Emergency measures
Special precautions for physicians
Monochloroacetic acid penetrates the skin and reacts with components of the blood and cells. It immediately forms sodium monochloroacetate and travels to other tissues including the brain via the blood (leading to destruction of cells). In addition, monochloroacetate compounds are formed from the interactions between highly concentrated MCA and blood and between highly concentrated MCA and cellular components. These compounds can cause serious symptoms, and prompt treatment is necessary. If monochloroacetic acid comes into contact with the skin, it is most important to immediately immerse the skin in sodium bicarbonate solution or immediately wash with large amounts of water. If possible, immerse in a bath of approximately 3-5% sodium bicarbonate solution (25-35℃) for a minimum of 4 hours (until the white patch produced from the chemical injury disappears). If the extent of chemical injury is 1% or more of the total body surface area, it can become a serious injury. Therefore, the symptoms should be continuously monitored in a hospital for at least 24 hours. Vomiting and decrease in blood pressure are signs of worsening symptoms. Flamazine ointment or Hirudoid ointment should be used as medication for the skin. Treatment should include blood pressure measurement, measurement of monochloroacetic acid content in blood, artificial respiration, resuscitation, N-acetyl cysteine therapy (detoxification treatment), hemodialysis, plasma exchange, and alkalinization.
Guidelines for handling monochloroacetic acid injury at the time of chemical injury
Monochloroacetic acid is a very corrosive and highly permeating substance. Its handling requires extreme caution, and if chemical injury from an accident occurs, immediate treatment must occur to effectively prevent serious injury. The following is a summary of “Guidelines for Handling MCA injury at the Time of Chemical Injury.”
1.First aid
1)Skin contact：
General treatment
If monochloroacetic acid comes into contact with the skin, it is most important to immediately immerse the skin in sodium bicarbonate solution or wash with large amounts of water. If possible, immerse in a bath of approximately 3-5% sodium bicarbonate solution (25-35℃) for a minimum of 4 hours (until the white patch produced from the chemical injury disappears), and seek medical care from a physician as needed. Contaminated clothes should be removed as the aforementioned treatment is performed.
※Flamazine ointment and Hirudoid ointment should be used for the treatment of chemical injury on the skin.
If the extent of chemical injury is less than 1% of the total body surface area (approximately palm of one hand) (often a minor injury)
：Promptly handle as indicated in a general treatment.
If the symptoms are mild (first or second degree burn), apply the ointment. If a blister forms, do not break the blister but apply Sofratulle (fradiomycin gauze for prevention of suppuration).
If the symptoms are worsen, seek care from a physician.
If the extent of chemical injury is 1-5% of the total body surface area (highly likely that the injury could become serious)
：Promptly handle as indicated in a general treatment.
Transport the patient to the hospital and receive diagnosis and treatment from a physician.
When transporting, it is desirable to carry sodium bicarbonate.
If necessary, hospitalize the patient for at least 24 hours and continuously monitor the symptoms.
→Vomiting and decrease in blood pressure are signs of worsening symptoms.
If the extent of chemical injury is over 5% of the total body surface area (highly likely that the injury could become extremely serious)
：Promptly handle as indicated in a general treatment.
Transport the patient to the hospital by ambulance and receive diagnosis and treatment from a physician.
When transporting, it is desirable to carry sodium bicarbonate.
Continually perform the neutralization of the affected area during transport to the hospital.
Be sure to hospitalize the patient for at least 24 hours and continuously monitor the symptoms.
→Vomiting and decrease in blood pressure are signs of worsening symptoms.
If the chemical injury is extensive or if the symptoms are severe (third degree burn, fourth degree burn, or worse) and if the patient cannot be transported to the hospital, immediately call a physician to the site and follow the physician’s instructions.
(Reference) Degree of burn
- First degree: Skin reddens with burning sensation
- Second degree: blistering
- Third degree: Skin becomes inflamed and necrotizes
- Fourth degree: Tissues char
Specific examples of the extent of chemical injury
Click here for reference
2) Eye contact：
Since MCA can injure the cornea and the eyelids, immediately wash the eyes thoroughly with large amounts of 0.9% saline solution or purified water. Be sure to seek medical care from an ophthalmologist.
Washing of eyes can be achieved effectively by opening the eyelids with the thumb and index finger.
3) Inhalation：
Wrap a blanket around the patient, allow the patient to rest quietly, and move him/her to a place with fresh air.
Immediately transport the patient to the hospital.
If the patient has dyspnea or has stopped breathing, immediately begin artificial respiration or use a resuscitator.
4) Accidental ingestion：
Rinse the mouth and have the patient drink water. (Do not induce vomiting.)
Allow the patient to rest quietly and to breathe fresh air. Place the patient in a reclined position and transport the patient to the hospital.
5) Others：
If the patient might have touched or ingested monochloroacetic acid or might have been exposed to its vapor, or if symptoms indicative of such events appear, be sure to have the patient seek medical care from a physician.
2. Examples of treatments by a physician
The representative symptoms in chemical injury by monochloroacetic acid include:
- Blood pressure decline
- Vomiting
- Tightness of chest
- Symptoms of shock
- Coma
A physician will treat the patient according to these symptoms. The examples of the treatments are the following.
- Measurement of blood pressure
- Measurement of MCA content in blood
Measures the extent of MCA penetration through the skin - Artificial respiration and artificial resuscitation
- N-acetyl cysteine therapy (detoxification treatment)
- Hemodialysis
- Plasma exchange
- Alkalinization
Conventionally, intravenous or oral administration of ethanol has been given to promote the metabolism of MCA in blood. However, a European study recently indicated that such an effect of ethanol is small.
3. Mechanism of chemical injury by monochloroacetic acid
＜From data of Akzo Nobel＞
- Since monochloroacetic acid is highly permeating through the skin, it is immediately absorbed through the skin surface and causes severe chemical injury in that area.
- Monochloroacetic acid components that penetrated react with the components of the blood and cells. They immediately form sodium monochloroacetate and travel to other tissues including the brain via the blood (leading to destruction of cells).
- Monochloroacetate compounds are formed from the interactions between highly concentrated MCA and blood and between highly concentrated MCA and cellular components. These compounds can cause serious symptoms.
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