Exposure of Patients to Phthalates from Polyvinyl Chloride Tubes and Bags during Dialysis

Nässberger, Lennart; Arbin, Astrid; Östelius, Jan

doi:10.1159/000184165

Cited by 91 publications

(47 citation statements)

References 15 publications

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“…A recent study documents good reproducibility of urinary phthalate monoester measurements from day to day (Pearson correlation coefficients ranged from 0.5 to 0.8); however, this was in a small number of subjects (n = 46), all of whom were women and African American (Hoppin et al 2002). Because phthalates have short half-lives (Nässberger et al 1987;Peck and Albro 1982), spot urine samples reflect recent exposure. However, if a steady state of exposure and biologic burden is achieved with chronic repeated exposures to phthalates through the diet and the use of household and personal care products, then the utility of a single specimen is improved.…”

Section: Discussionmentioning

confidence: 99%

“…Di(2-ethylhexyl) phthalate (DEHP), one of the more commonly used phthalates, leaches from blood products, intravenous and dialysate bags, and tubing made with polyvinyl chloride (Nässberger et al 1987). Phthalates are also present in drinking water, air, and food (ATSDR 1995(ATSDR , 1999(ATSDR , 2000.…”

Section: Volume 111 | Number 9 | July 2003 • Environmental Health Permentioning

confidence: 99%

“…Phthalates are also present in drinking water, air, and food (ATSDR 1995(ATSDR , 1999(ATSDR , 2000. Despite the rapid metabolism and elimination of most phthalates (Koo et al 2002;Nässberger et al 1987;Peck and Albro 1982), theoretically a constant steady state may be reached because of chronic and repetitive, low-level exposures from dietary ingestion and from many commonly used products.…”

Section: Volume 111 | Number 9 | July 2003 • Environmental Health Permentioning

confidence: 99%

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The relationship between environmental exposures to phthalates and DNA damage in human sperm using the neutral comet assay.

Duty¹,

Singh²,

Silva³

et al. 2003

Environ Health Perspect

274

145

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Phthalates are industrial chemicals widely used in many commercial applications. The general population is exposed to phthalates through consumer products as well as through diet and medical treatments. To determine whether environmental levels of phthalates are associated with altered DNA integrity in human sperm, we selected a population without identified sources of exposure to phthalates. One hundred sixty-eight subjects recruited from the Massachusetts General Hospital Andrology Laboratory provided a semen and a urine sample. Eight phthalate metabolites were measured in urine by using high-performance liquid chromatography and tandem mass spectrometry; data were corrected for urine dilution by adjusting for specific gravity. The neutral single-cell microgel electrophoresis assay (comet assay) was used to measure DNA integrity in sperm. VisComet image analysis software was used to measure comet extent, a measure of total comet length (micrometers); percent DNA in tail (tail%), a measure of the proportion of total DNA present in the comet tail; and tail distributed moment (TDM), an integrated measure of length and intensity (micrometers). For an interquartile range increase in specific gravity-adjusted monoethyl phthalate (MEP) level, the comet extent increased significantly by 3.6 micro m [95% confidence interval (95% CI), 0.74-6.47]; the TDM also increased 1.2 micro m (95% CI, -0.05 to 2.38) but was of borderline significance. Monobutyl, monobenzyl, monomethyl, and mono-2-ethylhexyl phthalates were not significantly associated with comet assay parameters. In conclusion, this study represents the first human data to demonstrate that urinary MEP, at environmental levels, is associated with increased DNA damage in sperm.

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Section: Discussionmentioning

confidence: 99%

Section: Volume 111 | Number 9 | July 2003 • Environmental Health Permentioning

confidence: 99%

Section: Volume 111 | Number 9 | July 2003 • Environmental Health Permentioning

confidence: 99%

See 1 more Smart Citation

The relationship between environmental exposures to phthalates and DNA damage in human sperm using the neutral comet assay.

Duty¹,

Singh²,

Silva³

et al. 2003

Environ Health Perspect

274

145

View full text Add to dashboard Cite

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“…They are used to hold color and scent in consumer and personal care products; as solvents in paints, glue, insect repellents, lubricants, and adhesives; and to soften a wide range of plastics, including medical products such as polyvinyl chloride (PVC) blood products and intravenous bags, as well as dialysate bags and tubing [Agency for Toxic Substances and Disease Registry (ATSDR) 1995, 2001Nassberger et al 1987]. Diethyl phthalate (DEP), dibutyl phthalate (DBP), and butyl benzyl phthalate (BBzP) are principally used in personal care products, such as body lotions, gels, shampoos, and deodorants (ATSDR 1995(ATSDR , 2001).…”

Section: Discussionmentioning

confidence: 99%

Medications as a source of human exposure to phthalates.

