PRODUCTS

CHLORHEXIDIN DIGLUCONATE

CAS NO:18472-51-0
EC NO:200-238-7

SYNONYMS:
CHLORHEXIDINE DIGLUCONATE; Hibiclens; Chlorhexidine gluconate; 18472-51-0; Peridex; Unisept; Chlorhexidine D-digluconate; UNII-MOR84MUD8E; Chlorhexidine di-D-gluconate; Exidine; Periogard; MOR84MUD8E; chlorhexidine; Hibiscrub; Hibitane; 1,1'-Hexamethylene bis(5-(p-chlorophenyl)biguanide), digluconate; Dyna-hex; Bacticlens; Chlorhexamed; Kleersight; Bioscrub; Corsodyl; Disteryl; Hibident; Hibidil; Microderm; Orahexal; Periochip; Plurexid; Septeal; Abacil; Fight bac; Plac out; Prevacare R; Arlacide G; Brian Care; Steri-Stat; Cida-Stat; Hibitane 5; Chlorhexidin glukonatu; Peridex (antiseptic); Bactoshield CHG 2%; MFCD00083599; Pharmaseal Scrub Care; CHG SCRUB; Caswell No. 481G; 55-56-1; Prevacare; PwrioChip; Chlorhexidin glukonatu [Czech]; pHiso-Med; Chlorhexidine digluconate solution; Hibitane gluconate; Hibiclens (TN); Periogard (TN); DRG-0091; EINECS 242-354-0; Peridex (TN); Chlohexidine gluconate; EPA Pesticide Chemical Code 045504; C22H30Cl2N10.2C6H12O7; Chlorhexidine gluconate [USAN:USP:JAN]; EC 242-354-0; SCHEMBL34468; 1,6-Bis(5-(p-chlorophenyl)biguandino)hexane digluconate; CHEMBL4297088; DTXSID5034519; CHEBI:28312; 1,1'-Hexamethylenebis(5-(p-chlorophenyl)biguanide) gluconate; 1,1'-Hexamethylenebis(5-(p-chlorophenyl)biguanide)digluconate; Chx plus concentrate premium chlorhexidine teat dip concentrate; 1,1'-Hexamethylenebis(5-(p-chlorophenyl)biguanide) di-D-gluconate; Biguanide, 1,1'-hexamethylenebis(5-(p-chlorophenyl)-, digluconate; Chlorhexidine gluconate (JP17/USP); AKOS015896303; AKOS025310696; D-Gluconic acid, compd. with N,N''-bis(4-chlorophenyl)-3,12-diimino-2,4,11,13-tetraazatetradecanediimidamide (2:1); D-Gluconic acid, compd. with N1,N14-bis(4-chlorophenyl)-3,12-diimino-2,4,11,13-tetraazatetradecanediimidamide (2:1); D-Gluconic acid, compound with N,N''-bis(4-chlorophenyl)-3,12-diimino-2,4,11,13-tetraazatetradecanediamidine (2:1); M166; C08038; D00858; Chlorhexidine digluconate solution, 20% in H2O; J-011837; Chlorhexidine digluconate, Pharmaceutical Secondary Standard; Certified Reference Material; 1,6-Bis(N5-[p-chlorophenyl]-N1-biguanido)hexane; 1,1'-Hexamethylenebis(5-[p-chlorophenyl]biguanide); 1-(4-chlorophenyl)-3-[N-[6-[[N-[N-(4-chlorophenyl)carbamimidoyl]carbamimidoyl]amino]hexyl]carbamimidoyl]guanidine; (2R,3S,4R,5R)-2,3,4,5,6-pentahydroxyhexanoic acid; 2,4,11,13-Tetraazatetradecanediimidamide, N,N''-bis(4-chlorophenyl)-3,12-diimino-, di-D-gluconate; 2,4,11,13-Tetraazatetradecanediimidamide, N,N''-bis(4-chlorophenyl)-3,12-diimino-, digluconate; 2,4,11,13-Tetraazatetradecanediimidamide, N,N'-bis(4-chlorophenyl)-3,12-diimino-, di-D-gluconate; D-Gluconic acid, compd with N,N''-bis(4-chlorophenyl)-3,12-diimino-2,4,11,13-tetraazatetradecanediimidamide (2:1); D-Gluconic acid, compd. with N,N''-bis(4-chlorophenyl)-3,12-diimino-2,4,11,13-tetraazatetradecane diimidamide (2:1); Gluconic acid, compd. with 1,1'-hexamethylene bis(5-(p-chlorophenyl)biguanide) (2:1), D- (8CI); N',N'''''-hexane-1,6-diylbis[N-(4-chlorophenyl)(imidodicarbonimidic diamide)]--D-gluconic acid (1/2)

Chlorhexidine Gluconate is the gluconate salt form of chlorhexidine, a biguanide compound used as an antiseptic agent with topical antibacterial activity. Chlorhexidine gluconate is positively charged and reacts with the negatively charged microbial cell surface, thereby destroying the integrity of the cell membrane. Subsequently, chlorhexidine gluconate penetrates into the cell and causes leakage of intracellular components leading to cell death. Since gram positive bacteria are more negatively charged, they are more sensitive to this agent.Chlorhexidine gluconate is an organochlorine compound and a D-gluconate adduct. It has a role as an antibacterial agent. It derives from a chlorhexidine.Stable under ambient warehouse conditions to moisture and simulated sunlight.Stable under recommended storage conditions.When heated to decomposition, emits very toxic fumes of Cl- and NOX.Antiseptic; disinfectant. (Vet): antiseptic; disinfectant.Cleanser: As a surgical hand scrub, skin wound and general skin cleanser, health care personnel hand wash, and for preoperative skin preparation. Chlorhedine gluconate significantly reduces the number of microorganisms on the hands and forearms prior to surgery or patient care.To determine if chlorhexidine can be used as an intervention to