http://en.wikipedia.org/wiki/Lidocaine

Lidocaine

Chemical structure of lidocaine
Lidocaine
IUPAC name     2-(diethylamino)-N-(2,6-dimethylphenyl)acetamide
monohydrochloride
Chemical formula     C14H22N2O·HCl·H2O
CAS number     137-58-6
Molecular weight     234.3406
Melting point     66 - 69
Excretion     Renal
Metabolism     Liver

Lidocaine (INN) or lignocaine (former BAN) is a popular local
anesthetic often used in dentistry or topically. It is marketed by
AstraZeneca under the brand name Xylocaine.

Lidocaine is the active ingredient in cloves. In fact, if one were to
chew on ground clove powder, one would get a numb mouth. This is
because of the lidocaine's local anesthetic effects.
Contents [showhide]
1 History
2 Pharmacology
3 Toxicity
4 Related Information
[edit]

History

Lidocaine, the first amide-type local anesthetic, was developed by Nils
Lofgren in 1943 and first marketed in 1948.

Pharmacology

Lidocaine is metabolized in the liver and excreted by the kidneys. It
is faster acting and longer lasting than procaine (novocaine).

When given intravenously, lidocaine is a class Ib antiarrhythmic agent
and will block the sodium channel of the cardiac action potential,
which decreases automaticity by reducing the slope of phase 4
depolarization with little effect on the PR interval, QRS complex or QT
interval.

This drug is used in the treatment of ventricular cardiac arrhythmias
and cardiac arrest with ventricular fibrillation, especially with acute
ischemia, though it is not useful in the treatment of atrial
arrhythmias.

The half life of intravenous lidocaine is about 109 minutes, but
because it is metabolized in the liver (which depends on liver blood
flow), dosage should be reduced in patients with low cardiac output or
who are in shock. In patients with cardiogenic shock, the half life may
exceed ten hours.

Toxicity

Toxicity is most often seen when there has been an inadvertant
intravascular injection of lidocaine when being used as a local
anesthetic. Central nervous system toxicity manifests as diziness,
paresthesia (pins and needles), confusion and - in more severe cases
- seizures or coma. Severe toxicity may also result in cardiovascular
system collapse or asystole.

Related Information

* Benzocaine
* Procaine
* Cocaine
* Cloves

Are there any interactions with Lidoderm?    Are there any interactions
with Lidoderm?
answer for 'Are there any interactions with Lidoderm?'Lidoderm is a
patch that contains lidocaine, a local anesthetic. By blocking nerve
endings in the skin, it can help relieve the pain that often follows a
case of shingles (postherpetic neuralgia). Lidoderm may interact with
drugs used to control irregular heartbeats, so be sure to talk to your
doctor before using Lidoderm if you take medication for this condition.

Sources:
Lidoderm Product Information. Endo Pharmaceuticals Inc, 1999.
Galer, B.S. "Topical Lidocaine Patch Relieves Postherpetic Neuralgia
More Effectively Than a Vehicle Topical Patch: Results of an Enriched
Enrollment Study," Pain 80 (1999).

This answer prepared 5/23/00.
http://www.drugstore.com/pharmacy/ayp/questions.asp?label=1534

Common Name:    Isopropyl Alcohol
CAS Number:     67-63-0
DOT Number:     UN 1219
Date:           September, 1988
-----------------------------------------

HAZARD SUMMARY
*    Isopropyl Alcohol can affect you when breathed in and by
passing through your skin.
*    There is an increased risk of cancer associated with the
manufacturing of Isopropyl Alcohol.
*    Exposure can cause irritation of the eyes, nose, mouth, and
throat.
*    Overexposure may cause headaches, drowsiness, clumsiness,
unconsciousness, and death.
*    Contact may irritate the skin. Repeated skin exposure can
cause itching, a rash, and drying and cracking.
*    Isopropyl Alcohol is a FLAMMABLE LIQUID and a FIRE HAZARD.

IDENTIFICATION
Isopropyl Alcohol is a colorless liquid. Rubbing alcohol is a
solution of Isopropyl Alcohol. It is used as a solvent and in
making many commercial products.

