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25 year old, HB , researcher exposed to organic solvent
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25 year old, HB , researcher exposed to organic solvent

Good day,

I am 25 years old and a 2nd year Masters Course Student. I am majoring in Environmental Microbiology, a time-consuming and sometimes stressful field of research.  I knew two years ago that I am HB positive and was advised by my doctor to sleep early, take enough rest and avoid alcohol. But with my major now I cannot  do it. Since then, I have a liver test every six months. My latest test was 3 months ago  the virus still there but there is no change of my liver status. Everything is normal.   I usually stay in the laboratory until midnight and sleep 5 hours a day. Yesterday, I worked with carbon tetrachloride and dichloromethane(with known potential to affect the liver) for the whole day  working under the  fumehood. However, it is unavoidable to inhale some. Since last night, I feel pain in my abdominal region and I am thinking  that it could be my liver. I am expected to graduate 8 months from now and for the entire duration  working with the same organic solvents.  I am planning to Pursue PhD after my MS. What do you think  would be the effect of this to my liver status. What advice can you give me regarding my present status?

Thank you very much
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16 Comments Post a Comment
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148588_tn?1407125204
I've heard carbon tet exposure by itself is enough to induce toxic hep. By the time I was in college, I had already had 3 bouts of acute hep and was given to understand that healthy working chemists had an average lifespan a couple years shorter than normal. So you might say I voted with my feet and said ixnay on the chem career.
What do your antigen tests say  - are you an active/inactive carrier?
And most importantly, have you discussed your concerns with your doctor?
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151263_tn?1243377877
I used to work in an analytical lab for several years, and I've had my time under the hood with benzene, CCl4, various acid digestions (including aqua regia) and even mercuric oxide on one occasion. I also was frequently exposed to acetone fumes, as we used it to rinse excess DI water from glassware after washing. I've had HCV for 23 years and my liver is still in pretty good shape (about an F1 on a scale of F0 being normal and F4 being cirrhosis). I also drank quite a bit of alcohol when I was younger, before I knew I had HCV.

I know that anxious feeling you can get, especially after handling a nasty substance like CCl4. But unless you really got some serious huffs of it, you're probably fine. And if it worries you that much, simply refuse to handle it. That's what I did with the mercuric oxide acid digestions I was asked to perform as mentioned above. I refused on the grounds that I could smell the digestion even while under the hood and considering how acutely toxic even trace amounts of mercury was, it was a non-starter for me. The lab director understood (he was a very nice guy though), and handled those samples himself.

If it worries you that much, refuse exposure to CCL4 and offer to perform an alternative experiment/procedure using a less harmful substance. Also have your liver enzymes (ALT/AST) checked. If your liver was damaged recently those should be elevated - and you can certainly use that as (probable) proof of a hazardous condition in the lab too.
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Avatar_dr_m_tn
The hood needs to be certified and recertified and checked for proper flowrate inwards in all positions with a maximum opening indicated after the certification/testing.

Having chronic HB; Is the e-antigen negative? Was always negative? what is the viral load?  having "normal lab tests" is not enough indication that things are fine.

Not a good idea to be exposed to these toxic chlorinated hydrocarbons with hepatitis. When you do inhalte them, then dependent on the dose, there will be some liver cell necrosis, that can activate the hepatitis, aside from causing direct "chemical hepatitis".

You should use a prophylactic dose of 2000mg N-acetyl cysteine per day to protect your liver if you cannot remove yourself from this exposure. The toxic mechanisms of these compounds involves a depletion of the hepatic glutathione reserve by free radicals. If you have a high resereve by using NAC your tolerance before toxic effects will be higher.
There is no question that NAC will improve your glutathione status.
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148588_tn?1407125204
Would the NAC also help one to tolerate exposure to solvents such as methylethylketone or other solvents used to solvent weld plstic?
Would a weeks worth of pre-dosing prior to exposure be enough?
Would your average rural pharmacy carry NAC or be able to order it?

Thanx
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151263_tn?1243377877
That's interesting to hear that NAC could potentially act as a protector of the liver for the reasons you cite. What is your opinion of Milk Thistle as well? I know they've used MT with success in lab animals with CCL4 poisoning and also with humans experiencing death cap mushroom poisoning. And if MT does provide protection/benefit for chemically based liver toxins, do you think it also provides meaningful protection for those with viral hepatitis? Are there any other substances/supplements you would recommend to benefit those with chronic hepatitis?  Thanks in advance...
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Avatar_dr_m_tn
Would the NAC also help one to tolerate exposure to solvents such as methylethylketone or other solvents used to solvent weld plstic?

