Course Overview

This educational case study document is one in a series of self-instructional modules designed to increase the primary health care provider’s knowledge of hazardous substances in the environment and to promote medical practices that aid in the prevention, evaluation and care of potentially exposed patients. The complete series of ATSDR Case Studies in Environmental Medicine is located on the ATSDR Web site at URL: https://www.atsdr.cdc.gov/csem/csem.html In addition, the downloadable PDF version [PDF – 481 KB] of this educational series and other environmental medicine materials provides content in an electronic, printable format, especially for those who may lack adequate Internet service.

We gratefully acknowledge the work of the medical writers, editors, and reviewers in producing this educational resource. Contributors to this version of the “ATSDR CSEM: Tetrachloroethylene Toxicity” manuscript are listed below.
Please Note: Each content expert for this case study has indicated that there is no conflict of interest that would bias the case study content.

ATSDR Authors: Dianyi Yu, M.D.

ATSDR Planners: Germania Pinheiro, M.D., MSc, Ph.D; Brian Tencza, M.Ed; John Doyle, M.P.A.; Diana Cronin

Peer Reviewers: Jessica Weiland, M.D.; Rae Benedict, Ph.D

This Case Study in Environmental Medicine (CSEM) provides an overview of tetrachloroethylene toxicity. Tetrachloroethylene is a chemical used in dry cleaning and other applications. Knowledge from this course will help health care providers diagnose and treat patients exposed to tetrachloroethylene.

This online course will take about 150 minutes to complete. You may finish the entire CSEM in one session or complete each chapter separately.

The course begins with a patient case study to help you assess your current knowledge about tetrachloroethylene toxicity.

After completing this course, you will be able to

• Define tetrachloroethylene;
• Describe uses of tetrachloroethylene;
• Identify sources of tetrachloroethylene exposure;
• Describe how people are exposed to tetrachloroethylene;
• Identify populations with potentially high exposures to tetrachloroethylene;
• Explain the major pathways of tetrachloroethylene metabolism in the body;
• Describe the clinical effects associated with tetrachloroethylene exposure;
• Describe what is included in the initial history of patients potentially exposed to tetrachloroethylene;
• Describe what is included in the physical examination of patients potentially exposed to tetrachloroethylene;
• Describe possible clinical symptoms in patients exposed to tetrachloroethylene;
• Identify tests that can help diagnose tetrachloroethylene toxicity;
• Describe treatment strategies for patients with tetrachloroethylene poisoning;
• Identify existing standards and guidelines for tetrachloroethylene in the environment;
• Identify existing standards and guidelines for tetrachloroethylene in the workplace;
• Identify suitable self-care for patients exposed to tetrachloroethylene;
• Identify clinical follow-up for patients exposed to tetrachloroethylene;
• Describe how to counsel patients appropriately on how to avoid further exposure to tetrachloroethylene.

Key concepts in this course include

1. Tetrachloroethylene is used mainly as a solvent for dry cleaning and metal degreasing.
2. Like most chlorinated solvents, tetrachloroethylene can cause central nervous system depression.
3. Chronic exposure to tetrachloroethylene can adversely affect the neurological system, liver, and kidneys.
4. Tetrachloroethylene is considered a human carcinogen, based on limited evidence from studies in humans and sufficient evidence from studies in experimental animals.
5. Tetrachloroethylene toxicity has no antidote.
6. In December 2020, federal regulations will require dry cleaners in urban locations to eliminate the use of tetrachloroethylene.

The goals of CSEM series are to

• increase the primary care provider’s knowledge of hazardous substances in the environment, and
• help clinicians evaluate and treat potentially exposed patients.

You can find the complete series of CSEMs online at https://www.atsdr.cdc.gov/csem/csem.html

You can download and print PDFs of this educational series and other environmental medicine materials from the ATSDR website.