FAQ – Frequently Asked Questions about Diphoterine® solution

The DIPHOTERINE® solution is a polyvalent, hypertonic, amphoteric, chelating agent for emergent decontamination of eye/skin chemical splashes. It is supplied as a sterile solution in water. When utilized during the initial minute following the splash and with the total quantity delivered from the application device, external decontamination with the DIPHOTERINE® solution has the objective of preventing or minimizing the appearance of lesions, and thus the risks of sequelae.

The DIPHOTERINE® solution has active binding sites and as an amphoteric compound can bind chemically opposite compounds such as acids-bases, oxidizers-reducing agents, etc. It is a chelating compound. Its hypertonicity also aids in setting up an osmotic gradient which can stop the penetration of chemicals and assist in removing chemicals which have already penetrated.

The DIPHOTERINE® solution is hypertonic in order to stop and avoid the penetration of the chemicals into the tissues. An hyperosmolar pressure creates a flux from the inside to the outside of the tissues: the chemicals are then pulled out from the inside of the tissues to their surface, skin or eye. With an hypertonic solution, the decontamination is then accelerated.

An amphoteric compound is one capable of binding (and thus decontaminating) opposing chemical substances such as acids-bases or oxidizers-reducing agents. The rinsing with an amphoteric solution such as the DIPHOTERINE® solution allows a quick return to a physiological state and has the objective of securing the result of the rinsing.

Yes, the DIPHOTERINE® solution is a chelator. It can chelate radionuclides such as strontium, cobalt, cesium or uranium. It can chelate anions such as oxalate, but doesn’t chelate calcium or magnesium. {slilder 6. What are the demonstrated advantages of the DIPHOTERINE® solution regarding efficacy ?} The DIPHOTERINE® solution is polyvalent. As such, it is effective against a very wide range of chemicals/chemical groups (over 600 tested in vitro), including acids, bases, oxidizers, reducing agents, irritants, solvents, and lacrimators. It is thus a logical choice for use in decontaminating unknown chemical splashes.

• The DIPHOTERINE® solution is non-toxic (LD50 > 2,000 mg/kg oral/skin in experimental animals). No toxicity has been reported in human workplace use despite the fact that the manufacturer has had an active pharmacovigilance program.
• No mutagenic effect was detected by Ames test.
• The DIPHOTERINE® solution itself and its reaction residues with strong acid and base are not irritating in rabbit eyes. It was not irritating to the eyes of normal human volunteers. No adverse effects have been reported following its use in industrial accidents. In guinea pigs, the DIPHOTERINE® solution was not a skin sensitizer.
• In ecotoxicity tests, it was non-toxic to standard test organisms.

The DIPHOTERINE® solution is recommended for skin/eye decontamination of nearly all chemical substances, such as acids, bases, oxidizers, reducing agents, and solvents.

a) The DIPHOTERINE® solution has limited efficiency on hydrofluoric acid (HF) and fluorides in acidic environment. The DIPHOTERINE® solution is not recommended for white phosphorous decontamination.

b) Rinsing with the DIPHOTERINE® solution is most efficacious when used as soon as possible after the skin/eye chemical exposure (within the first minute). The longer the delay to use the DIPHOTERINE® solution, the less likely it is to prevent or decrease the severity of the burn. Delayed use of the DIPHOTERINE® solution can stop the action of the chemical product and specific treatment will be necessary to improve wound healing.
Once the exposed skin/eye tissue cells have been destroyed by the splashed chemical, the DIPHOTERINE® solution can no longer be efficacious.

• The DIPHOTERINE® solution is not currently recommended for first aid response to purely thermal burns. There are proposals to test it for this use. Combined thermal/chemical burns from chemicals used at high temperatures may well benefit from initial DIPHOTERINE® solution decontamination.
• It is recommended to first decontaminate the chemical burn and then to treat the thermal burn.

Because it is a chelator, the DIPHOTERINE® solution can be used to decontaminate metals (as well as radionuclides such as uranium-238, cesium-137, strontium/yttrium-90, and cobalt-60). For dusts and other chemically inert substances, the DIPHOTERINE® solution is supplied as a sterile water-based solution and thus has dilutional and mechanical rinsing activity. However, AFTERWASHII®, a comfort isotonic rinsing solution, is more appropriated for dusts and other chemically inert substances.

The DIPHOTERINE® solution can be used to efficiently rinse solid active chemicals. Case reports have been described for pellets of sodium hydroxide following an eye exposure.
The DIPHOTERINE® solution rinsing allows dilution of the pellets and, at the same time, to neutralize them, avoiding or stopping the chemical burn, depending on the contact time.
The use of the DIPHOTERINE® solution is not appropriated for white phosphorous exposures.

Nothing. The DIPHOTERINE® solution is non-toxic and not irritating. It is not a sensitizer.