REASON FOR CITATION
*    Isopropyl Alcohol is on the Hazardous Substance List because
it is regulated by OSHA and cited by ACGIH, DOT, NFPA and EPA.
*    This chemical is on the Special Health Hazard Substance List
because it is FLAMMABLE.
*    Definitions are attached.

HOW TO DETERMINE IF YOU ARE BEING EXPOSED
*    Exposure to hazardous substances should be routinely
evaluated. This may include collecting air samples. Under OSHA
1910.20, you have a legal right to obtain copies of sampling
results from your employer. If you think you are experiencing
any work related health problems, see a doctor trained to
recognize occupational diseases. Take this Fact Sheet with
you.
*    ODOR THRESHOLD = 22 ppm.
*    The odor threshold only serves as a warning of exposure. Not
smelling it does not mean you are not being exposed.

WORKPLACE EXPOSURE LIMITS
OSHA:     The legal airborne permissible exposure limit (PEL) is
400 ppm averaged over an 8 hour workshift.
NIOSH:     The recommended airborne exposure limit is 400 ppm
averaged over a 10 hour workshift and 800 ppm, not to be
exceeded during any 15 minute work period.
ACGIH:    The recommended airborne exposure limit is 400 ppm
averaged over an 8 hour workshift and 500 ppm as a STEL
(short term exposure limit).

*    The above exposure limits are for air levels only. When skin
contact also occurs, you may be overexposed, even though air
levels are less than the limits listed above.

WAYS OF REDUCING EXPOSURE
*    Where possible, enclose operations and use local exhaust
ventilation at the site of chemical release. If local exhaust
ventilation or enclosure is not used, respirators should be
worn.
*    Wear protective work clothing.
*    Wash thoroughly immediately after exposure to Isopropyl
Alcohol and at the end of the workshift.
*    Post hazard and warning information in the work area. In
addition, as part of an ongoing education and training effort,
communicate all information on the health and safety hazards
of Isopropyl Alcohol to potentially exposed workers.

This Fact Sheet is a summary source of information of all potential
and most severe health hazards that may result from exposure.
Duration of exposure, concentration of the substance and other
factors will affect your susceptibility to any of the potential
effects described below.
------------------------------------------

HEALTH HAZARD INFORMATION

Acute Health Effects
The following acute (short term) health effects may occur
immediately or shortly after exposure to Isopropyl Alcohol:

*    It may irritate the skin, causing a rash or burning feeling on
contact.
*    Exposure can irritate the eyes, nose, and throat.
*    Overexposure to the vapor may cause headaches, drowsiness, a
loss of coordination, collapse, and death.

Chronic Health Effects
The following chronic (long term) health effects can occur at some
time after exposure to Isopropyl Alcohol and can last for months or
years:

Cancer Hazard
*    There is an increased incidence of nasal sinus cancer in
workers involved in the manufacture of Isopropyl Alcohol by
the strong acid process. There is no evidence that Isopropyl
Alcohol is a carcinogen.

Reproductive Hazard
*    According to the information presently available to the New
Jersey Department of Health, Isopropyl Alcohol has not been
tested for its ability to adversely affect reproduction.

Other Long Term Effects
*    Skin exposure can cause itching, redness, and rashes in some
people. Repeated or prolonged exposure can cause dryness and
cracking of skin.
*    This chemical has not been adequately evaluated to determine
whether brain or other nerve damage could occur with repeated
exposure. However, many solvents and other petroleum based
chemicals have been shown to cause such damage.  Effects may
include reduced memory and concentration, personality  changes
(withdrawal, irritability), fatigue, sleep disturbances,
reduced coordination, and/or effects on nerves supplying
internal organs (autonomic nerves) and/or nerves to the arms
and legs (weakness, "pins and needles").

MEDICAL TESTING

*    There is no special test for this chemical. However, if
illness occurs or overexposure is suspected, medical attention
is recommended.
*    Interview for brain effects, including recent memory, mood
(irritability, withdrawal), concentration, headaches, malaise
and altered sleep patterns. Consider cerebellar, autonomic and
peripheral nervous system evaluation. Positive and borderline
individuals should be referred for neuropsychological testing.