prolong the time to relapse of oral candidiasis. SUBJECTS AND METHODS: A double-blinded randomized clinical trial was performed in 75 HIV/AIDS subjects with oral candidiasis. Clotrimazole troche was prescribed, and the subjects were re-examined every 2 weeks until the lesions were completely eradicated. The subjects were then randomly divided into two groups; 0.12% chlorhexidine (n = 37, aged 22-52 years, mean 34 years) and 0.9% normal saline (n = 38, aged 22-55 years, mean 38 years). They were re-examined every 2 weeks until the next episode was observed. RESULTS: The time to recurrence of oral candidiasis between the chlorhexidine and the saline group was not statistically significant (P > 0.05). The following variables were significantly associated with the time of recurrence; frequency of antifungal therapy (P = 0.011), total lymphocyte (P = 0.017), alcohol consumption (P = 0.043), and candidiasis on gingiva (P = 0.048). The subjects with lower lymphocyte showed shorter oral candidiasis-free periods (P = 0.034). CONCLUSIONS: Chlorhexidine showed a small but not statistically significant effect in maintenance of oral candidiasis-free period. This lack of significance may be due to the small sample size. Further study should be performed to better assess the size of the effect, or to confirm our findings.For external use only: For external use only. Keep out of eyes, ears, and mouth. Chlorhexidine gluconate should not be used as a preoperative skin preparation of the face or head. Misuse of products containing chlorhexidine gluconate has been reported to cause serious and permanent eye injury when it has been permitted to enter and remain in the eye during surgical procedures. If chlohexidine gluconate should contact these areas, rinse out promptly and thoroughly with cold water. Avoid contact with neninges. Do not use in genital area.Chlorhexidine gluconate should not be used by persons who have a sensitivity to it or its components.Hypersensitivity reactions: Irritation, sensitization, and generalized allergic reactions have been reported with chlorhexidine-containing products, especially in the genital areas. If adverse reactions occur and last more than 72 hr, discontinue use immediately and, if severe, contact a health care provider.Chlorhexidine gluconate has been reported to cause deafness when instilled in the middle ear through perforate ear drums.Chlorhexidine Gluconate is the gluconate salt form of chlorhexidine, a biguanide compound used as an antiseptic agent with topical antibacterial activity. Chlorhexidine gluconate is positively charged and reacts with the negatively charged microbial cell surface, thereby destroying the integrity of the cell membrane. Subsequently, chlorhexidine gluconate penetrates into the cell and causes leakage of intracellular components leading to cell death. Since gram positive bacteria are more negatively charged, they are more sensitive to this agent.34 newborn infants who had been bathed in a standard manner with Hibiscrub were studied to find out whether it was absorbed percutaneously. Low levels of chlorhexidine were found in the blood of all 10 babies sampled by heel prick, and 5 of 24 from whom venous blood was taken.Less than 5% of the topically applied chlorhexidine was absorbed during a 5-day period. Excretion of absorbed radioactivity occurred mainly in the feces. For tests carried out on whole skin, storage in cutaneous structures after 48 hr was more important than diffusion; the reverse was observed for stripped skin. When the skin was stripped, the amount absorbed was multiplied by approximately 100, and the amount stored in skin by approximately 10. The difference in chlorhexidine diffusion observed between whole and stripped skin was related to the physicochemical characteristics of chlorhexidine.To evaluate the elimination kinetics of chlorhexidine in milk when used as an intramammary infusion to stop lactation in cows. ... The study was performed in 2 phases. Three cows were studied in each phase. All cows were treated with chlorhexidine suspension by infusion into a mastitic mammary gland quarter after 2 milkings 24 hours apart. Foremilk samples (100 mL) were collected from treated and untreated (controls) mammary gland quarters of each cow. Chlorhexidine was extracted from raw milk, and residue concentrations were quantified by use of high-performance liquid