The DIPHOTERINE® solution is being studied for decontamination of caustic ingestions in a pig model. Preliminary data indicate that it can be efficacious in this setting. It is not currently recommended for this purpose in humans. The DIPHOTERINE® solution is non-toxic as the oral LD50 is greater than 2000 mg/Kg.

In INRS studies, it was found that using water or normal saline either before or after the DIPHOTERINE® solution resulted in a worse outcome than if the DIPHOTERINE® solution was used alone. Theoretically, this is because using water or saline first delays the use of the active decontamination compound and using water or saline after the DIPHOTERINE® solution washes the active decontamination compound off the skin or out of the eye.

The DIPHOTERINE® solution is optimally utilized as soon as possible after the skin/eye chemical exposure and in sufficient volume. Workers/rescuers must be trained to use the entire volume of the appropriate size container.

Because the DIPHOTERINE® solution very rapidly relieves pain once decontamination is started, the use of the total appropriate volume must be an important and frequently emphasized subject of worker/rescuer training.

The DIPHOTERINE® solution should be used as soon as possible after nearly all skin/eye chemical splashes.

Because it is active against a very wide variety of chemical substances, the DIPHOTERINE® solution is particularly well-suited for use with unknown chemical exposures.

No. The DIPHOTERINE® solution has no physiological action on the eye or the skin.

It is registered as a Medical Device in Europe.

• AFTERWASHII® is a comfort rinsing solution, isotonic to the tears. It can be used after the DIPHOTERINE® rinsing to return to a physiological state or directly to rinse chemically inert dusts.
• The TRIVOREX® powder is a solid material for absorption and active decontamination of a wide variety of chemical products spilled in the workplace or environment (not for use on humans).
• As PREVOR Laboratory specializes in chemical risks,
  – books are published and available in French on Chemical risk and Health assessment, solvent prevention, MSDS interpretation and organization,

– Training sessions are regularly organized in Paris for all prevention workers and specialists, on evaluation and prevention of chemical risks at the workplace.

The 2-year shelf-life is to ensure :

• that the product is replaced before it loses its sterility
• that the washing solution conserves all of its properties
• that the dispenser remains functional and retains optimal reliability for the end users

A gel form of the DIPHOTERINE® solution has been produced and is undergoing testing for a variety of potential uses, especially for esophago-gastrointestinal burns. It is not currently commercially available.

The DIPHOTERINE® solution neutralizes the splashed chemical actively. It and its strong caustic decontamination residues are non-toxic and not ecotoxic. Used DIPHOTERINE® solution can be disposed of in the sanitary sewer system (unlike water decontamination solutions which will still have active chemical(s) present and should be disposed of as hazardous waste).

The AFTERWASHII® assists in restoring the normal physiological state of the cornea after the DIPHOTERINE® solution decontamination. It is also designed for rinsing of chemical inert dusts.

PREVOR put its system of patented eye washes on the market in order to fulfil various requirements, in particular those related to the principle of emergency washing in the workplace:

• To allow any victim to begin washing alone;
• To allow the victim to correctly open the eye in order to make an effective washing;
• To allow continuous and uniformly distributed washing of the cornea surface.

The possibility of using the Morgan lens had been considered but dismissed, following various tests showing:

• The difficulty of installing the lens in emergency situations, where the intervention time is limited;
• A washing insufficiently uniform to be effective and a reproducible in all cases.

It is for these reasons that PREVOR conceived, developed and patented its own system of a specific eyebath.

The Morgan lens device is in particular designed to deliver the washing solution in the absence of medical personnel. This device could thus have an advantage in the case of a patient with multiple injuries or for the medical management of a large number of patients.
However, the ophthalmologists consulted do not recommend the use of the Morgan lens to carry out ocular washing following a chemical splash because the result is not likely to be sufficiently homogeneous. It has indeed already been noted that when the Morgan lens is used, the washing fluid follows the channels and that created zones which were not irrigated by the instilled solution. However, to be effective in the washing of a chemical projection, it is necessary to irrigate the totality of the cornea and the conjunctival cul-de-sacs. We thus believe that the Morgan lens cannot guarantee the same advantages as manual washing carried out carefully by a specialist.

Nota :
Description of the Morgan lens:
Tube connected to a perforated lens.
Diameter of the tube < 2 mm
Polystyrene lens glued to a tube.

Ophthalmologists consulted:
Dr Norbert Schrage, Clinique Ophtalmologique de Merheim
Dr Harold Merle, Centre Hospitalier de Fort de France

The DIPHOTERINE® solution, which acts directly on the chemical, permits a quick reduction in the sensation of pain. The anaesthetic is thus, in practice, often of no use. Its possible use in the protocol of certain companies or in a hospital environment under medical ophthalmologic supervision could have only a complementary synergistic effect.