Any evaluation should include a careful history of past and present
symptoms with an exam. Medical tests that look for damage already
done are not a substitute for controlling exposure.

Request copies of your medical testing. You have a legal right to
this information under OSHA 1910.20.

WORKPLACE CONTROLS AND PRACTICES

Unless a less toxic chemical can be substituted for a hazardous
substance, ENGINEERING CONTROLS are the most effective way of
reducing exposure. The best protection is to enclose operations
and/or provide local exhaust ventilation at the site of chemical
release. Isolating operations can also reduce exposure. Using
respirators or protective equipment is less effective than the
controls mentioned above, but is sometimes necessary.

In evaluating the controls present in your workplace, consider: (1)
how hazardous the substance is, (2) how much of the substance is
released into the workplace and (3) whether harmful skin or eye
contact could occur. Special controls should be in place for highly
toxic chemicals or when significant skin, eye, or breathing
exposures are possible.

In addition, the following controls are recommended:

*    Where possible, automatically pump liquid Isopropyl Alcohol
from drums or other storage containers to process containers.
*    Specific engineering controls are recommended for this
chemical by NIOSH. Refer to the NIOSH criteria document:
Isopropyl Alcohol #76 142.

Good WORK PRACTICES can help to reduce hazardous exposures. The
following work practices are recommended:

*    Workers whose clothing has been contaminated by Isopropyl
Alcohol should change into clean clothing promptly.
*    Contaminated work clothes should be laundered by individuals
who have been informed of the hazards of exposure to Isopropyl
Alcohol.
*    On skin contact with Isopropyl Alcohol, immediately wash or
shower to remove the chemical. At the end of the workshift,
wash any areas of the body that may have contacted Isopropyl
Alcohol, whether or not known skin contact has occurred.
*    Do not eat, smoke, or drink where Isopropyl Alcohol is
handled, processed, or stored, since the chemical can be
swallowed. Wash hands carefully before eating or smoking.

PERSONAL PROTECTIVE EQUIPMENT

WORKPLACE CONTROLS ARE BETTER THAN PERSONAL PROTECTIVE EQUIPMENT.
However, for some jobs (such as outside work, confined space entry,
jobs done only once in a while, or jobs done while workplace
controls are being installed), personal protective equipment may be
appropriate.

The following recommendations are only guidelines and may not apply
to every situation.

Clothing
*    Avoid skin contact with Isopropyl Alcohol. Wear solvent
resistant gloves and clothing. Safety equipment suppliers/
manufacturers can provide recommendations on the most
protective glove/ clothing material for your operation.
*    All protective clothing (suits, gloves, footwear, headgear)
should be clean, available each day, and put on before work.
*    ACGIH recommends natural rubber, neoprene, nitrile, or
polyvinyl chloride protective material.

Eye Protection
*    Wear splash proof chemical goggles and face shield when
working with liquid, unless full facepiece respiratory
protection is worn.

Respiratory Protection
IMPROPER USE OF RESPIRATORS IS DANGEROUS. Such equipment should
only be used if the employer has a written program that takes into
account workplace conditions, requirements for worker training,
respirator fit testing and medical exams, as described in OSHA
1910.134.

*    Where the potential exists for exposures near or over 400 ppm,
use a MSHA/ NIOSH approved respirator with an organic vapor
cartridge/canister. More protection is provided by a full
facepiece respirator than by a half mask respirator, and even
greater protection is provided by a powered air purifying
respirator.
*    If while wearing a filter, cartridge or canister respirator,
you can smell, taste, or otherwise detect Isopropyl Alcohol,
or in the case of a full face piece respirator you experience
eye irritation, leave the area immediately. Check to make sure
the respirator to face seal is still good. If it is, replace
the filter, cartridge, or canister. If the seal is no longer
good, you may need a new respirator.
*    Be sure to consider all potential exposures in your workplace.
You may need a combination of filters, prefilters, cartridges,
or canisters to protect against different forms of a chemical
(such as vapor and mist) or against a mixture of chemicals.
*    Where the potential for higher exposures exists, use a
MSHA/NIOSH approved supplied air respirator with a full
facepiece operated in the positive pressure mode or with a
full facepiece, hood, or helmet in the continuous flow mode,
or use a MSHA/NIOSH approved self contained breathing
apparatus with a full facepiece operated in pressure demand or
other positive pressure mode.
*    Exposure to 20,000 ppm is immediately dangerous to life and
health. If the possibility of exposures above 20,000 ppm
exists, use a MSHA/NIOSH approved self contained breathing
apparatus with a full facepiece operated in continuous flow or
other positive pressure mode.