chromatography. Foremilk samples from days 2, 5, and 8 were analyzed in phase I, and samples from time 0 and days 3, 7, 14, 21, 28, 35, and 42 were analyzed in phase II. In phases I and II, there was no quantifiable transference of chlorhexidine to milk in untreated mammary gland quarters. Measurable chlorhexidine residues were found in milk from treated mammary gland quarters of 2 cows throughout the 42-day sample period in phase II. Estimated mean elimination half-life for chlorhexidine in milk was 11.5 days.To evaluate the elimination kinetics of chlorhexidine in milk when used as an intramammary infusion to stop lactation in cows. ... The study was performed in 2 phases. Three cows were studied in each phase. All cows were treated with chlorhexidine suspension by infusion into a mastitic mammary gland quarter after 2 milkings 24 hours apart. Foremilk samples (100 mL) were collected from treated and untreated (controls) mammary gland quarters of each cow. Chlorhexidine was extracted from raw milk, and residue concentrations were quantified by use of high-performance liquid chromatography. Foremilk samples from days 2, 5, and 8 were analyzed in phase I, and samples from time 0 and days 3, 7, 14, 21, 28, 35, and 42 were analyzed in phase II. In phases I and II, there was no quantifiable transference of chlorhexidine to milk in untreated mammary gland quarters. Measurable chlorhexidine residues were found in milk from treated mammary gland quarters of 2 cows throughout the 42-day sample period in phase II. Estimated mean elimination half-life for chlorhexidine in milk was 11.5 days. Chlorhexidine is a solid crystal. It will not volatilize and is slightly soluble in water. Salts of chlorhexidine are solid powders. They will not volatilize and are soluble in water. USE: Salts of chlorhexidine are used as disinfectants. Chlorhexidine salts are used in skin and hand disinfectants, skin creams, toothpaste, and deodorants. They are also used as a preservative in eyedrops, wound dressings and antiseptic mouthwashes. Water-based solutions of the salts, chlorhexidine diacetate and chlorhexidine digluconate, are used to control bacteria and viruses on farms, egg handling and packaging equipment, meat and poultry processing plants, and in certain veterinary settings. The chlorhexidine part of these salts is the active antimicrobial ingredient. EXPOSURE: People may be exposed to chlorhexidine by dermal contact or ingestion of antimicrobial products containing salts of this compound. The U.S. EPA requires workers to wear protective clothing and gloves when they are using solutions of chlorhexidine salts to disinfect surfaces. If these solutions are applied as a mist, workers must also wear protective respirators. Dietary exposure to chlorhexidine salts is not expected in the U.S., because workers using the salts to disinfect surfaces in food processing plants are directed to rinse the surfaces with water after treatment. Chlorhexidine is used commercially as its salts which are soluble in water. This reaction can then release chlorhexidine to the environment through direct discharge or discharge to waste water treatment plants. If released to the air, chlorhexidine may be broken down by sunlight. It is not likely to move through soil. Chlorhexidine may not volatilize from soil or water. It is not broken down by microorganisms and is not expected to build up in aquatic organisms. RISK: Direct contact with solutions of chlorhexidine salts can be damaging to eyes and skin. Repeated exposure of the skin of laboratory animals to high doses of solutions of chlorhexidine diacetate salt produced skin damage and liver effects in some animals. Animals given high doses of chlorhexidine diacetate by mouth during pregnancy had decreased body weight gain, but no abortions or birth defects were found. The potential for chlorhexidine salts to produce cancer in laboratory animals has not been tested. The potential for chlorhexidine or its salts to cause cancer in humans has not been assessed by the U.S. EPA IRIS program, the International Agency for Research on Cancer, or the U.S. National Toxicology Program 13th Report on Carcinogens. For chlorhexidine (USEPA/OPP Pesticide Code: 217100) there are 0 labels match. /SRP: Not registered for current use in the U.S., but approved pesticide uses may change periodically and so federal, state and local authorities must be