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Direct observations: clinical cases, poisoning incidents and other

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direct observations: clinical cases, poisoning incidents and other
Type of information:
other: case report
Adequacy of study:
other information
2 (reliable with restrictions)
Rationale for reliability incl. deficiencies:
study well documented, meets generally accepted scientific principles, acceptable for assessment

Data source

Reference Type:
Acute respiratory symptoms following massive carbon black exposure
Hailemariam Y, Mojazi Amiri H, Nugent K.
Bibliographic source:
Occupational Medicine 2012;62:578–580

Materials and methods

Study type:
poisoning incident
Endpoint addressed:
acute toxicity: inhalation

Test material

Constituent 1
Chemical structure
Reference substance name:
Carbon black
EC Number:
EC Name:
Carbon black
Cas Number:
Molecular formula:
Carbon black


Type of population:
44-year old male
Route of exposure:
Reason of exposure:
Exposure assessment:
not specified
Details on exposure:
The patient estimates that he inhaled CB for approximately 2 to 3 min.
- Lung function parameters:

Results and discussion

Clinical signs:
Acute exposure to a high dose of carbon black caused respiratory symptoms and changes in pulmonary function.
Results of examinations:
The patient presented as a well-nourished man in no acute distress. Vital signs were normal, with O2 saturation of 95% in room air. Thoracic examination revealed normal expansion on inspiration, normal expiratory flow rates and normal percussion notes. Breath sounds were slightly increased in intensity. There were high-pitched expiratory wheezes in the anterior fields when supine but not when sitting. Cardiac examination was within normal limits. Complete blood count and chest x-ray were within normal limits. Pulmonary function tests revealed FVC 5.5 l (96% of predicted), FEV1 3.70 l (82%), FEV1/FVC 0.67 (predicted 0.79), FEF25-75% 2.44 l/s (60%), total lung capacity 7.92 l (105%), residual volume 2.67 l (128%), RV/TLC 0.34 and a normal diffusion capacity (106%)
Effectivity of medical treatment:
The patient was started on fluticasone (500 micrograms per puff)/salmeterol (50 micrograms per puff) one puff twice daily. After 6 weeks his symptoms improved but had not resolved. He had no wheezing. His spirometry was within normal limits with FEV1 of 4.91 l (122% predicted) and FVC of 6.07 l (110% predicted).

Applicant's summary and conclusion

Acute massive exposure to carbon black can cause respiratory symptoms and an obstructive ventilatory defect. This presentation suggests a small airway disease which improved over time with inhaled steroids and long-acting beta-agonists. Patients with intense carbon black exposure following industrial accidents will need frequent evaluation to manage any related respiratory tract injury.
Executive summary:

A 44-year-old man had intense exposure to carbon black when his crane ran into a truck with a trailer filled with carbon black. One week after this exposure he developed shortness of breath and cough with sputum production. These symptoms persisted and increased in intensity. Physical examination revealed expiratory wheezes when in the supine position. Pulmonary function tests revealed a mild obstructive ventilatory defect with a reduced FEV1/FVC ratio. The patient responded to treatment with fluticasone and salmeterol with a reduction in symptoms and improvement in his spirometry to a normal range.

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