“... oral ingestion by monkeys, chlorine dioxide was rapidly converted into chloride ion and, to a lesser extent, chlorite and chlorate.. In rats, excretion of chloride and, to a lesser extent, chlorite ion is mainly via the urine, smaller amounts being excreted in faeces... At typical low drinking-water levels, chlorine dioxide would be decomposed by oxidation–reduction reactions with saliva and stomach contents...” “Drinking-water containing chlorine dioxide at a concentration of 0, 10 or 100 mg/L (equivalent to approximately 0, 1.5 and 15 mg/kg bw per day) was administered to mice... with no apparent effects on blood parameters... “ “study with Sprague-Dawley rats at drinking-water concentrations ranging from 0 to 200 mg/L...enzymatic changes suggested liver toxicity; the principal effect was histopathology of nasal turbinates from inhalation of the gas. Although chlorine dioxide is water soluble, it is a gas at room temperature, so there can be difficulty in interpreting toxicity findings.” “In a 2-year study in rats at drinking-water concentrations up to 100 mg/L, the NOAEL was 10 mg/L (1.3 mg/kg bw per day)” "Currently, there is no readily available and low-cost treatment available to remove chlorate ion once it has been formed in drinking-water. "

"Neonates and persons with G-6-PD deficiency are likely to be unusually susceptible to MetHb formation from these compounds because their red cells lack the metabolic machinery to adequately protect against oxidant stress." "Since male blacks represent the largest population in the U.S. to be G-6-PD deficient, Black male neonates may represent the group at highest risk to the use of chlorine dioxide"."

****!!!! The use of chlorine dioxide (ClO[2] ) increased in the last year to prevent SARS-CoV-2 infection due to its use as disinfectant and therapeutic human treatments against viral infections. The absence of toxicological studies and sanitary regulation of ...

"Chlorination products measured at the clinic after this purification and prior to preparation of the dialysate consisted only of chlorite at the 0.02-0.08 mg/L level. No evidence of CIO2-induced anemia was found, nor were any other biologically significant responses observed."

"very limited human experience has failed to reveal adverse health effects. Further study, caution, and extreme vigilance are indicated, but dialysis patients in carefully controlled facilities may be at no greater risk than the general population."

"...the modulation of liver cytochrome P450-linked monooxygenases (MFO) and the genotoxic effects in erythrocytes of Cyprinus carpio fish exposed in situ to surface drinking water in the presence of ...chlorine dioxide (ClO2) ...were investigated in winter and summer." " In contrast, ClO2 generated the most notable inactivation, the CYP2E1-supported hydroxylation of p-nitrophenol being decreased up to 71% after 10 days’ treatment."

{Includes references to CD exams by various agencies} Following a request from the European Commission, the risks to human health related to the presence of chlorate in food were assessed by the EFSA Panel on Contaminants in the Food Chain (CONTAM Panel...

{includes safety limits for Chlorine Dioxide}

Alcide chlorine dioxide gel

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"the toxicity of ClO2 (0, 1, 10, 100, 1000 mg/l) and its metabolites, ClO3- and ClO3- (10, 100 mg/l) in drinking water in rats. After nine months treatment the osmotic fragility of the red blood cells was decreased in all treatment groups, while a decreased blood glutathione was only observed in the metabolite groups. At 2, 4 and 6 mon no significant hematologic changes were noted in treated rats compared to control. However, after 9 mon RBC counts, hematocrit and hemoglobin were decreased in all treatment groups. ClO2, ClO2- and ClO3- administered chronically in drinking water for three months inhibited the incorporation of 3H-thymidine into nuclei of rat testes. Also, this inhibition was observed in the liver of ClO2- groups and in the kidney of 100 mg/l ClO2- treatment. The incorporation in small intestinal nuclei was increased in both 10 and 100 mg/l ClO2 and in 10 mg/l ClO2-. The treatment with Cl-compounds decreased rat body weight in all groups after 10 and 11 months treatment. "