consulted for currently approved uses.For chlorhexidine diacetate (USEPA/OPP Pesticide Code: 045502) ACTIVE products with label matches. /SRP: Registered for use in the U.S. but approved pesticide uses may change periodically and so federal, state and local authorities must be consulted for currently approved uses.For chlorhexidine digluconate (USEPA/OPP Pesticide Code: 045504) ACTIVE products with label matches. /SRP: Registered for use in the USA but approved pesticide uses may change periodically and so federal, state and local authorities must be consulted for currently approved uses.For chlorhexidine dihydrochloride (USEPA/OPP Pesticide Code: 481700) there are 0 labels match. /SRP: Not registered for current use in the U.S., but approved pesticide uses may change periodically and so federal, state and local authorities must be consulted for currently approved uses.Trade names for various chlorhexidine salts and formulations: chlorhexidine: Sterilon, Hibitane, Rotersept; chlorhexidine dihydrochloride: Lisium, Arlacide H, AY-5312; chlorhexidine diacetate: Hibitane diacetate, Novalsan; chlorhexidine digluconate: Abacil, anti Plaque, Arlacide G, Bacticlens, Chlorhexamed, Disteryl, Orahexal, Septeal, Unisept, Corsodyl, Hibiclens, Hibidil, Hibiscrub, Hibitane, Larylin, Peridex, Plac out, Plurexid, Rotersept, Savacol, Solvahex.Production volume for non-confidential chemicals reported under the 2006 Inventory Update Rule. Chemical: 2,4,11,13-Tetraazatetradecanediimidamide, N,N''-bis(4-chlorophenyl)-3,12-diimino-. Aggregated National Production Volume: < 500,000 pounds.Chlorhexidine is used primarily as its salts e.g., the dihydrochloride, diacetate, and digluconate in disinfectants (disinfection of the skin and hands), cosmetics (additive to creams, toothpaste, deodorants, and antiperspirants), and pharmaceutical products (preservative in eyedrops, active substance in wound dressings and antiseptic mouthwashes).Three methods are described for the specific determination of chlorhexidine and its salts at various levels in dental creams and related oral materials. The method of measuring the colored reaction product with alkaline sodium hypobromite is less sensitive than that based on hydrolysis of chlorhexidine to give p-chloroaniline. This p-chloroaniline is then reacted with nitrous acid and alpha-naphthol to give a red-colored derivative. The third method is for the determination of submicrogram quantities. After conversion to 1:4 iodochlorobenzene this is determined by electron capture gas chromatography. This method has been applied to the measurement of the uptake of significant amounts of chlorhexidine by dental plaques from a mouthrinse.Accidental Release Measures. Personal precautions, protective equipment and emergency procedures: Use personal protective equipment. Avoid dust formation. Avoid breathing vapours, mist or gas. Ensure adequate ventilation. Evacuate personnel to safe areas. Avoid breathing dust. Environmental precautions: Prevent further leakage or spillage if safe to do so. Do not let product enter drains. Discharge into the environment must be avoided. Methods and materials for containment and cleaning up: Pick up and arrange disposal without creating dust. Sweep up and shovel. Keep in suitable, closed containers for disposal. The most favorable course of action is to use an alternative chemical product with less inherent propensity for occupational harm/injury/toxicity or environmental contamination. Recycle any unused portion of the material for its approved use or return it to the manufacturer or supplier. Ultimate disposal of the chemical must consider: the material's impact on air quality; potential migration in soil or water; effects on animal and plant life; and conformance with environmental and public health regulations.Waste treatment methods. Product: Offer surplus and non-recyclable solutions to a licensed disposal company. Contact a licensed professional waste disposal service to dispose of this material. Dissolve or mix the material with a combustible solvent and burn in a chemical incinerator equipped with an afterburner and scrubber. Contaminated packaging: Dispose of as unused product.The scientific literature for the use of contact lenses by industrial workers is inconsistent. The benefits or detrimental effects of wearing contact lenses depend not only upon the substance, but also on factors