The production of free radicals in the liver (and elsewhere) is a common pathway for many organic solvents, but each has their particular toxicity profile and primary target organ. Thus one has to check the toxnet for those particulars.
Nevertheless NAC will be protective in many of these toxicities, however only to a limited extent and depending on the dose of toxin and NAC.

In acute acetaminophen "Tylenol" poisoning, doses of up to 40 grams of NAC are given orally and now also intravenously to save the patients life from acute liver failure. It is FDA approved for that use.

It is also used for chronic bronchial problems as "Mucomyst" for inhalation, because it loosens/liquifies mucous secretions and has local antiinflammatory/detoxifying  properties.


Would a weeks worth of pre-dosing prior to exposure be enough?

I think this will saturate the glutathione levels to a good degree, particularly if doses of 2 grams/day are used ( which many are using as a constant liver protectant)

Would your average rural pharmacy carry NAC or be able to order it?
A good vitamin store should have it, or companies like VRP will ship it and the cost is low.

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148588_tn?1407125204
Thank you, thank you, and thank you :-)
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148588_tn?1407125204
Thank you also for pointing me in the direction of toxicity profiles. It looks like cyclohexanone and tetrahydrofuran are the two I should be more concerned with than MEK - and I work with all of them.
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Avatar_dr_m_tn
That's interesting to hear that NAC could potentially act as a protector of the liver for the reasons you cite. What is your opinion of Milk Thistle as well? I know they've used MT with success in lab animals with CCL4 poisoning and also with humans experiencing death cap mushroom poisoning. And if MT does provide protection/benefit for chemically based liver toxins, do you think it also provides meaningful protection for those with viral hepatitis? Are there any other substances/supplements you would recommend to benefit those with chronic hepatitis? Thanks in advance

That is a very big question the answers to which typically raises hot debates and emotions. I do research the literature and all the liver meetings since 12 years for concepts and practical research/trials with cells, animals, humans to sort all the possibilities and destill them into real life approaches.
Since there is such a large amount of trash and semitrash opinions offered in regard to supplements for liver protection on the internet i tend to discuss this with people in a thorough fashion by pointimg to the scientific basis and the conceptual grounds on which "liver protective" supplements should be considered. This is not a good place to do this, so I can only make a few remarks.

Particularly if someone is on tx things are very delicate. We do not know if some of the liver protective features are not negating some of the toxic effects e.g. of riba which are the basis of its antiviral effect as well.
On the other hand there is reason to believe that some improvements in metabolism and cellular function that you can achieve by repleting the proper suboptimal "deficiencies" of immune cells ( like T lymphocytes) that have to replicate rapidly and function efficiently in this (HCV) context are actually quite important in the dynamic war towards SVR.
But since we do not know this for sure and things are indeed delicate we do not typically recommend anything but a healthy diet/lifestyle to the patient while on TX.

To return to your question, there are a few non brainers in the arena of liver protection and NAC,lactulose and probiotics, -provided a healthy diet is already followed and weight has been lost- are almost certainly liver protective. MT is probably effective as well, debates are if Silymarin, Silybin or Isosilibin or a mix are the best and a prescription drug named " Legalon" is used in Europe since 2 decades for that " liver supportive" feature. Mind you that many of the small MT research studies have indeed been paid by the manufacturer of this MT drug and that one must not expect too much of it.
Other flavonoids and flavonoid like compounds hold great promise as antiinflammatory substances, like transresveratrol, green tea and curcumin preparations, or the prescription "medicinal food' Limbrel ( Catechin plus Baicalin).
Lipoic acid and taurin have their place and SAMe and Vit E as well. Those substances help with the critical importance of Methylation reactions and provide SH groups for the replenishing of the ever so important Glutathione and have critical but not well understood places in the chain of antioxiddant reactions that take place and can only be understood in their integrated interplay and never as a monosubstance and only with the understanding that at the end of this chain enzymatic regenerative processes recharge the individual antioxidants for reuse. The cooperative nature of this process makes it also necessary that -for instance- NAC has to be used with a good ( like 1:1 dose of Ascorbic Acid.
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Avatar_m_tn
It's interesting reading what people have written but just to play devils advocate I'll throw in my 2 cents worth.  I think you are wise to ask the questions and see if you can manage the toxins you work with. You've gotten some good answers.