HANDLING AND STORAGE

*    Prior to working with Isopropyl Alcohol you should be trained
on its proper handling and storage.
*    Isopropyl Alcohol must be stored to avoid contact with STRONG
OXIDIZERS (such as CHLORINE, BROMINE, and FLUORINE) since
violent reactions occur.
*    Store in tightly closed containers in a cool, well ventilated
area away from HEAT.
*    Sources of ignition, such as smoking and open flames, are
prohibited where Isopropyl Alcohol is used, handled, or stored
in a manner that could create a potential fire or explosion
hazard.
*    Metal containers involving the transfer of 5 gallons or more
of Isopropyl Alcohol should be grounded and bonded. Drums must
be equipped with self closing valves, pressure vacuum bungs,
and flame arresters.
*    Use only non sparking tools and equipment, especially when
opening and closing containers of Isopropyl Alcohol.

Common Name: Isopropyl Alcohol
DOT Number: UN 1219
DOT Emergency Guide code: 26
CAS Number: 67-63-0
----------------------------------------
Hazard rating         NJ DOH  NFPA
FLAMMABILITY            -       3
REACTIVITY              -       0
----------------------------------------
POISONOUS GASES ARE PRODUCED IN FIRE
CONTAINERS MAY EXPLODE IN FIRE
----------------------------------------
Hazard Rating Key: 0=minimal; 1=slight; 2=moderate; 3=serious;
4=severe

FIRE HAZARDS
*    Isopropyl Alcohol is a FLAMMABLE LIQUID.
*    Vapors may travel to a source of ignition and flash back.
*    CONTAINERS MAY EXPLODE IN FIRE.
*    Use dry chemical, CO2, water spray, or alcohol foam
extinguishers.
*    POISONOUS GASES ARE PRODUCED IN FIRE.
*    If employees are expected to fight fires, they must be trained
and equipped as stated in OSHA 1910.156.

SPILLS AND EMERGENCIES
If Isopropyl Alcohol is spilled or leaked, take the following
steps:

*    Restrict persons not wearing protective equipment from area of
spill or leak until cleanup is complete.
*    Remove all ignition sources.
*    Ventilate area of spill or leak.
*    Absorb liquids in vermiculite, dry sand, earth, or a similar
material and deposit in sealed containers.
*    Keep Isopropyl Alcohol out of a confined space, such as a
sewer, because of the possibility of an explosion, unless the
sewer is designed to prevent the buildup of explosive
concentrations.
*    It may be necessary to contain and dispose of Isopropyl
Alcohol as a HAZARDOUS WASTE. Contact your Department of
Environmental Protection (DEP) or your regional office of the
federal Environmental Protection Agency (EPA) for specific
recommendations.

=====================================FOR LARGE SPILLS AND FIRES immediately call your fire department.
====================================FIRST AID

POISON INFORMATION

Eye Contact
*    Immediately flush with large amounts of water for at least 15
minutes, occasionally lifting upper and lower lids.

Skin Contact
*    Quickly remove contaminated clothing. Immediately wash
contaminated skin with large amounts of water.

Breathing
*    Remove the person from exposure.
*    Begin rescue breathing if breathing has stopped and CPR if
heart action has stopped.
*    Transfer promptly to a medical facility.