including the form of the substance, characteristics and duration of the exposure, the uses of other eye protection equipment, and the hygiene of the lenses. However, there may be individual substances whose irritating or corrosive properties are such that the wearing of contact lenses would be harmful to the eye. In those specific cases, contact lenses should not be worn. In any event, the usual eye protection equipment should be worn even when contact lenses are in place.Precautions for safe handling Avoid contact with skin and eyes. Avoid formation of dust and aerosols. Provide appropriate exhaust ventilation at places where dust is formed.Appropriate engineering controls: Handle in accordance with good industrial hygiene and safety practice. Wash hands before breaks and at the end of workday.Gloves must be inspected prior to use. Use proper glove removal technique (without touching glove's outer surface) to avoid skin contact with this product. Dispose of contaminated gloves after use in accordance with applicable laws and good laboratory practices. Wash and dry hands.Local exhaust ventilation should be applied wherever there is an incidence of point source emissions or dispersion of regulated contaminants in the work area. Ventilation control of the contaminant as close to its point of generation is both the most economical and safest method to minimize personnel exposure to airborne contaminants. Ensure that the local ventilation moves the contaminant away from the worker.Based on the reviews of the generic data for the active ingredient chlorhexidine diacetate, the Agency has sufficient information on the health effects of chlorhexidine diacetate and on its potential for causing adverse effects in fish and wildlife and the environment. The Agency has determined that chlorhexidine diacetate products, labeled and used as specified in this Reregistration Eligibility Decision, will not pose unreasonable risks or adverse effects to humans or the environment. Therefore, the Agency concludes that products containing chlorhexidine diacetate for all uses are eligible for reregistration.As the federal pesticide law FIFRA directs, EPA is conducting a comprehensive review of older pesticides to consider their health and environmental effects and make decisions about their continued use. Under this pesticide reregistration program, EPA examines newer health and safety data for pesticide active ingredients initially registered before November 1, 1984, and determines whether the use of the pesticide does not pose unreasonable risk in accordance to newer saftey standards, such as those described in the Food Quality Protection Act of 1996. Pesticides for which EPA had not issued Registration Standards prior to the effective date of FIFRA '88 were divided into three lists based upon their potential for human exposure and other factors, with List B containing pesticides of greater concern than those on List C, and with List C containing pesticides of greater concern than those on List D. Chlorhexidine diacetate is found on List C. Case No: 3038; Pesticide type: antimicrobial; Case Status: RED Approved 06/1995; OPP has made a decision that some/all uses of the pesticide are eligible for reregistration, as reflected in a Reregistration Eligibility Decision (RED) document.; Active ingredient (AI): chlorhexidine diacetate; Data Call-in (DCI) Date(s): 03/31/1992; AI Status: OPP has completed a Reregistration Eligibility Decision (RED) for the case/AI.As the federal pesticide law FIFRA directs, EPA is conducting a comprehensive review of older pesticides to consider their health and environmental effects and make decisions about their continued use. Under this pesticide reregistration program, EPA examines newer health and safety data for pesticide active ingredients initially registered before November 1, 1984, and determines whether the use of the pesticide does not pose unreasonable risk in accordance to newer saftey standards, such as those described in the Food Quality Protection Act of 1996. Pesticides for which EPA had not issued Registration Standards prior to the effective date of FIFRA '88 were divided into three lists based upon their potential for human exposure and other factors, with List B containing pesticides of greater concern than those on List C, and with List C containing pesticides of greater concern than those on List