Diphoterine® solutions water

This severe water uptake is confirmed by the next figure (Fig. 6.3) showing the hydration of the cornea after bum that is kept untreated for up to 7 days or respectively treated by three times daily rinsing of the eye with phosphate buffer (Isogutt ), saline solntion, or Diphoterine solution for 16 days. 

Flush eyes with copious amounts of tepid 0.9% saline or water for at least 15 min. Diphoterine solution can be used for decontamination of both eyes and skin after exposure to lacrimators (Viala et al., 2005). Ocular signs resolve... 

Figure 4.7 shows the experimental device. One milliliter of titaninm tetrachloride is used for this experience. What does happen during the addition of an increasing volume of water and, in comparison, with an increasing volume of DIPHOTERINE solution The reaction instantaneously generates a release of energy and an increase of temperature. Very quickly, when adding 5 mL of water or DIPHOTERINE solution, this exothermic effect decreases, because of dilution, and the tanperature falls back to 20 °C. 

On this purely physical aspect, water and DIPHOTERINE solution have the same effect. DIPHOTERINE solution improves the washing effect of water by restoring the pH toward the physiologically acceptable zone while water maintains a corrosive pH (Fig. 4.8). For the latter sulfuric acid, the fundamental elanent of aggressiveness is the persistence of pH valnes out of the physiological range. 

Example of high concentrated 95 % sulfuric acid (H2SO4). In contact with water, the static solvation of 1 mL of add releases a very big quantity of heat. The temperature reaches nearly 80 °C (Fig. 4.10). The result is the same with addition of water or DIPHOTERINE solution. 

Evolution of the temperature during an external rinsing simulation of 1 mLof 95 % sulfuric acid (H2SO4) comparing DIPHOTERINE solution and tap water... 

High concentration of acetic acid, virtually excludes the presence of water. It is named glacial acetic acid. Experimental dilution with tap water at 20.3 °C, in comparison with DIPHOTERINE solution at 19.9 °C, shows the following curves (Fig. 4.12). 

With this acid, despite the water pumping, the dilution does practically not increase the temperature of the mixture, even in static. The results are similar with the use of DIPHOTERINE solution. A much lower exothermic effect, compared to the previous examples, is observed. 

Fig. 4.12 Glacial acetic acid dilution by tap water or DIPHOTERINE solution...

Static dilution of 1 mL of 99.7 % glacial acetic acid Comparison between water and Diphoterine solution... 

The following experience is a simple dosage of 1 mL of each chemical peeling agent by an increasing volume of water (pH=7) and DIPHOTERINE solution (Fig. 4.21). 

Fig. 4.21 Dosage of 70 % glycolic acid or 20 % trichloroacetic acid by water versus DIPHOTERINE solution...

DIPHOTERINE solution can control pH value toward a physiological acceptable value with less volume than water does. No heat release is observed. 

Two studies done in China in a rabbit model with concentrated sodium hydroxide and concentrated sulfuric acid found that there were no significant skin temperature changes, and while DIPHOTERINE solution rapidly returned the skin pH to normal values, water rinsing did not do so [207, 208]. 

Amphoteric Agents Water-Based Solution Containing Amphoteric Agents Such as DIPHOTERINE Solution and HEXAFLUORINE Solution... 

Design of DIPHOTERINE solution was also to add new additional secondary properties, so as to go beyond the limits of water when possible ... 

Improve the mechanical effect of water by attracting the chemicals and stopping their penetration through the skin. DIPHOTERINE and HEXAFLUORINE solutions are to chemicals what soap is to grease. They improve the washing effect and leave a cleaner surface. DIPHOTERINE solution is not only water but, to continue this picture, it is water plus soap. ... 

An experiment was conducted by Battelle USA Comparison of the Mechanical Effect of DIPHOTERINE solution using pH Measmement in 2010. It compared the effect of Milli-Q water versus DIPHOTERINE ... 

During the first study, washing hydrochloric acid solution, DIPHOTERINE solution returned the pH of a 1 M hydrochloric acid (HCl) and sodium hydroxide (NaOH) solution to physiological acceptable values (5.5-9.0), while with addition of similar volume of water, the pH remained 2 (HCl) or 12 (NaOH), respectively [242]. DIPHOTERINE solntion has the ability to decontaminate more than 1,200 chemicals/chem-ical classes for an npdated Ust see http //www. prevor.com/EN/sante/RisqueChimique/produits testes/produitsTestesV2.php. 

With alkahne corrosive, TMAH (tetramethyl-ammonium hydroxide, in vitro it required 17 times more water than DIPHOTERINE solution to achieve pH normalization [243]. In an in vitro MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphen-yltetrazolium bromide) cell toxicity assay, 2/3 of cell remained viable after DIPHOTERINE solution washing compared with only 1/3 of cells which remained viable after water washing [243]. 

DIPHOTERINE solution, boric acid, and tap water after 40 % sodium hydroxide exposure... 

DIPHOTERINE solution, sodium bicarbonate, and tap water after 95 % sulfuric acid exposure... 

Comparison criteria (see section Chemical reacting violently with water under Sect. 4.1.1.1 for details of the experimental protocol) were pH, temperature, and quantities of decontamination needed to reach a physiologically acceptable pH for macroscopic observations of the lesions. When the DIPHOTERINE solution is used, lesions are less severe, temperature increase is less, and it needs less solution to reach the physiological pH compared to tap water, sodium bicarbonate, or boric acid. 

