lutz123 February 7, 2011 February 7, 2011 Severe allergic reaction. Please call <removed after contact made for privacy> if you can help.
treesprite February 7, 2011 February 7, 2011 Is this another hobby-related health warning to add to the increasingly long list? Hope you recover fast!
Origami February 8, 2011 February 8, 2011 (edited) On 2/7/2011 at 5:16 PM, treesprite said: Is this another hobby-related health warning to add to the increasingly long list? Hope you recover fast! Not sure. Use as directed or, according to the MSDS, it can be. For future reference, Flat Worm Exit is Levamisole hydrochloride. It's a pig dewormer. <<< EDIT: This is unconfirmed and just speculation in the hobby as of the date it was originally written. From the MSDS located here: http://www.sciencelab.com/msds.php?msdsId=9924487 "Potential Acute Health Effects: Hazardous in case of ingestion, of inhalation. Slightly hazardous in case of skin contact (irritant), of eye contact irritant). Severe over-exposure can result in death. "Potential Chronic Health Effects: CARCINOGENIC EFFECTS: Not available. MUTAGENIC EFFECTS: Not available. TERATOGENIC EFFECTS: Not available. DEVELOPMENTAL TOXICITY: Classified Reproductive system/toxin/female [POSSIBLE]. The substance may be toxic to blood, lungs, immune system, central nervous system (CNS). Repeated or prolonged exposure to the substance can producetarget organs damage. Repeated exposure to a highly toxic material may produce general deterioration of health by an accumulation in one or many human organs. "First Aid Measures "Eye Contact: Check for and remove any contact lenses. In case of contact, immediately flush eyes with plenty of water for at least 15 minutes. Get medical attention if irritation occurs. "Skin Contact: Wash with soap and water. Cover the irritated skin with an emollient. Get medical attention if irritation develops. "Serious Skin Contact: Not available. "Inhalation: If inhaled, remove to fresh air. If not breathing, give artificial respiration. If breathing is difficult, give oxygen. Get medical attention. "Serious Inhalation: Evacuate the victim to a safe area as soon as possible. Loosen tight clothing such as a collar, tie, belt or waistband. Seek medical attention. "Ingestion: If swallowed, do not induce vomiting unless directed to do so by medical personnel. Never give anything by mouth to an unconscious person. Loosen tight clothing such as a collar, tie, belt or waistband. Get medical attention immediately. "Serious Ingestion: Not available." Edited November 19, 2018 by Origami I want to be clear that this may not be fact.
lutz123 February 8, 2011 Author February 8, 2011 So...the verdict is it was a reaction to the drug - likely absorption since my first symptoms were my left thumb and right hand feeling tingly (siphoning), though inhalation could have been a factor I suppose. Less than two minutes from my hand being in the tank to the computer for a quick google, which I abandoned immediately in favor of 911. My blood pressure had skyrocketed. I read those stupid directions time and time again. No warnings except to keep away from children. I think it was the right initial amount - I need to look at the box again. Under a capful for 70 gallons minus room for rock/substrate. In less than 10 minutes I could see the darkest orange flatworms floating around so I thought I would begin to siphon some out. There just weren't enough to continue so I opted to wait. My hand was in the tank probably 30 seconds. I do understand it's virtually unheard of, but it was extremely scary how difficult it was to find out the ingredients - active or inactive. I wasn't able to help with anything but providing the box, instructions, and bottle - neither the paramedics, nor the hospital, nor Poison Control could figure it out. If I weren't able to get the info (thank you!!) at all they would have had nothing. By the time we could provide the info things were already getting slowly better so they opted just to let it continue. FWIW, they typically don't have people show up with veterinary dewormer problems. It apparently used to be used for humans, but the doc figured that they likely don't anymore for a reason. Who knows why I reacted? Lesson learned though about not using any medication without knowing the ingredients and why they do. I made the assumption that since fish and snails are fine I should be too. Also, perhaps not using a new medication without anyone home besides my two year old. Brings me to my question...I need to get this water changed so this stuff is out. Pardon me for be a little gun shy, but I don't really feel comfortable (and doc said no way). I managed to do about 10% tonight, and put fresh carbon in the reactor (sorry doc). Everything is doing surprisingly well, but I'm sure it won't last. I think I may have lost a couple of cerith snails. I needed to do a good water change anyway because my nitrates were inching up above 25 - newly transferred tank. I'll start making water, but anyone have any suggestions? My hubby doesn't care how many people have touched it and been fine - he's not interested in playing with it either. I feel like 50% of the water is changed out a few times over the next few weeks things should be safer for me. Or 10% every other day? Sorry if it doesn't make too much sense...still feeling a bit crappy.