D. Chlorhexidine digluconate is found on List C. Case No: 3038; Pesticide type: antimicrobial; Case Status: RED Approved 06/1995; OPP has made a decision that some/all uses of the pesticide are eligible for reregistration, as reflected in a Reregistration Eligibility Decision (RED) document.; Active ingredient (AI): chlorhexidine digluconate; AI Status: The active ingredient is no longer contained in any registered products ... "cancelled." As the federal pesticide law FIFRA directs, EPA is conducting a comprehensive review of older pesticides to consider their health and environmental effects and make decisions about their continued use. Under this pesticide reregistration program, EPA examines newer health and safety data for pesticide active ingredients initially registered before November 1, 1984, and determines whether the use of the pesticide does not pose unreasonable risk in accordance to newer saftey standards, such as those described in the Food Quality Protection Act of 1996. Pesticides for which EPA had not issued Registration Standards prior to the effective date of FIFRA '88 were divided into three lists based upon their potential for human exposure and other factors, with List B containing pesticides of greater concern than those on List C, and with List C containing pesticides of greater concern than those on List D. Chlorhexidine dihydrochloride is found on List C. Case No: 3038; Pesticide type: antimicrobial; Case Status: RED Approved 06/1995; OPP has made a decision that some/all uses of the pesticide are eligible for reregistration, as reflected in a Reregistration Eligibility Decision (RED) document.; Active ingredient (AI): chlorhexidine dihydrochloride; AI Status: The active ingredient is no longer contained in any registered products ... "cancelled."The Approved Drug Products with Therapeutic Equivalence Evaluations List identifies currently marketed prescription and over-the-counter drug products, incl chlorhexidine gluconate, approved on the basis of safety and effectiveness by FDA under sections 505 of the Federal Food, Drug, and Cosmetic Act.Ophthalmic and topical dosage form new animal drugs. Chlorhexidine. Each gram of ointment contains 10 milligrams chlorhexidine acetate. ... Conditions of use in dogs, cats, and horses - (1) Indications for use. For use as a topical antiseptic ointment for surface wounds. (2) Limitations. Do not use in horses intended for human consumption.Certain other dosage form new animal drugs. Chlorhexidine tablets and suspension. Each tablet and each 28-mL syringe of suspension contain 1 g of chlorhexidine dihydrochloride. ... Indications for use: For prevention or treatment of metritis and vaginitis in cows and mares when caused by pathogens sensitive to chlorhexidine dihydrochloride.Tolerances for residues of new animal drugs in food. A tolerance of zero is established for residues of chlorhexidine in the uncooked edible tissues of calves. Chlorhexidine forms solid crystals. Chlorhexidine diacetate is registered for current use in the U.S., but approved pesticide uses may change periodically and so federal, state and local authorities must be consulted for currently approved uses. Currently, two end-use products with 2% chlorhexidine diacetate are registered for use as hard surface-treatment disinfectant/virucides. Chlorhexidine is used primarily as its salts e.g., the dihydrochloride, diacetate, and digluconate in disinfectants (disinfection of the skin and hands), cosmetics (additive to creams, toothpaste, deodorants, and antiperspirants), and pharmaceutical products (preservative in eyedrops, active substance in wound dressings and antiseptic mouthwashes). HUMAN EXPOSURE AND TOXICITY: Chlorhexidine diacetate is highly acutely toxic when applied to the eye. Skin reactions to chlorhexidine-acetate and chlorhexidine-gluconate were tested among eczema patients. Positive reactions were found in 52 (5.4%) of the 1,063 subjects at the initial test. Of these subjects, 29 were retested, and 21 were still found to have positive reactions. Chlorhexidine specific IgE was detected only in Japanese individuals who had experienced anaphylactic type reactions and was not detected in Japanese nurses and patients or in a group of British nurses and hospital staff, all having regular contact with chlorhexidine. All chromogens plus chlorhexidine, but not chlorhexidine alone, produced some