PHYSICAL DATA

Vapor Pressure:     33 mm Hg at 68oF (20oC)
Flash Point:           53oF (11.6oC)
Water Solubility:   Miscible

OTHER COMMONLY USED NAMES

Chemical Name:
2-Propanol

Other Names and Formulations:
Rubbing Alcohol; Dimethylcarbinol; Isopro panol; sec-Propyl
Alcohol.
------------------------------------------
Not intended to be copied and sold for commercial purposes.
------------------------------------------
NEW JERSEY DEPARTMENT OF HEALTH
Right to Know Program
CN 368, Trenton, NJ 08625 0368
------------------------------------------
------------------------------------------

ECOLOGICAL INFORMATION

Isopropyl alcohol is a clear, flammable liquid with numerous uses.
It is used in antifreeze; as a solvent for gums, shellac and
essential oils; in quick-drying inks and oils; in cosmetics such as
body rubs, hand lotions and after-shave lotions; and to make other
chemicals.  It may enter the environment from industrial
discharges, municipal waste water treatment discharges, or spills.

ACUTE (SHORT-TERM) ECOLOGICAL EFFECTS

Acute toxic effects may include the death of animals, birds, or
fish, and death or low growth rate in plants.  Acute effects are
seen two to four days after animals or plants come in contact with
a toxic chemical substance.

Isopropyl alcohol has slight toxicity to aquatic life.
Insufficient data are available to evaluate or predict the short-
term effects of isopropyl alcohol to plants, birds, or land
animals.

CHRONIC (LONG-TERM) ECOLOGICAL EFFECTS

Chronic toxic effects may include shortened lifespan, reproductive
problems, lower fertility, and changes in appearance or behavior.
Chronic effects can be seen long after first exposure(s) to a toxic
chemical.

Isopropyl alcohol has slight chronic toxicity to aquatic organisms.
Insufficient data are available to evaluate or predict the long-
term effects of isopropyl alcohol to plants, birds, or land
animals.

WATER SOLUBILITY

Isopropyl alcohol is highly soluble in water.  Concentrations of
1,000 milligrams and more will mix with a liter of water.

DISTRIBUTION AND PERSISTENCE IN THE ENVIRONMENT

Isopropyl alcohol is slightly persistent in water, with a half-life
of between 2 to 20 days.  The half-life of a pollutant is the
amount of time it takes for one-half of the chemical to be
degraded.  About 77.5% of isopropyl alchohol will eventually end up
in water; the rest will end up in the air.

BIOACCUMULATION IN AQUATIC ORGANISMS

Some substances increase in concentration, or bioaccumulate, in
living oranisms as they breathe contaminated air, drink
contaminated water, or eat contaminated food.  These chemicals can
become concentrated in the tissues and internal organs of animals
and humans.

The concentration of isopropyl alcohol found in fish tissues is
expected to be about the same as the average concentration of
isopropyl alcohol in the water from which the fish was taken.

SUPPORT DOCUMENT:   AQUIRE Database, ERL-Duluth, U.S. EPA,
Phytotox.

...............................................................................
http://paranoia.lycaeum.org/alcohol/Isopropyl-Alcohol

Isopropyl Alcohol

Isopropyl alcohol ingestion is common among children and adults as both
accidental and suicidal ingestions because it is an easily available
product. It is best known as the main ingredient in rubbing alcohol,
but is also present in window cleaners, toiletries, disinfectants,
antifreeze, and paint remover. To complicate matters some products that
contain isopropyl alcohol also contain methanol, ethanol, or ethylene
glycol.

Pharmacology: Isopropyl alcohol is a clear, colorless liquid with a
somewhat bitter taste and a smell of acetone. Unless the ingested dose
is large, absorption occurs in as little as 30 minutes. This agent is
well absorbed through the lungs and rectal mucosa. The alcohol can also
penetrate the skin, but with less success than via a pulmonary or GI
exposure. Isopropyl alcohol is metabolized to acetone in the liver by
alcohol dehydrogenase. Eighty percent of the absorbed dose is then
excreted by the kidneys as acetone with 20% being excreted unchanged.
The acetone is also excreted in the lungs, saliva, and gastric juices.