LanglandJoshua February 8, 2011 February 8, 2011 (edited) umm wow....there should be a sticky of things that could cause allergic reactions and poisons involved in this hobby.(if there is already i have not seen it) Maybe make it printable for paramedics, or make checklist so we can mark off what we have for the paramedics in an emergency. I am glad that it was not worse...as bad as it was to begin with. Edited February 8, 2011 by LanglandJoshua
Origami February 8, 2011 February 8, 2011 I'm glad that you're home and on the mend. It's scary how fast it acted on you. I'm now not convinced that FWE is levamisole. It may be something else. I cannot find contact information for Salifert, but have sent Habib (Salifert's CEO) a PM over at Reef Central telling him of the situation here and asking him to disclose something so that treatment decisions can be made and a repeat of this situation avoided. (His screen name at RC is Habib.) How long after dosing the tank before you reached in? How bad was your flatworm problem? I've just read that flatworms will release toxic fluids from their body upon exposure to FWE. I don't know if this means toxic to corals, to people, or both. I'm really glad that you're feeling better, though.
Origami February 8, 2011 February 8, 2011 From Habib at Salifert: Hi Tom, I looked at that thread earlier today, saw she wanted to work on the tank again. It almost sounds like having been stung by something like nematocysts in the tank followed by an allergic reaction? Or just a timing coincidence? We sell Flatworm eXit to our master distributor in the USA and they have a MSDS for it. I copied the tox data from it and pasted it below. HTH Habib Toxicological Data on Ingredients: Anthelmintic: ORAL (LD50s): 4800 mg/kg [Rat]. 2100 mg/kg [Mouse]. Note to physician: The maximum amount of solution per package is approximately 10 ml ( 0.34 fl. oz.) or the equivalent of approximately 10,000 mg. Citric acid: ORAL (LD50s): 100 g/kg [Mouse]. 60 g/kg [Rat]. Note to physician: The maximum amount of solution per package is approximately 10 ml ( 0.34 fl. oz.) or the equivalent of approximately 10 g. Section 3: Hazards Identification Potential Acute Health Effects: Hazardous in case of ingestion of large amounts, larger than what is contained in one package (10 ml). Hazard of inhalation only if it is transformed into a mist or aerosol. Prolonged skin contact may cause irritation. Eye contact may cause irritation. Potential Chronic Health Effects: CARCINOGENIC EFFECTS: Not available. MUTAGENIC EFFECTS: Not available. TERATOGENIC EFFECTS: Not available. NTP Carcinogen for all ingredients: Known: No Anticipated: No IARC Category: None Edit 11/19/2018 Note that the LD50 numbers seem to correspond to a 10% (TW) dilution of Tetramisole HCl, a racemic form of Levamisole. The MSDS from Fisher Scientific on Tetramisole HCl indicates a Oral TDLo (Human) of 2 mg/kg as the minimum dosage observed to produce some effect of toxicity in humans. If this is, in fact, what FWE is, then assuming that you don't drink the stuff right out of the bottle (which would undoubtedly be a bad idea), a 150# person would have to ingest 42 gallons of tank water to get this level of exposure. The salt and water would get you long before the Tetramisole would. However, for Lutz123's story, there could be other factors at work: Namely, exposure to flatworm toxins, an unusual sensitivity, or some other unknown factor.
lutz123 February 8, 2011 Author February 8, 2011 Interesting...and I thought of other possibilities as well. I didn't feel any kind of sting per se - but didn't touch anything but the water and don't have any corals except a leather, GSP, and xenia - maybe a small tube coral. There a a few small colonies of colonial hydroids. And who knows what else is lurking... I also thought of the possibility that I was allergic to the flatworm toxin - I don't know anything about what's released. I must admit I do feel like a bit of a wimp since the xenia are still pulsing away and all of the snails are back to their usual activities this morning. Even the GSP I tipped upside down adding water is peeking out from under the sand. It was a pretty decent population of flatworms, but they weren't covering everything. I just figured I'd go ahead and knock them out before I add fish. My hands were in the water about 5-10 minutes after adding the medication. All of that being said, if I did react to it, it was obviously because I'm somehow more sensitive than most folks. I did do my research to learn from others experiences...no word on anyone being remotely reactive. And I think it's still used on humans (not for deworming) with no word on sensitivity or reactions like I had. Maybe I just really ticked something off - I hope not. I'm a wee bit afraid of the tank now. This was a good article I saw this morning - not saltwater, but informative... http://www.loaches.com/disease-treatment/levamisole-hydrochloride-1 No more flatworms though!
lutz123 February 8, 2011 Author February 8, 2011 Moderator, can you please change the topic title to something a little less scary?
