title: Considerable exposure to the endocrine disrupting chemicals phthalates and bisphenol-A in intensive care unit (ICU) patients.
abstract: Critical care medicine has largely benefited from plastic-containing medical devices. However, bisphenol-A (BPA) and phthalates present in the plastics can leach from such devices. We hypothesized that intensive care unit (ICU) patients are exposed to BPA and phthalates through (plastic) medical devices. Serum (n = 118) and urine (n= 102) samples of adult ICU patients (n = 35) were analyzed for total BPA and phthalate metabolites (PMs). Our results showed that adult ICU patients are continuously exposed to phthalates, such as di(2-ethylhexyl)phthalate (DEHP), as well as to BPA, albeit to a lesser extent. This exposure resulted in detectable high serum and urinary levels in almost every patient and at every studied time point. Moreover, these levels were significantly higher than in controls or compared to referenced literature. The chronology of exposure was demonstrated: pre-operative urinary and serum levels of the DEHP metabolites were often below the detection limit. Plastic-containing medical devices were the main source of DEHP exposure: post-operative patients on hemofiltration, extracorporeal membrane oxygenation or both showed serum levels 100-or 1000-fold higher than the levels in the general population reported in the literature. The serum and some of the urinary levels of the DEHP metabolites are the highest ever reported in humans; some at biologically highly relevant concentrations of ≥ 10-50 μM. Despite the continuously tightening regulations, BPA and DEHP appear to be still present in (some) medical devices. Because patient safety is a concern in the ICU, further research into the (possibly toxic and clinical) effects of these chemicals released from medical devices is imperiously necessary.
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Huygh
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Belgium.
authors.forename: Katrien
authors.initials: K
authors.lastname: Clotman
authors.affiliation: Toxicological Centre, University of Antwerp, Belgium.
authors.forename: Govindan
authors.initials: G
authors.lastname: Malarvannan
authors.affiliation: Toxicological Centre, University of Antwerp, Belgium.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covaci
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Schepens
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: Verbrugghe
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Belgium.
authors.forename: Eveline
authors.initials: E
authors.lastname: Dirinck
authors.affiliation: Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, University of Antwerp, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Van Gaal
authors.affiliation: Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Belgium; Toxicological Centre, University of Antwerp, Belgium. Electronic address: Philippe.Jorens@uza.be.
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Jorens
mesh_terms: D000328:Adult; D000368:Aged; D001559:Benzhydryl Compounds / Q000097:blood / Q000652:urine; D004051:Diethylhexyl Phthalate / Q000097:blood / Q000652:urine; D052244:Endocrine Disruptors / Q000097:blood / Q000652:urine; D004781:Environmental Exposure / Q000032:analysis*; D004785:Environmental Pollutants / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D010636:Phenols / Q000097:blood / Q000652:urine; D010969:Plastics; D000098826:Bisphenol A Compounds
chemical_list: D001559:Benzhydryl Compounds; D004051:Diethylhexyl Phthalate; D052244:Endocrine Disruptors; D004785:Environmental Pollutants; D010636:Phenols; D010969:Plastics; C006780:bisphenol A; D000098826:Bisphenol A Compounds
keywords: Adult; Bisphenol-A; Critical care; Endocrine disruption; Phthalates; Plastics