Ver el código de «Hydrazine toxicity»

==Background==
* Clear, colorless liquid that has an ammonia-like odor
* Powerful reducing agent that is highly reactive
* Exposure to metal oxides makes it highly exothermic and combustible
* Used in rocket fuels, missile fuels, aircraft emergency power unit fuel (notably the F-16)
* Used in chemical manufacturing (intermediate for insecticides/herbicides/dyes, polymerization catalyst for making plastics, used to manufacture sodium azide [air bag propellant], used to make isoniazid and fluconazole
*Hydrazine is used as a propellant in the International Space Station

===Toxic Dose===
* OSHA limit 1 ppm in air for 8-hour workday
* NIOSH recommends 0.03 ppm in air for 2-hour period
* Odor threshold 3.7 ppm in air

===Routes of Exposure===
* Inhalation
* Skin contact / absorption (rapid within 30 seconds of contact)
* Ingestion

===Mechanism of Action===
* Hydrazine + ketone/aldehyde = hydrazones + B6 = hydrazones of pryidoxine
** "consumes" B6 in body
** functional B6 deficiency results
* Metabolism of hydrazine produces free radical intermediates
* Inhibits pyridoxine kinase as well as glutamic acid decarboxylase which results in decrease production of GABA neurotransmitter

[[Category:Toxicology]]
[[Category:Space Medicine]]

==Clinical Features==
*Short term inhalation exposure may cause:
**[[Cough]], oropharyngeal/pulmonary irritation
**[[Pulmonary edema]]
**[[CNS Depression]], [[seizure]], [[tremor]]
*Long term inhalation exposure:
**Above, plus may cause [[hepatic failure|liver]] and [[renal failure|kidney damage]]
*Ingestion
**[[Nausea/vomiting]]
**Uncontrollable shaking, [[seizure]], nerve inflammation/polyneuritis, [[coma]]
*Contact exposure
**[[rash|Dermatitis]], [[chemical burns]]
**If absorbed systemically, can -> [[hemolytic anemia]], [[methemoglobinemia]]

==Differential Diagnosis==
{{Space medicine}}
{{Inhalation exposure}}

==Evaluation==
*BMP
*[[LFTs]]
*CBC
*[[UA]]
*[[VBG]], MetHb
*[[Lactate]]
*[[CXR]] if inhalational exposure or pulmonary symptoms

==Management==
===Mild to Moderate Exposure===
* Ensure patient has been decontaminated
* Irrigate eyes with normal saline or water if exposed
* Treat [[chemical burns]] if present
* Monitor pulmonary status
* Monitor for development of [[methemoglobinemia]]

===Severe Exposure===
* [[Seizures]] - [[pyridoxine]] 25 mg/kg IM or IV up to 5 grams plus [[benzodiazepine]]
* Respiratory distress - secure airway and assist ventilation
* [[Methemoglobinemia]] - initiate oxygen therapy, give methylene blue if patient is symptomatic; Methylene blue dose 1 mg/kg IV over 5 to 30 minutes repeat dose may be given 1 hour after first if symptoms persist
* Consider [[hemodialysis]] and acidification of urine if member has severe CNS depression
* [[Hypoglycemia]] treat with D10 and [[thiamine]]

==Disposition==
* Home in cases of mild skin exposure without burns
* Observation for patients with inhalation or ingestion exposure for at least 12 hours to ensure no serious symptoms develop
* Admit patients with CNS symptoms or persistent pulmonary/gastrointestinal symptoms

==See Also==
*[[Pyridoxine]]
*[[Methylene blue]]

==References==
<references/>


[[Category:Military]]
[[Category:Toxicology]]