Hauser

Duty

Godfrey‐Bailey

et al. 2004

Environ Health Perspect

224

148

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Phthalates are a group of multifunctional chemicals used in consumer and personal care products, plastics, and medical devices. Laboratory studies show that some phthalates are reproductive and developmental toxicants. Recently, human studies have shown measurable levels of several phthalates in most of the U.S. general population. Despite their widespread use and the consistent toxicologic data on phthalates, information is limited on sources and pathways of human exposure to phthalates. One potential source of exposure is medications. The need for site-specific dosage medications has led to the use of enteric coatings that allow the release of the active ingredients into the small intestine or in the colon. The enteric coatings generally consist of various polymers that contain plasticizers, including triethyl citrate, dibutyl sebacate, and phthalates such as diethyl phthalate (DEP) and dibutyl phthalate (DBP). In this article we report on medications as a potential source of exposure to DBP in a man who took Asacol [active ingredient mesalamine (mesalazine)] for the treatment of ulcerative colitis. In a spot urine sample from this man collected 3 months after he started taking Asacol, the concentration of monobutyl phthalate, a DBP metabolite, was 16,868 ng/mL (6,180 micro g/g creatinine). This concentration was more than two orders of magnitude higher than the 95th percentile for males reported in the 1999-2000 National Health and Nutrition Examination Survey (NHANES). The patient's urinary concentrations of monoethyl phthalate (443.7 ng/mL, 162.6 micro g/g creatinine), mono-2-ethylhexyl phthalate (3.0 ng/mL, 1.1 micro g/g creatinine), and monobenzyl phthalate (9.3 ng/mL, 3.4 micro g/g creatinine) were unremarkable compared with the NHANES 1999-2000 values. Before this report, the highest estimated human exposure to DBP was more than two orders of magnitude lower than the no observable adverse effect level from animal studies. Further research is necessary to determine the proportional contribution of medications, as well as personal care and consumer products, to a person's total phthalate burden.

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“…6,7 Therefore, patients who undergo medical procedures that involve the use of medical devices that contain PVC may be potentially exposed to much higher levels of DEHP than the general population because these procedures may deliver to the patient via ingestion, intravenous, and dermal absorption considerable doses of DEHP. 2,[8][9][10] In humans, DEHP is rapidly hydrolyzed to its monoester, mono-(2-ethylhexyl) phthalate (mEHP), which in a multistep pathway is oxidized to other metabolites, including mono-(2-ethyl-5-hydroxyhexyl) phthalate (mEHHP) and mono-(2-ethyl-5-oxohexyl) phthalate (mEOHP). 1,[11][12][13][14] These metabolites are excreted in the urine and feces, either in their free form or as conjugates, primarily glucuronides.…”

mentioning

confidence: 99%

Exposure to Di-(2-Ethylhexyl) Phthalate Among Premature Neonates in a Neonatal Intensive Care Unit

et al. 2004

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ABSTRACT. Objective. Premature neonates who spend time in a neonatal intensive care unit may be at increased risk of adverse health effects from exposure to di-(2-ethylhexyl) phthalate (DEHP) because of their increased risk of high exposure, their small body size, and their physical condition. DEHP, a reproductive toxicant in animals, is a major component in polyvinyl chloride (PVC) plastics, which are frequently used in medical tubing and blood storage bags. DEHP is not covalently bound to PVC, and it may be easily released from the PVC medical devices. The objective of this study was to determine whether premature infants who undergo medical procedures, such as blood transfusions, intravenous therapy, enteral and parenteral nutrition support, and dialysis, are at increased risk of exposure to DEHP than the general population. Because of their smaller size, children and especially premature and small infants may receive a larger dose of DEHP on a milligram per kilogram basis than adults when the same-size medical device is used for all ages.Methods. Premature neonates who seemed to have the potential to be on intravenous infusion for >2 weeks and were expected to survive were eligible for enrollment in the study. We assessed exposure to DEHP in 6 premature newborns by measuring in 41 urine samples the levels of 3 DEHP metabolites: mono-(2-ethylhexyl) phthalate (mEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (mEHHP), and mono-(2-ethyl-5-oxohexyl) phthalate (mEOHP).Results. mEHHP and mEOHP were detected in all 41 urine samples, and mEHP was detected in 33. Because only 33 of the samples had detectable amounts for all 3 metabolites, statistical analyses were limited to those 33. The levels of all 3 DEHP metabolites varied widely, and the urinary mean and median concentrations of mEOHP and mEHHP were 1 order of magnitude higher than those for mEHP. Furthermore, the geometric mean urinary concentrations of mEOHP (1617 ng/mL), mEHHP (2003 ng/mL), and mEHP (100 ng/mL) in these 6 premature infants who underwent intensive therapeutic interventions were found to be severalfold higher than in the US general population (for mEHP, geometric mean in those 6 years and older was 3.43 ng/mL).Conclusions. This study provides the first quantitative evidence confirming that newborns who undergo intensive therapeutic medical interventions are exposed to higher concentrations of DEHP than the general population. Although the overall benefits of medical procedures using PVC devices outweigh the risks associated with exposure to DEHP, more research is needed to determine whether infants and children who undergo intensive therapeutic interventions using DEHP-containing devices are at higher risk for altered health outcomes than infants and children who undergo similar treatments but are not potentially exposed to DEHP. Pediatrics 2004;113:e429 -e434. URL: http://www.pediatrics.org/ cgi/content/full/113/5/e429; DEHP, phthalate, plasticizer, urine, biomarker.ABBREVIATIONS. PVC, polyvinyl chloride; DEHP, di-(2-ethylhexyl) phthalate; mEHP,...

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Exposure of Patients to Phthalates from Polyvinyl Chloride Tubes and Bags during Dialysis

Cited by 91 publications

References 15 publications

The relationship between environmental exposures to phthalates and DNA damage in human sperm using the neutral comet assay.

The relationship between environmental exposures to phthalates and DNA damage in human sperm using the neutral comet assay.

Medications as a source of human exposure to phthalates.

Exposure to Di-(2-Ethylhexyl) Phthalate Among Premature Neonates in a Neonatal Intensive Care Unit

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