discoloration of hydroxyapatite and human teeth. A 67-yr-old man undergoing a colectomy for colon cancer was unintentionally administered 0.8 mg of chlorhexidine gluconate intravenously and subsequently developed acute respiratory distress syndrome. Occupational asthma has been described in two health care workers, as a result of exposure to chlorhexidine and alcohol aerosols. Another case report describes six patients who developed urticaria, dyspnea, and anaphylactic shock due to topical application of chlorhexidine gluconate solution. Even very dilute solutions of chlorhexidine can cause marked chondrolysis of articular cartilage leading to severe permanent damage to the knee.Basic treatment: Establish a patent airway (oropharyngeal or nasopharyngeal airway, if needed). Suction if necessary. Watch for signs of respiratory insufficiency and assist ventilations if needed. Administer oxygen by nonrebreather mask at 10 to 15 L/min. Monitor for pulmonary edema and treat if necessary ... . Monitor for shock and treat if necessary ... . Anticipate seizures and treat if necessary ... . For eye contamination, flush eyes immediately with water. Irrigate each eye continuously with 0.9% saline (NS) during transport ... . Do not use emetics. For ingestion, rinse mouth and administer 5 mL/kg up to 200 mL of water for dilution if the patient can swallow, has a strong gag reflex, and does not drool ... . Cover skin burns with dry sterile dressings after decontamination.Advanced treatment: Consider orotracheal or nasotracheal intubation for airway control in the patient who is unconscious, has severe pulmonary edema, or is in severe respiratory distress. Positive-pressure ventilation techniques with a bag valve mask device may be beneficial. Consider drug therapy for pulmonary edema ... . Consider administering a beta agonist such as albuterol for severe bronchospasm ... . Monitor cardiac rhythm and treat arrhythmias as necessary ... . Start IV administration of D5W TKO /SRP: "To keep open", minimal flow rate/. Use 0.9% saline (NS) or lactated Ringer's (LR) if signs of hypovolemia are present. For hypotension with signs of hypovolemia, administer fluid cautiously. Watch for signs of fluid overload ... . Treat seizures with diazepam or lorazepam ... . Use proparacaine hydrochloride to assist eye irrigation ... . To evaluate the efficacy of chlorhexidine solution in the treatment of patients with Acanthamoeba keratitis. Prospective nonrandomized study. Five patients infected with culture-proven Acanthamoeba keratitis. Chlorhexidine solution was used hourly on six eyes and gradually reduced to four times a day after 1 month. Follow-up ranged from 1 to 10 months (mean, 4 months). Severity of symptoms and signs, time for healing, and final visual acuity. Clinical results in four patients showed improved visual acuity, with a rapid recovery within 1 wk. No adverse drug reaction was encountered, but one patient with a perforated ulcer developed glaucoma. 83% of 6 eyes were medically cured with chlorhexidine and recovered visual acuity 6/18 or better. Four of five patients improved within 3 weeks, with resolution of infiltration and healing of epithelial defects. By 2 to 3 weeks, visual acuity 6/18 or better had improved in four (66.7%) of six eyes and recovered 6/6 in two eyes (33.3%). Bacterial coinfection occurred in one eye. Chlorhexidine dramatically hastened clinical improvement in all eyes and is a successful medical therapy that has excellent results in patients who are diagnosed early.Skin reactions to chlorhexidine-acetate and chlorhexidine-gluconate were tested among eczema patients. Subjects were tested with 1% chlorhexidine-gluconate and 1% chlorhexidine-acetate by patch test. The patches were applied for 48 hours and read at 72 hours. Subjects with a positive reaction at the initial testing were retested 1 month later. Positive reactions were found in 52 (5.4%) of the 1,063 subjects at the initial test. Of these subjects, 29 were retested, and 21 were still found to have positive reactions. A use test performed on these 29 patients resulted in all of them developing a dermatitis with one or both of the chlorhexidine solutions. Those patients with leg eczema or leg ulcers appeared to be particularly at risk. The /study/ conclude that patients with eczema, and especially those with leg ulcers or leg eczema, are especially prone to chlorhexidine