<i>P</i>-Chloroaniline Poisoning Causing Methemoglobinemia: A Case Report and Review of the Literature

Messmer, Anna S.; Nickel, Christian H.; Bareiss, Dirk

doi:10.1155/2015/208732

Cited by 8 publications

(8 citation statements)

References 18 publications

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“…[1516] Studies found that PCA, apart from being proven carcinogenic in animals, also led to methemoglobinemia in humans. [1718] This is regardless of toxicity from PCA powder or the spontaneous breakdown of CHX. The International Agency for Research on Cancer (IARC, 2006) classified PCA as group 2B carcinogens.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Precipitate Formation on Interaction of Chlorhexidine with Sodium Hypochlorite, Neem, Aloevera and Garlic: An in vitro Study

Siddique¹,

Jayalakshmi²

2019

Ind. Jour. of Publ. Health Rese. & Develop.

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Introduction:The interaction between chlorhexidine (CHX) and sodium hypochlorite (NaOCl) yields a thick precipitate capable of occluding dentinal tubules. Previous studies are unclear as to the above-mentioned precipitate contains para-chloroaniline (PCA) or not. PCA is a known toxic and carcinogenic compound which may lead to methemoglobinemia in humans.Aim:This study aims to evaluate the precipitate formed on combination of different irrigants, weigh the amount of precipitate formed and to analyze the precipitate for PCA by using thin layer chromatography (TLC), high performance liquid chromatography (HPLC), column chromatography (CC), electron spray ionization mass spectrometry (ESI-MS), Ultraviolet (UV), and nuclear magnetic resonance (1H-NMR and C-13 NMR).Materials and Methods:Four different irrigants namely 2% CHX gluconate, 3% NaOCl, 5% neem and 5% tulsi were taken in different test tubes. Group 1, 2 and 3 included 1 ml 2% CHX combined with 1 ml each of 3% NaOCl, 5% neem and 5% tulsi. Group 4 and 5 comprised of 1 ml 3% NaOCl in combination with 1 ml 5% each of neem and tulsi. Finally, group 6 constituted 1 ml 5% neem mixed with 1 ml 5% tulsi. Each group was observed for 2 min for the formation of any precipitate, and the formed precipitate was weighed and analyzed using 1H-NMR and C-13 NMR, TLC, CC, HPLC, ESI-MS, and UV.Statistical Analysis:One-way ANOVA and Post hoc–Tukey test were used.Results:Presence of PCA was detected in group 1 (CHX + NaOCl), group 2 (CHX + neem) and group 3 (CHX + tusli) in all the sensitive methods employed.Conclusion:The presence of PCA in precipitate was confirmed by TLC, CC, HPLC, ESI-MS, and UV. Based on the results of the present study, we assume that components in CHX are responsible for precipitate formation which contains PCA as well. Extrusion of precipitate beyond the apex may cause periapical tissue damage and delay wound healing at the same time.

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Section: Introductionmentioning

confidence: 99%

Assessment of Precipitate Formation on Interaction of Chlorhexidine with Sodium Hypochlorite, Neem, Aloevera and Garlic: An in vitro Study

Siddique¹,

Jayalakshmi²

2019

Ind. Jour. of Publ. Health Rese. & Develop.

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“…The purpose of this in vitro study is to determine whether PCA was formed as a byproduct of the reactions between NaOCl and final rinse CHX and QMix solutions, as well as a result of EDTA/CHX combination. This can be important because PCA is considered to be cytotoxic on human cells (WORLD HEALTH ORGANISATION, 2006), carcinogenic (THOMAS et al, 2010) and can lead to neonates methemoglobinemia (MESSMER et al, 2015). TLC, 1 H NMR and IR methods were chosen for this study due to their great sensitivity in identifying components of a given reaction mixture, as well as determination of mixture purity.…”

Section: Resultsmentioning

confidence: 99%

Investigation of p-chloroaniline formation in the reactions between different endodontic irrigants

Bjelović¹,

Glišić²,

Živković³

et al. 2019

Kragujevac J Science

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The aim of this study was to determine whether p-chloroaniline (PCA) is formed in the reactions of sodium hypochlorite (NaOCl) with final rinse chlorhexidine (CHX), QMix (combination of ethylenediaminetetraacetic acid (EDTA), CHX and detergent) and EDTA/CHX solutions by thin-layer chromatography (TLC), proton nuclear magnetic resonance ( 1 H NMR) and infrared (IR) spectroscopy. Commercially available 5.25% NaOCl solution was mixed with 2% CHX and QMix in 1:1 (v/v) ratio at room temperature. Furthermore, 2% CHX was associated with 17% EDTA under the same experimental conditions. The obtained solutions were evaluated qualitatively for color changing, precipitate and/or bubble formation and analyzed by TLC chromatography. The association products were investigated by spectroscopic ( 1 H NMR and IR) methods in order to determine whether they contain PCA. It was found that interactions between NaOCl/CHX and CHX/EDTA led to forming of brown and white precipitate. When NaOCl was mixed with QMix, an orange-brown precipitate was formed. PCA was not detected as a product of the reactions between NaOCl and final rinse solutions of CHX, QMix and EDTA/CHX association.

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“…On the contrary, recently, the brown precipitate has been reported as toxic on both Caenorhabditis elegans and primary immortalized human gingival fibroblasts (Jeong et al, 2021). PCA, 4-chloroaniline or ClC6H4NH2 is known to be toxic (Boehncke et al, 2003), carcinogenic (Chhabra et al, 1991), and may lead to cyanosis related to methemoglobinemia (Kulkarni et al, 1969;Messmer et al, 2015;Ramsay & Harvey, 1959) in mammals, see Figure 2. According to the universal regulation, acute toxicity of PCA is corresponds to 'Category 3' if swallowed, inhaled or contacted.…”

Section: What Does Not Form After Accidental Sodium Hypochlorite Cont...mentioning

confidence: 99%

What does not form after accidental sodium hypochlorite contact with chlorhexidine?

2022

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If the chemical structure of brown precipitate is aimed to analyse in any research and the hypothesis is tested by any mass spectroscopy method, the fragmented PCA main peak of CHX is always detected in mass spectra. After all these considerations, in summary, it is certain that mass spectrometry-based on fragmentation analysis of molecules is not suitable for PCA analysis from brown precipitate, and this has been experimentally proven. CONFLICT OF INTERESTThe authors declare that there is no expectation of a response to this letter from Jeong et al. ( 2021). The authors have stated explicitly that there are no conflicts of interest or financial interest in connection with chlorhexidine manufacturing or chlorhexidine-related products. Also, the authors have stated that there are no conflicts of interest in connection with this manuscript.

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P-Chloroaniline Poisoning Causing Methemoglobinemia: A Case Report and Review of the Literature

Cited by 8 publications

References 18 publications

Assessment of Precipitate Formation on Interaction of Chlorhexidine with Sodium Hypochlorite, Neem, Aloevera and Garlic: An in vitro Study

Assessment of Precipitate Formation on Interaction of Chlorhexidine with Sodium Hypochlorite, Neem, Aloevera and Garlic: An in vitro Study

Investigation of p-chloroaniline formation in the reactions between different endodontic irrigants

What does not form after accidental sodium hypochlorite contact with chlorhexidine?

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