Section 1 - CHEMICAL PRODUCT AND COMPANY IDENTIFICATION

PRODUCT NAME

HYDROCORTISONE 3-(O-CARBOXYMETHYL)OXIME BSA

NFPA

PRODUCT USE

Hydrocortisone is the main glucocorticoid secreted from the adrenal cortex. Administered
by mouth for replacement therapy in Addison' s disease or chronic adrenocortical
insufficiency secondary to hypopituitarism. When a rapid efect is required such as in
post- adrenalectomy crises, during the acute pases of status asthmaticus and in allergic
crises such as laryngeal oedema and drug sensitivity, hydrocortisone is given by slow
intravenous infusion. Also applied topically in the treatment of various skin disorders.
The acetate is the preferred injectable form and is administered intra- articularly into
joints affected by rheumatoid arthritis, osteoarthritis and similar conditions.

SYNONYMS

"acetic acid, [(((11beta)-11, 17, 21-trihydroxy-20-oxopregn-4-en-3-ylidene)-amino)oxy],
bovine serum albumin", "acetic acid, [(((11beta)-11, 17, 21-trihydroxy-20-oxopregn-4-en-
3-ylidene)-amino)oxy], bovine serum albumin", "cortisol 3-(carboxymethyloxime) albumin",
"cortisol 3-(carboxymethyloxime) albumin", "cortisol 3-(O-carboxymethyl)oxime protein-
linked", "cortisol 3-(O-carboxymethyl)oxime protein-linked", "4-pregnene-11beta, 17alpha,
21-triol-3, 20-dione 3-(O-carboxymethyl)oxime BSA", "4-pregnene-11beta, 17alpha, 21-triol-
3, 20-dione 3-(O-carboxymethyl)oxime BSA", "11beta, 17alpha, 21-trihydroxy-4-pregnene-3,
20-dione 3-(O-carboxymethyl)oximebovine serum albumin", "11beta, 17alpha, 21-trihydroxy-4-
pregnene-3, 20-dione 3-(O-carboxymethyl)oximebovine serum albumin", corticosteroid,
"corticoid anti-inflammatory"

Section 2 - HAZARDS IDENTIFICATION

CANADIAN WHMIS SYMBOLS

EMERGENCY OVERVIEW

RISK

May form explosive peroxides.

POTENTIAL HEALTH EFFECTS

ACUTE HEALTH EFFECTS

SWALLOWED

  Although ingestion is not thought to produce harmful effects, the material may still be damaging to the health of the individual following ingestion, especially where pre-  existing organ (e.g. liver, kidney) damage is evident. Present definitions of harmful or toxic substances are generally based on doses producing mortality (death) rather than those producing morbidity (disease, ill-health). Gastrointestinal tract discomfort may produce nausea and vomiting. In an occupational setting however, ingestion of insignificant quantities is not thought to be cause for concern.  The corticosteroids cause alterations in metabolism of fats, proteins and carbohydrates, and affect a range of organs in the body including the heart, muscle and kidneys. Blood chemistry may change and there is decreased activity and shrinkage of the thymus gland, adrenal glands, spleen and lymph nodes. The liver becomes enlarged, thyroid activity decreases, and mineral is drawn away from bone. Muscle wasting occurs, and the immune system is adversely affected causing the person to be more susceptible to infections, especially of the eye. Allergies can occur. Wound healing is slowed. In large doses, corticosteroids cause a severe chemical imbalance in the body's minerals, leading to salt and water being retained in the body, causing swelling and high blood pressure. This is more severe when natural rather than synthetic drugs are used. Blood glucose is raised, and in extreme cases the heart may fail. The characteristic "moon-face" appearance may be seen, with weakness of the muscles and bones, high blood pressure, cessation of periods, profuse sweating, mental disturbance, flushing, a humped back, hairiness, and obesity of the trunk with wasting of the arms and limbs ("lemon with matchsticks" shape). These generally improve when treatment is stopped. High pressure in the head, an inflamed pancreas and mental disturbance become more common, and bone tissue may die. The blood also condenses more easily leading to an increased risk of clots. Psychiatric changes include mood swings, personality changes, severe depression and psychosis (hallucinations and delusions). One should be beware of an increased susceptibility to a wide range of infections which may be masked by the ability of corticosteroids to reduce pain, inflammation and fever. Those with ulcers, gastrointestinal disease, kidney impairment, hypothyroidism, high blood pressure, liver damage and osteoporosis may be especially susceptible to the adverse effects of corticosteroids. Prolonged exposure can cause cataracts and eye nerve damage, leading to blindness.  

EYE

  Although the material is not thought to be an irritant, direct contact with the eye may produce transient discomfort characterized by tearing or conjunctival redness (as with windburn).  The dust may produce eye discomfort causing smarting, pain and redness.  When applied to the eye, corticosteroids may produce ulceration of the cornea, raised eye pressure and reduced vision; internal administration can cause cataracts.  

SKIN

  Skin contact with the material may damage the health of the individual; systemic effects may result following absorption.  The material is not thought to be a skin irritant (as classified using animal models). Temporary discomfort, however, may result from prolonged dermal exposures. Good hygiene practice requires that exposure be kept to a minimum and that suitable gloves be used in an occupational setting.  Toxic effects may result from skin absorption.  Topically applied corticosteroids may be absorbed in sufficient quantity to produce systemic effects. Application to the skin may result in collagen loss and subcutaneous atrophy and local bleaching of deeply pigmented skin. Systemic absorption may produce adrenal suppression and collapse.  

INHALED

  Inhalation may produce health damage*.  The material is not thought to produce respiratory irritation (as classified using animal models). Nevertheless inhalation of the material, especially for prolonged periods, may produce respiratory discomfort and occasionally, distress.  Persons with impaired respiratory function, airway diseases and conditions such as emphysema or chronic bronchitis, may incur further disability if excessive concentrations of particulate are inhaled.  Systemic absorption of aerosols containing corticosteroids may produceadrenal insufficiency and collapse.  Respiratory sensitization may result in allergic/asthma like responses; from coughing and minor breathing difficulties to bronchitis with wheezing, gasping.  

CHRONIC HEALTH EFFECTS

  There is some evidence that inhaling this product is more likely to cause a sensitization reaction in some persons compared to the general population.  

  Principal routes of exposure are by accidental skin and eye contact andinhalation of generated dusts.  Chronic exposure to glucocorticoids can lead to changes in hormone production, a characteristic "moon face" appearance and a "lemon with matchsticks" fat distribution (central obesity with wasting of limbs), susceptibility to infections, osteoporosis, cataracts, glaucoma, mental disturbance, high blood sugar and sugar in the urine. There may be muscular weakness and fatigue, acne, period disturbances in women and peptic ulcers. Growth retardation can occur in children and birth defects are possible. Corticosteroids appear in human milk and ' may stunt the growth of infants.  Dusts produced by proteins can sometimes sensitize workers like other foreign bodies. Symptoms include asthma appearing soon after exposure, with wheezing, narrowing of the airways and breathing difficulties. There may also be a chronic cough, phlegm, fever, muscle pains, fatigue and airway obstruction; chest X-rays may show a characteristic net-  like pattern or scarring at the tip and base. There may also be chest discomfort, headache, stomachache and a general feeling of unwellness. Often the clinical picture is similar to "farmer's lung" and other allergic lung inflammations. Prolonged contact with the skin can cause pain, redness, inflammation and ulceration. Repeated attacks can cause loss of lung function due to scarring.