My understanding of chemical hepatitis is that the damage can occur many times faster than from the effects of drinking or from Hepatitis A, B, or C.  I have heard many examples from people who drank and drugged for years and still may not have cirrhosis.  There are many people who have experienced death or severe damage to their liver from single or short term exposures to chemicals.  It may be risky business indeed attempting to "manage" ones exposure to hepatoxic substances particularly when one is A) HB positive and B) facing continued exposure to hepatoxic substances, C) experiencing symptoms from exposures (although these symptoms could be imagined).  If you intend to continue to do the above you might also ask what testing and precautionary measures you need take to ensure you don't expose yourself to serious injury.

It may sound judgmental but if the situation was presented that instead of an occupational hazard you were asking if you could drink in spite of your having HB or various ways you could mitigate your damage from continuing to drink you might get a good scolding.  : )

I support your right to choose.  I also understand that you are researching the subject and getting points of view so that you can make an informed decision.  The key points that I would drive home are that chemical damage to your liver may occur many many times faster than other routes, when coupled with your HB status it could further have a multiplying effect on your damage, and that you appear to be facing years of exposure of this elevated danger to your liver.

Best wishes,
Willy
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151263_tn?1243377877
Thanks a million hr for your thoughtful and very informative response. I know that you
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Avatar_dr_m_tn
As you can imagine the full line of reasoning and the support of individual measures by literature and experimental research is a very voluminous task. But we could talk about it - that speeds the communication by about 1000%- and cover much more about the supporting concepts - or lack thereof of these liver protective measures. If you e-mail kalio ( she has posted her mail here a few posts below) she has agreed to forward that mail to me and I can talk to you directly.

I agree that it would be of great value to many participants here to become more familiar with serious literature, research and concepts that might have practical impact, but at best it can be done in a piecemeal fashion, like I tried to introduce the thinking behind the influence of lactulose and probiotics on the pathophysiology of the gut liver interaction and the value of reducing proinflammatory signals/ substances in the intestines (reduce "leaky gut syndrome" and bacterial translocation) and reduce the proinflammatory stimuli that reach the liver via the portal circulation with undoubtedly negative effects on fibrosis and general hepatitis. One really needs to dwell on this subject until the full impact sinks in.

Another "for example" antifibrotic subject would be a discussion on the impressive research behind polyenylphosphatidylcholine by Dr. Charles Lieber, who did a tremendous amount of serious scientific work ( and presented several times at the AASLD conference)  to show the effectiveness and even unravel some mechanisms of the antifibrotic effect of this wonderfully innocent (GRAS - Generally Regarded As Safe) substance. I would like to hear from members of this forum if they have taken this, or if not, why not.

The trick is to be able to judge the research as believable, understand the toxicity - or nontoxicity- issues and draw the practical consequences. Then of course comes the biggest obstacle: any such measure, like a surmised or hoped for antifibrotic effect is not going to be rapid and even more problematic it is very hard to assess it, measure it, objectivize it even if it is indeed happening. When you walk in the dark it is hard to see if your are on the right track....
BTW these types of very trivial insights have actually prompted me to obtain this fibroscan instrument as the very first lab in the USA. What matters most in the liver -fibrosis extent- is hard to quantitate and therapeutic success or lack thereof is hard to verify. Thats why the FDA rightfully wants a prior and post tx bx in most antiviral hepatitis trials. And thats also why "supplemental" antifibrotic measures are rarely and barely ever proven to be real, because it costs a ton to do so.
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151263_tn?1243377877
Thanks once again so much for the great response. I
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Avatar_n_tn
A million thanks to all of your replies. Indeed it is sucha great help!
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151263_tn?1243377877
One more thing I forgot to mention, and you've probably considered this yourself - but you could also wear an organic vapor respirator (with activated charcoal). You wouldn't want to have to wear one all day, as they irritate your skin. But you might just wear it during the riskiest moments of exposure, like during the decanting and pouring/metering process. Once the nasty stuff is settled in your beaker/graduated cylinder/erlenmyer/whatever, and the bottle is capped while all is still under the hood, then you can back off in a safer position before removing the respirator.

Just a thought, good luck with your studies.
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Avatar_f_tn
hi
i m chronic hep B positive.can it be cured/ my MD told me that TX is successful only on 40 % patient. and i want to know one more thing hep B is more dengerous or hep C ? i want to get pregnant also is there any risk for my baby?is there any seperate forum for hep B?
please reply me by mail
thank u
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