In terms of evolution of the bum, the skin washed with 50 g/L sodium bicarbonate after 95 % sulfuric acid is scarlet this may be due to increased temperature when neutralizing, while after DIPHOTERINE solution washing, the trauma is dry and blood red. It may be due to lower temperature and hyperosmolarity, which better removes and reacts with sulfuric acid at the surface and preserves deeper tissue structure. The wound due to 40 % sodium hydroxide healed in 12 days after use of DIPHOTERINE solution, 16 days after use of 3 % boric acid, and 21 days after the use of water. 

The DIPHOTERINE solution is able to change the pH of a corrosive solution quicker and under a volume much lower than water does, thus improving the return to an area of physiologically acceptable pH (experiments in vitro and ex vivo). 

Some studies have compared DIPHOTERINE solution with water or other flushing fluids. 

A Clinical Study in an Australian Facility Water Versus DIPHOTERINE Solution... 

The workers either chose to have decontamination alkali skin chemical splashes with water first (n=42) or DIPHOTERINE solution first (n=138). There were no statistically significant differences between the two groups for the TBSA involved or for the elapsed time between chemical splash and clinical assessment. The median TBSA was 1 %, although a maximum of 38 % TBSA was observed [246]. There was no difference between the groups in term of the length of time that an alkali was on the surface of the skin. 

The use of DIPHOTERINE solution first showed statistically significant (/7<0.001) better outcomes following alkali skin splashes than the use of water first. The signs of chemical skin injury were divided into four categories (Table 4.11) [246] ... 

Thus, no chemical skin injury developed in 52.9 % of the workers who used DIPHOTERINE solution first for skin decontamination compared to 21.4 % who used water first, and only 7.9 % of workers who used DIPHOTERINE solution first had blistering or more severe chemical skin injury signs compared to 23.8 % who used water first [246]. 

A Clinical Study In Germany Water, Acetic Acid Solution, and DIPHOTERINE Solution... 

The first was a study of 45 cases of sodium hydroxide or other strong bases (pH =14 or greater) in a German facility that produces aluminum oxide and aluminum hydroxide. A comparison was made between skin splash decontamination with water, acetic acid solution, and DIPHOTERINE solution. There was a significant reduction in lost work time with DIPHOTERINE solution decontamination as compared with the other two rinsing solutions, and no further treatment was required when DIPHOTERINE solution was utilized [249]. 

A third study was done in a French facility focusing on 5 predominant chanicals acrylates, 98 % sulfuric add, oleum, sodium hydroxide, and diethylaminoacrylate. The study involved 375 cases with 205 cases washed with water and 170 washed with DIPHOTERINE solution. When DIPHOTERINE solution washing was used as compared to water washing, there was a significantly (p <0.05) decreased incidence of lost work time (Table 4.12), a decreased incidence of longterm sequelae, and a nonsignificant (p < 0.1) trend for lesser needs to bum center consultations [249] (Table 4.12). 

An epidemiological study of 145 eye/skin splashes with a variety of chemical substances including acids, alkalis, oxidants, solvents, and glues self-reported by occupational physicians was conducted by the French INRS (Institut National de Recherche et de Security, or National Institute for Research and Safety) [250-252]. DIPHOTERINE solution was found to be efficacious for decontamination of acids and alkali eye/ skin splashes, and its combination with water washing did not improve efficacy [253, 254]. Outcome endpoints such as severity of chemical injury, lost work time, and requirement for treatment other than initial decontamination were all improved when DIPHOTERINE solution was utifized as the initial washing solution [250-252]. 

One hundred and sixty-one normal volunteers composed the study group [256], The volunteers underwent an induction period with either DIPHOTERINE solution or vehicle (water). Clinical examinations by blinded observers were conducted throughout the induction and elicitation phases of the study. 

For DIPHOTERINE solution, this Swedish Institute wrote The number of studies related to DIPHOTERINE is limited but a seemingly well-done study with systematic assessment of both exposure and health outcomes compares the results from initial treatments with water with that of DIPHOTERINE. The result clearly shows that DIPHOTERINE, at the surveyed workplaces, in comparison with water reduced the number of injuries in total, and also reduce the number with severe chemical bums. With the support from experimental studies and case reports, there is support for the positive effects of DIPHOTERINE for personal decontamination of strong acids and bases. ... 

As previously exposed, DIPHOTERINE solution protects the patient from hypothermia and would be preferred to water copious irrigation. 

To the main mechanical washing effect, DIPHOTERINE solution adds chelating and amphoteric abilities which aim to stop each of the six possible reactions with chemical substances (acid-base reaction, reduction/oxidation, chelation, addition, substitution, solvation). Its hypertonic property allows it to attract chemical product from tissues to the outside. The solution is applied with a spray or with a shower depending on the stroked area, even if previously an irrigation with water was done previonsly. Nevertheless, some anthors have shown that the better results are obtained when DIPHOTERINE solution is first applied. 

A male, 60 years old, driver of a maxitruck, transporting caustic soda. During unloading of his truck, he was splashed with caustic soda on the face. At the place of accident he was hrst washed with water and in inhrmary of the factory rinsed with DIPHOTERINE solution. He came to the bum center about 1 h after the accident. The face remains painful and we apply again DIPHOTERINE solution until pH come back to 7 and the pain disappears. 

Severity of cUnical signs DIPHOTERINE solution first Water first... 

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