Animal studies have suggested that isopropyl alcohol is two-three times
more potent than ethanol as a CNS depressant. The breakdown product,
acetone, is also a CNS depressant.

Clinical Presentation: The symptoms of ingestion occur within 30
minutes, with GI complaints of pain, vomiting, and hematemesis being
predominant. Central nervous system effects include headache, muscular
incoordination, ataxia, confusion, and coma. The initial excitatory
phase that is well recognized with ethanol intoxication does not seem
to be present with isopropanol ingestion. Pupil size may vary, but it
is not uncommon to have miotic pupils. Should the eyes have direct
exposure to isopropyl alcohol corneal de-epithelialization has been
reported. The patient may have a distinct odor of acetone. With very
large doses cardiovascular effects include myocardial depression and
severe hypotension. Less common presentations include renal tubular
necrosis, hemolytic anemia, acute myopathy, and hypothermia.

Diagnosis: The patient presenting in coma who has a suspected exposure
to some type of alcohol, the diagnosis can be challenging. The patient
will be unresponsive to narcan and glucose, and usually entities such
as DKA, hepatic coma (in an older patient), carbon monoxide, trauma,
etc. can usually be quickly ruled out by a careful exam and a few
simple tests. Once the diagnosis of a toxic alcohol (or a toxic amount
of a usually nontoxic alcohol) is suspected the difficulty comes in
making the diagnosis. The onset of the central nervous system effects
of all the alcohols is rapid. The more severe consequences of ethylene
glycol and methanol (the blindness, renal failure, and severe metabolic
acidosis may be slightly delayed. All of the major alcohols have a
distinct odor except ethylene glycol. In the case of isopropyl alcohol
the odor is a sweet ketotic scent due to the release of acetone in the
breath. Isopropyl alcohol tends to produce only a mild elevation of the
anion gap and only a mild acidosis if any. It is alsounique in
producing a very large amount of ketones (the acetone that is being
excreted from the kidneys) in the urine.

Serum osmolality may be greater than calculated with all four alcohols,
thus isopropanol is similar to ethanol in that it produces little to no
anion gap metabolic acidosis (unless the patient has other problems
such as hypotension, hypoxia, etc.), but does have an elevated osmolol
gap. Isopropyl alcohol also tends to have significant hypoglycemia.

Treatment: The treatment of isopropyl alcohol exposure is recognition
and support of the complications. If exposure was through the skin then
decontamination is appropriate while trying to maintain body
temperature. If the exposure was respiratory the patient should be
removed from the environment. Hemorrhagic trachoebronchitis is a
complication of inhaled isopropanol. If the exposure was a large,
recent dose of isopropanol, gastric lavage and charcoal may be
appropriate. Isopropanol does undergo gastric re-excretion and
continuous gastric emptying has been recommended, but this is usually
not required. Should the patient be stable after the initial evaluation
it is reasonable to observe the patient and use simple supportive
measures until the patient recovers. Suspicion should always be present
about other ingestions and the labs previously discussed should be
ordered.

Isopropanol is an ideal substance for dialysis because of its low
molecular weight, low volume of distribution, and low protein plasma
binding. The question then, is who requires dialysis? Those patients
with isopropyl levels above 400-500 mg/dl are usually the ones that
have significant hypotension and coma. Thus, patients with coma and
hypotension with or without a level of 400-500 mg/dl should probably
receive hemodialysis.

Pediatric Considerations: Young children may accidentally ingest
isopropyl alcohol just as they can with any other available substance.
However, children may develop a serious intoxication following topical
application of isopropyl alcohol for the relief of fever. This exposure
may actually be more of an inhalation injury than a dermal exposure,
but the end result in the same. Isopropyl alcohol can come in
concentrations of 70%. At this concentration as little as 2-2.5 ml/kg
may lead to toxicity. The children may present with altered mental
status or coma. The key to diagnosis is the same as with adults. The
child should have acetonuria, coma, little to no acidosis and anion
gap, with a wide osmolol gap. Treatment is the same as for adults.
http://www.embbs.com/cr/alc/alc5.html