Origami February 8, 2011 February 8, 2011 Title changed. You may want to consider getting some full length gloves - like aqua gloves - for working in the tank with chemicals that you're unsure about. They're a bit clunky, but it's better than an unplanned trip to the ER.
trockafella February 8, 2011 February 8, 2011 Another reason to wear gloves when handling things. Ive had several members ask me why I always were gloves when I do tank work. There are so many things in and out of the tank that can be harmful, better to be safe than sorry.! Good luck with the recovery, glad your ok.!!!
lutz123 February 8, 2011 Author February 8, 2011 Already ordered and on their way! My leather is droopy. Might move it into the QT temporarily to see if that helps. Hopefully the carbon will absorb whatever it is. I'll change it out again in a few days. Oh, and I do have a few flatworms still. Oh well. They are tinier and look more like the pacman ghosts. Guess they will be permanent residents. By the way, if anyone wants any FWE and is near me, it's all yours.
BowieReefer84 February 8, 2011 February 8, 2011 You have any wrasses in your tank? If you turkey baste the fw's into the water column the wrasse may eat them....
lutz123 February 8, 2011 Author February 8, 2011 FYI - Flatworms contain a toxin called ttx, or tetradotoxin. TTX has been implicated in some marine food deaths (pufferfish, most commonly). I have no clue if that's what's being released when they die, but it sure looked like that's the "toxin" that everyone refers to. Who knows if it's potentially harmful without ingesting though. I'm just sharing what I found because the question was raised - and it pretty much ruled out ttx being my problem yesterday based on symptoms.
davelin315 February 9, 2011 February 9, 2011 Ashley, glad to see you're OK. I was guessing that it had something to do with the flatworms themselves, too, but the world of allergies is something that is unpredictable, so I'm glad you're buying gloves!
flowerseller February 9, 2011 February 9, 2011 Another reason to wear gloves when handling things. Ive had several members ask me why I always were gloves when I do tank work. There are so many things in and out of the tank that can be harmful, better to be safe than sorry.! Good luck with the recovery, glad your ok.!!! here all along I thought you were afraid of your nail polish getting in your tank.
flowerseller February 9, 2011 February 9, 2011 My first thought too was a reaction to the fw toxin having never heard of someone reacting to the medication. Never know. Glad you're getting better.
lutz123 February 9, 2011 Author February 9, 2011 I thought I'd share that I stumbled across a nearly identical experience to mine. Scary, and it looks like it happened to someone in the DC area in 2005 or earlier. Not sure if it's okay to post a link to another forum, but here goes... http://www.fishforums.net/index.php?showtopic=79056&st=20 If not, I suppose I could copy/paste. Does this sound familiar to anyone? Mostly scary because I didn't "squish" anything - I just had my hand in the tank. It had to be from the death of whatever... I did find at least one 2-3" polyclad flatworm earlier and it died (and saw a few that were about 1/2 inch long that looked identical to this one)...and at least 2 other kinds of flatworms. Does flatworm exit kill nudibranches? Either way, this confirms as closely as I could that it was indeed a toxin. BTW, I did have a hangnail but no big open cuts. I hope this serves as yet another reason to take precautions. Does carbon remove toxins?
Origami February 9, 2011 February 9, 2011 Could be very different, actually. That post is about poisoning by palytoxin coming from zoanthids. I've, unfortunately, been hit by the stuff. My symptoms were shortness of breath, lowered blood pressure, fever, and severe chills. It's very flu-like. It took 2 hours for my symptoms to come on. I'm pretty sure that Jan suffered the same. Neither of us, though, had it as bad as Steve Outlaw did when he tried to boil some off of a rock and breathed in the toxin-laden steam.
lutz123 February 9, 2011 Author February 9, 2011 From what I read, he thinks it is at first, but is corrected by someone that it was actually the nudi that he squished that released a toxin. I don't have any zoas FWIW. Either way, my symptoms were nearly identical...like I could have pretty much written that. Aren't his symptoms a little different than normal zooanthid palytoxin reactions? I don't know anything about that.
Origami February 11, 2011 February 11, 2011 It could be different. But it could also be that because this was a zoa-eating nudibranch that it retained concentrated palytoxin in its tissues as a deterrent to predation and that this individual was exposed to a large amount in a short time. That may explain the difference in symptoms between a very slight exposure (like Jan's or mine). It's hard to say. I had missed that the link that you provided linked to the second page of the discussion thread. I went back to the beginning where I saw the guy's symptoms. That was really scary and settled in very, very quickly.
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