allergies.Chlorhexidine's production and use primarily as its salts in disinfectants, cosmetics, and pharmaceutical products may result in its release to the environment through various waste streams. Chlorhexidine diacetate salt's use as a disinfectant to control bacteria on farms, egg handling and packaging equipment, meat and poultry processing plants, and certain viruses in veterinary settings may result in chlorhexidine's direct release to the environment. If released to air, an estimated vapor pressure of 2.0X10-14 mm Hg at 25 °C indicates chlorhexidine will exist solely in the particulate phase in the atmosphere. Particulate-phase chlorhexidine will be removed from the atmosphere by wet and dry deposition. Irradiation (lambda >290 nm) of chlorhexidine sorbed to silica gel resulted in 20% degradation after 17 hours. However, this chemical is expected to exist in the particulate phase in the ambient atmosphere and, therefore, photo-degradation is not expected to be an important fate process. If released to soil, chlorhexidine is expected to have no mobility based upon an estimated Koc of 8.5X10+5. Values of pKa 7.63, 9.92, 8.22 and 10.52, indicate that this compound will exist almost entirely in the cation form in the environment and cations generally adsorb more strongly to soils containing organic carbon and clay than their neutral counterparts. Volatilization from moist soil is not expected because the compound exists as an cation and cations do not volatilize. Chlorhexidine is not expected to volatilize from dry soil surfaces based upon its vapor pressure. Using the OECD Minimal test, chlorhexidine, present at 12 mg/L, achieved 0% degradation after 3 weeks in soil extract inoculum indicating that biodegradation is not expected to be an important fate process in soil. If released into water, chlorhexidine is expected to adsorb to suspended solids and sediment based upon the estimated Koc. Using the Closed Bottle test, chlorhexidine, present at 5.35 ppm, resulted in 0% COD after 28 days using an activated sludge inoculum, indicating that biodegradation is not expected to be an important fate process in water. The pKa values indicate chlorhexidine will exist almost entirely in the cation form at pH values of 5 to 9 and, therefore, volatilization from water surfaces is not expected to be an important fate process. An estimated BCF of 3 suggests the potential for bioconcentration in aquatic organisms is low. Hydrolysis is not expected to be an important environmental fate process since this compound lacks functional groups that hydrolyze under environmental conditions (pH 5 to 9). Occupational exposure to chlorhexidine may occur through inhalation and dermal contact with this compound at workplaces where chlorhexidine is produced or used. Use data indicate that the general population may be exposed to chlorhexidine via oral and dermal contact with consumer products containing this compound.Chlorhexidine's production and use primarily as its salts in disinfectants, cosmetics, and pharmaceutical products(1) may result in its release to the environment through various waste streams(SRC). Chlorhexidine diacetate salt's use as a disinfectant to control bacteria on farms, egg handling and packaging equipment, meat and poultry processing plants, and certain viruses in veterinary settings(2) may result in chlorhexidine's direct release to the environment(SRC).Based on a classification scheme(1), an estimated Koc value of 8.5X10+5(SRC), determined from a structure estimation method(2), indicates that chlorhexidine is expected to be immobile in soil(SRC). Values of pKa 7.63, 9.92, 8.22 and 10.52(3), indicate that this compound will exist almost entirely in the cation form in the environment and cations generally adsorb more strongly to soils containing organic carbon and clay than their neutral counterparts(4). Volatilization from moist soil is not expected because the compound exists as a cation and cations do not volatilize. Chlorhexidine is not expected to volatilize from dry soil surfaces(SRC) based upon an estimated vapor pressure of 2.0X10-14 mm Hg at 25 °C(SRC), determined from a fragment constant method(2). Using the OECD Minimal test, chlorhexidine, present at 12 mg/L, achieved 0% degradation after 3 weeks in soil extract inoculum(5), indicating that biodegradation is not expected to be an important fate process in soil(SRC).