Methyl Bromide Poisoning

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   Our user asked: "Hello, I am a Physical Therapy student working as a Physical Therapy technician. There is a new patient at my work which the therapists have never experienced before. About 1 year ago he was poisoned at his job where he fumigated grapes. He was unknowingly poisoned by methyl bromide and exposed for one hour. He presents with no sensation in left LE, severe weakness and fatigue and severe pain which is managed by Schedule II opiates. A good day for him is a 6 out of 10 pain level. He also has shooting pain and a feeling of shaking within his nervous system. The therapists are providing moist HP to his LEs and lumbar spine. They are also providing estim to his lumbar spine and massage to his legs. He experiences immense pain during massage but reports that later in the day it gives him relief for about an hour or two. I researched the poisoning and feel that he might be suffering from Porphyria. His diagnosis is simply peripheral neuropathy. I searched for articles for both Porphyria and chemical poisoning for physical therapy interventions and came up with nothing regarding what type of therapy he should be receiving. I believe that we can do more for this patient but the therapists don't know what to do with him. Any help or references that I could give them???" 

Ask a PT Repsonse: "This is a very interesting case which you have brought to our attention. We were not familiar with the effects of Methyl bromide on humans and had to do some research. From what we discovered it appears that the symptoms which your patient is experiencing could be consistent with Methyl bromide poisoning:
http://pmep.cce.cornell.edu/profiles/extoxnet/haloxyfop-methylparathion/methyl-bromide-ext.html 
http://www.epa.gov/ttn/atw/hlthef/methylbr.html 
However, we were surprised that his condition is so severe given he was only exposed to the substance for only an hour. Your theory of porphyria is possible and can be ruled out through spectroscopy and biochemical analysis. Should this be the case the appropriate medications and diet can be prescribed which may help your patient recover. 
As far as treating the patient, I would treat the patient by addressing his problem list and developing a plan of care based on this. If he has functional deficits work on breaking the deficits into parts and then putting them together later into the actual functional task as the patient progresses. ROM and strengthening exercises can be prescribed as tolerated by the patient with care not to over exert. As far as pain control, you can also try various strategies such as inhibition, STM/MFR, or infared therapy. I've had some mild/mod success with the anodyne infared for pain management for patients with peripheral neuropathy. Let me know how things go."   

Edited by Ask a PT - Jul 08 2008 at 11:42pm

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Ask a PT Members Profile Send Private Message Find Members Posts Add to Buddy List Senior Member Joined: Jul 07 2008 Status: Offline Points: 954	Post Options Post Reply Quote Ask a PT Report Post Thanks(0) Quote Reply Topic: Methyl Bromide Poisoning Posted: Jul 08 2008 at 11:41pm
	Our user asked: "Hello, I am a Physical Therapy student working as a Physical Therapy technician. There is a new patient at my work which the therapists have never experienced before. About 1 year ago he was poisoned at his job where he fumigated grapes. He was unknowingly poisoned by methyl bromide and exposed for one hour. He presents with no sensation in left LE, severe weakness and fatigue and severe pain which is managed by Schedule II opiates. A good day for him is a 6 out of 10 pain level. He also has shooting pain and a feeling of shaking within his nervous system. The therapists are providing moist HP to his LEs and lumbar spine. They are also providing estim to his lumbar spine and massage to his legs. He experiences immense pain during massage but reports that later in the day it gives him relief for about an hour or two. I researched the poisoning and feel that he might be suffering from Porphyria. His diagnosis is simply peripheral neuropathy. I searched for articles for both Porphyria and chemical poisoning for physical therapy interventions and came up with nothing regarding what type of therapy he should be receiving. I believe that we can do more for this patient but the therapists don't know what to do with him. Any help or references that I could give them???" Ask a PT Repsonse: "This is a very interesting case which you have brought to our attention. We were not familiar with the effects of Methyl bromide on humans and had to do some research. From what we discovered it appears that the symptoms which your patient is experiencing could be consistent with Methyl bromide poisoning: http://pmep.cce.cornell.edu/profiles/extoxnet/haloxyfop-methylparathion/methyl-bromide-ext.html http://www.epa.gov/ttn/atw/hlthef/methylbr.html However, we were surprised that his condition is so severe given he was only exposed to the substance for only an hour. Your theory of porphyria is possible and can be ruled out through spectroscopy and biochemical analysis. Should this be the case the appropriate medications and diet can be prescribed which may help your patient recover. As far as treating the patient, I would treat the patient by addressing his problem list and developing a plan of care based on this. If he has functional deficits work on breaking the deficits into parts and then putting them together later into the actual functional task as the patient progresses. ROM and strengthening exercises can be prescribed as tolerated by the patient with care not to over exert. As far as pain control, you can also try various strategies such as inhibition, STM/MFR, or infared therapy. I've had some mild/mod success with the anodyne infared for pain management for patients with peripheral neuropathy. Let me know how things go." Edited by Ask a PT - Jul 08 2008 at 11:42pm

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