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Environmental Medicine: Integrating a Missing Element into Medical Education
products. It has been estimated that food accounts for 98% of total adult exposures. TCDD has been detected in fish from Saginaw Bay, contaminated sections of the Great Lakes, and some Michigan rivers, although levels in both the water and fish have decreased over time.
Use of products known or thought to be contaminated by dioxins and furans has been significantly restricted in the last few decades. The U.S. Environmental Protection Agency (EPA) has removed the herbicide 2,4,5-T from the commercial market, and heat-transfer agents using polychlorinated biphenyls (PCBs), which form dioxins during combustion, are being phased out of production and use.
(1) Whom would you contact to obtain further information about the herbicide used?
❑ Workers in the chemical industry may have increased likelihood of exposure.
❑ Overt clinical effects from dioxin exposure have been seen primarily after major industrial accidents involving these compounds.
❑ Fetuses and nursing infants may be at increased risk of dioxin exposure if the mothers have been exposed.
Dioxins are no longer manufactured in the United States, except for small amounts used for scientific research. Nevertheless, some workers may encounter dioxins as contaminants in certain industrial processes such as the manufacture of chlorinated herbicides, germicides, and organic solvents. Firefighters and cleanup crews involved with capacitor or transformer fires and hazardous waste accidents may also be exposed to dioxins through dermal absorption or inhalation. Municipal and waste incinerator workers may encounter dioxins in smoke, gases, or fly ash formed during combustion processes. Major industrial accidents have been the source of most overt clinical effects from dioxins.
Because TCDD crosses the placenta and accumulates in breast milk, fetuses and nursing infants of contaminated mothers are potentially at increased risk of exposure. Ingestion of contaminated soil due to pica or normal hand-to-mouth activities may contribute to a child’s dioxin body burden. No cases of dioxin toxicity have been reported by either of these routes.
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