1981. "An epldemioiogic study of 198 persons exposed for 3 months to drinking water disinfected with chlorine dioxide was conducted in a rural village. A control population of 118 nonexposed persons was also studied. Pre-exposure hematologic and serum chemical parameters were compared with test results after 115 days of exposure. Chlorite ion levels In the water averaged approximately 5 ppm during the study period. Statistical analysis (ANOVA) of the data failed to identify any significant exposure-related effects. This study suggests that future evaluations of chlorine dioxide disinfection should be directed toward populations with potentially increased sensitivity to hemo-lytic agents"

****!!!!*** "Previous investigators have reported cardiovascular abnormalities in experimental animals exposed to chlorinated water. Plasma thyroxine (T4) levels were significantly decreased in pigeons fed a normal or high-cholesterol diet and drinking water containing these drinking water disinfectants at a concentration of 15 ppm for 3 months" "The factor(s) associated with the effect of these disinfectants on plasma T4 and cholesterol is not known. We suggest however that these effects are probably mediated by products formed when these disinfectants react with organic matter in the upper gastrointestinal tract."

"Bromate (BrO(3)(-)) is a drinking water disinfection by-product (DBP) that induces renal cell death via DNA damage-dependent and -independent mechanisms. Drinking water contains other DBPs in addition to BrO(3)(-). We tested the effect of two of these, sodium chlorite (NaClO(2)) and bromochloroaceti …"

"RSC for chlorite could be lower than 80% (which could potentially support lowering the MCLG) because there is more dietary exposure than previously assumed due to the increased use of chlorine dioxide and acidified sodium chlorite as disinfectants in the processing of foods" "chlorite and chlorine dioxide may share common health endpoints, namely hematological and thyroid effects" "chlorate levels above the health reference level of 210 µg/L occurred frequently in systems that use hypochlorite, chlorine dioxide or chloramines." "Chlorite (a regulated DBP) and chlorine dioxide (a disinfectant) are associated with methemoglobinemia, and for infants, young children and pregnant women, effects on the thyroid are also of concern."

Due to its very reactive nature, chlorine dioxide is rapidly (in a few hours) reduced to chlorite, which is persistent also as a biocide but 16 times less toxic to fish, according to MATC. Therefore, it is much more likely that fish will be exposed to chlorite than to chlorine dioxide in natural wat …

Chlorite, a by-product of chlorine dioxide disinfection of water, is a strong oxidant compound that produces markedly exaggerated effects in vitro on red cells of G6PD deficient humans when compared to normal human cells. Levels of methemoglobin are significantly greater and GSH levels significantly lower in the G6PD deficient cells than in normal cells after chlorite exposure. Persons with G6PD deficiency may be 3 to 4 times more likely to develop hemolytic anemia from chlorite exposure as persons with normal activity levels when GSH levels are used as a measure of susceptibility. The proposed use of chlorine dioxide as an alternate disinfectant for drinking water supplies should consider this potential high risk group. "

"ClO2 and its disinfection by-products, chlorite and chlorate. Deleterious effects of moderately high levels of these oxychlorines have been demonstrated experimentally on red blood cells, thyroid function, and development in laboratory animals. Adverse effects in controlled prospective studies in humans and in actual use situations in community water supplies have as yet failed to reveal clear evidence of adverse health effects. Among groups who may be at special risk from this suggested alternative are patients who must undergo chronic extracorporeal hemodialysis... Again, very limited human experience has failed to reveal adverse health effects... dialysis patients in carefully controlled facilities may be at no greater risk than the general population."

"An epidemiologic study of 198 persons exposed for 3 months to drinking water disinfected with chlorine dioxide was conducted in a rural village. A control population of 118 nonexposed persons was also studied. Pre-exposure hematologic and serum chemical parameters were compared with test results after 115 days of exposure. Statistical analysis (ANOVA) of the data failed to identify any significant exposure-related effects. "