Journal of Clinical Toxicology
Open Access

Abstract

Use of an Amphoteric Solution in Eye, Skin and Oral Chemical Exposures: Retrospective Multicenter Clinical Case Series

Fortin JL, Fontaine M, Bodson L, Depil-Duvala A, Bitar MP, Macher JM, Paulin P, Ravat F and Hall AH

Introduction: A polyvalent amphoteric flushing solution (Diphoterine®) has been in use for a number of years, mainly in industrial settings for decontamination of acid, base, and other corrosive or irritant substances eye and skin splashes. Methods: Retrospective collection of 34 cases from several centers reporting use of Diphoterine® decontamination of eye, skin or oral chemical exposures. The following data were retrieved: exposure circumstances (workplace, domestic, deliberate assault), chemical nature and pH, exposure type, initial clinical signs, clinical signs after flushing, initial and final visual analog scale (VAS) pain ratings, consulting specialist physicians’ conclusions. Results: 58.8% of the 34 cases were occupational exposures, 29.4% were domestic, 5.9% occurred in schools, and 5.9% were deliberate chemical assaults. Of involved chemicals, 11 were basic substances, 11 were acidic, 1 was an oxidizing substance, 2 were solvents, and 9 were miscellaneous substances. There were 21 ocular exposures, 8 cutaneous exposures, 4 mixed (ocular/cutaneous), and 1 oral exposure. Initial clinical findings in ocular exposures were: pain, blepharospasm, hyperemia, palpebral edema, excessive tearing, and blurred vision. Of cutaneous exposures, 1 was a deep necrotic injury and 7 were superficial. Median (IQR) VAS before flushing with Diphoterine® was 7; VAS after ocular or skin flushing was 1. Conclusion: Early application of the amphoteric solution to the eye or skin reduces the intensity of pain associated with chemical injury. While randomized clinical trials are lacking, early use of the amphoteric solution appears to reduce the incidence of sequelae.