Clinial Evaluation

The following information is provided by Dr. M Harbut of the Karmanos Cancer Institute and is intended for use by physicians. If you suspect you have been impacted by chemical exposure, provide the following information to your physician. If your doctor has questions, he/she may contact Dr. Harbut via the email address at the bottom of this page or get more information from The Karmanos Cancer Institute’s Environmental Cancer program. Patients should not contact Dr. Harbut directly.

Fact sheet:  A clinical approach to initial evaluation for disease processes caused by exposure to crude oil, organic solvents, petroleum distillate, dispersants & related agents.

Target audience: Medical care providers presented with patients exhibiting symptoms and/or signs consistent with processes caused by exposure to Gulf oil spill chemicals in crude oil and dispersants.

Background: Many medical care providers have seen only a limited number of persons with disease processes attributable to exposure to chemicals generated by the current Gulf of Mexico oil spill. The following does not constitute comprehensive medical advice and should not be construed to be patient care in any individual presentation.  It does offer an approach to evaluation of this patient population and does constitute the initial steps which clinicians may wish to adopt in their care of patients in the non-the emergency room setting.

  • An exposure history directed toward times and places of exposure and a characterization of
    exposures should be obtained.  The guide to Taking an Exposure History by ATSDR/CDC can be
    very helpful: http://www.atsdr.cdc.gov/csem/exphistory/ehexposure_form.html.
  • A complete history and physical should be performed.
  • Testing should, of course, depend on the individual clinical presentation, but often includes special attention to the respiratory apparatus, the skin, the central nervous system, neuropsychological
    changes and establishing a baseline to which future hematologic and other possibly mutagenic
    and/or carcinogenic indicators may be compared.

In the Environmental Cancer Program at the Karmanos Cancer Institute in Detroit*, persons presenting with  applicable signs or symptoms of exposures would, at a minimum, receive the following:

  • complete pulmonary function testing, including diffusion capacity
  • gamma-glutamyltransferase
  • beta-2 microglobulin
  • a complete blood count
  • serum protein electrophoresis with immunofixation
  • urinalysis
  • antihistamine antibody
  • a mental status examination
  • a minimum of a chest x-ray and if pertinent abnormalities are found on the radiographs
    or other applicable studies, a high-resolution CT on the 64 slice unit

Pregnancy presents additional concerns not only to the mother; the fetus may be at even greater risk of birth abnormality or for the development of the consequences of mutagenic and carcinogenic exposures.

Treatment decisions should be based on clinical presentation and objective evidence and usually do not vary from non-toxin induced presentations of the same condition, with the exception of cancer surveillance.

At present there is no readily available clinical blood test proven to be broadly reliable for measurement of organic solvent level.  Furthermore, obtaining these levels is of unclear clinical significance.  Additionally, air sample or water levels should generally not be used to make individual patient treatment decisions.

Questions regarding diagnosis and treatment may be directed to Dr. Harbut at noraianc@karmanos.org

Report on health hazards of crude oil & dispersants:  http://www.sciencecorps.org/crudeoilhazards.htm

Michael R. Harbut, M.D., M.P.H. is a Clinical Professor of Internal Medicine at Wayne State University, Director of the Karmanos Cancer Institute’s Environmental Cancer Program & Past Chair of the Occupational & Environmental Medicine section of the American College of Chest Physicians.  He is Chief at the Center for Occupational and Environmental Medicine, P.C. and has treated many patients with solvents and petroleum exposures. 

*http://www.karmanos.org/app.asp?id=1264&ssec=7              Version 1.  July 28, 2010                     Copyright 2010

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