medications with known hepatotoxicity, ethanol, and chlorinated solvents.

The carcinogenic potential and other risks from exposure to PCBs should be carefully reviewed with the patient.

AAP encourages breastfeeding in all but the most unusual circumstances [AAP 2003].

Prevention in the Workplace

Work Practices

The following measures [LaDou 2006] may be adopted at work to avoid exposure to PCBs.

  • Eliminate PCBs from the workplace or implement engineering changes to isolate the PCBs. If neither of these approaches is feasible, then use special PCB-resistant gloves and protective clothing.
  • Maintain adequate ventilation during spill cleanup or maintenance of vessels containing PCBs. If this is not possible, provide approved respirators.
  • Make provisions for proper decontamination or disposal of contaminated clothing or equipment.
  • Post clearly the locations where PCBs are stored as required by law.
  • Conduct environmental sampling as necessary to ensure adequate worker protection or safety for public reentry to contaminated areas.
  • Establish reentry or cleanup levels for dioxins and PCBs to protect workers who reoccupy buildings after a PCB fire.
  • Record health complaints of any type.

Medical Surveillance

Workers intermittently exposed to PCBs should have a baseline skin examination and liver function tests. For workers with signs and symptoms consistent with large exposures to PCBs (e.g., chloracne, elevated AST and ALT), obtain confirmation of exposure to determine serum PCB level.

Prevention at Home

Home Practices

  • Open all windows and use fans in your workspace when maintaining or repairing any products containing PCBs.
  • Wear a respirator or protective gloves, or both.
  • You and your children may be exposed to PCBs by eating fish or wildlife caught from contaminated locations. Certain states, Native American tribes, and U.S. territories have issued advisories to warn people about PCB-contaminated fish and fish-eating wildlife. You can reduce your family’s exposure to PCBs by following these advisories.
Key Points
  • The goal of treating chronically exposed patients is preventing any additional exposure to PCBs.
  • Exposure to PCBs at work or home is avoidable if the proper preventive measures are adopted.