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Al-Shami K, Almurabi S, Shatnawi J, Qasagsah K, Shatnawi G, Nashwan AJ. Ophthalmic Manifestations of Chlorine Gas Exposure: What Do We Know So Far? Cureus 2023; 15:e35590. [PMID: 37007383 PMCID: PMC10062433 DOI: 10.7759/cureus.35590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Chlorine gas is a hazardous substance that can cause severe health effects when inhaled or exposed to the skin. It is an odorless, colorless gas in many industrial and manufacturing settings and conflict areas. While exposure to chlorine gas is generally limited to the workplace and public areas, there are instances in which people may be exposed to high levels of chlorine gas for a short period of time due to spills, mishaps on the road or railroads, or other tragedies. In addition to the general health effects of chlorine gas, this essay will focus on the effects of chlorine gas on the eyes. The eyes are particularly sensitive to chlorine gas, and exposure can cause various symptoms, ranging from mild irritation to severe damage. Symptoms of chlorine gas exposure to the eyes include redness, burning, tearing, and blurred vision. In more serious cases, exposure to chlorine gas can cause permanent damage to the eyes, including corneal ulcers, scarring, and blindness. It is important to be aware of the signs and symptoms of chlorine gas exposure and the potential long-term effects to take the necessary steps to protect oneself. In addition to the potential health effects, it is important to understand the properties of chlorine gas. Chlorine gas is heavier than air and tends to settle in low-lying areas. It is highly reactive and can react with other substances to form hazardous compounds. As such, it is important to be aware of the potential for chlorine gas to react with other environmental substances and accumulate in certain areas. Finally, it is important to understand the background of chlorine gas use in various conflict areas. Chlorine gas has been used as a chemical weapon for centuries, and its use in modern warfare has been documented in various conflicts. As such, it is important to be aware of the potential for chlorine gas to be used in war zones and to take the necessary precautions to protect oneself. In conclusion, chlorine gas is a hazardous substance that can cause severe health effects when inhaled or exposed to the skin. The eyes are particularly sensitive to chlorine gas, and exposure can cause various symptoms, ranging from mild irritation to severe damage. It is important to be aware of the signs and symptoms of chlorine gas exposure and the potential long-term effects to take the necessary steps to protect oneself. Additionally, it is important to understand chlorine gas's properties and its background use in various conflict areas.
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Warren B, Royall N, Smith H, Bhullar IS. Novel Treatment of Acute Respiratory Distress Syndrome after Chlorine Gas Inhalation Injury. Am Surg 2016. [DOI: 10.1177/000313481608200818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Brittany Warren
- Department of Surgery Orlando Regional Medical Center Orlando, Florida
| | - Nelson Royall
- Department of Surgery Orlando Regional Medical Center Orlando, Florida
| | - Howard Smith
- Department of Surgery Orlando Regional Medical Center Orlando, Florida
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Massa CB, Scott P, Abramova E, Gardner C, Laskin DL, Gow AJ. Acute chlorine gas exposure produces transient inflammation and a progressive alteration in surfactant composition with accompanying mechanical dysfunction. Toxicol Appl Pharmacol 2014; 278:53-64. [PMID: 24582687 DOI: 10.1016/j.taap.2014.02.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/29/2014] [Accepted: 02/04/2014] [Indexed: 12/17/2022]
Abstract
Acute Cl2 exposure following industrial accidents or military/terrorist activity causes pulmonary injury and severe acute respiratory distress. Prior studies suggest that antioxidant depletion is important in producing dysfunction, however a pathophysiologic mechanism has not been elucidated. We propose that acute Cl2 inhalation leads to oxidative modification of lung lining fluid, producing surfactant inactivation, inflammation and mechanical respiratory dysfunction at the organ level. C57BL/6J mice underwent whole-body exposure to an effective 60ppm-hour Cl2 dose, and were euthanized 3, 24 and 48h later. Whereas pulmonary architecture and endothelial barrier function were preserved, transient neutrophilia, peaking at 24h, was noted. Increased expression of ARG1, CCL2, RETLNA, IL-1b, and PTGS2 genes was observed in bronchoalveolar lavage (BAL) cells with peak change in all genes at 24h. Cl2 exposure had no effect on NOS2 mRNA or iNOS protein expression, nor on BAL NO3(-) or NO2(-). Expression of the alternative macrophage activation markers, Relm-α and mannose receptor was increased in alveolar macrophages and pulmonary epithelium. Capillary surfactometry demonstrated impaired surfactant function, and altered BAL phospholipid and surfactant protein content following exposure. Organ level respiratory function was assessed by forced oscillation technique at 5 end expiratory pressures. Cl2 exposure had no significant effect on either airway or tissue resistance. Pulmonary elastance was elevated with time following exposure and demonstrated PEEP refractory derecruitment at 48h, despite waning inflammation. These data support a role for surfactant inactivation as a physiologic mechanism underlying respiratory dysfunction following Cl2 inhalation.
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Affiliation(s)
- Christopher B Massa
- Department of Pharmacology & Toxicology, Ernest Mario School of Pharmacy, Rutgers University, USA
| | - Pamela Scott
- Department of Pharmacology & Toxicology, Ernest Mario School of Pharmacy, Rutgers University, USA
| | - Elena Abramova
- Department of Pharmacology & Toxicology, Ernest Mario School of Pharmacy, Rutgers University, USA
| | - Carol Gardner
- Department of Pharmacology & Toxicology, Ernest Mario School of Pharmacy, Rutgers University, USA
| | - Debra L Laskin
- Department of Pharmacology & Toxicology, Ernest Mario School of Pharmacy, Rutgers University, USA
| | - Andrew J Gow
- Department of Pharmacology & Toxicology, Ernest Mario School of Pharmacy, Rutgers University, USA.
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Popa A, Li J, Samia ACS. Hybrid platinum nanobox/carbon nanotube composites for ultrasensitive gas sensing. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2013; 9:3928-3933. [PMID: 23828860 DOI: 10.1002/smll.201203260] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 03/12/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Adriana Popa
- Department of Chemistry, Case Western Reserve University, 10900 Euclid Ave. Cleveland, Ohio 44106, USA
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Price JA, Rogers JV, Plahovinsak JL, Wendling MQS, Perry MR, Reid FM, Graham JS. Toxicogenomic analysis of chlorine vapor-induced porcine skin injury. Cutan Ocul Toxicol 2012; 31:323-31. [PMID: 22533443 DOI: 10.3109/15569527.2012.679374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Chlorine is an industrial chemical that can cause cutaneous burns. Understanding the molecular mechanisms of tissue damage and wound healing is important for the selection and development of an effective post-exposure treatment. This study investigated the effect of cutaneous chlorine vapor exposure using a weanling swine burn model and microarray analysis. Ventral abdominal sites were exposed to a mean calculated chlorine vapor concentration of 2.9 g/L for 30 min. Skin samples were harvested at 1.5 h, 3 h, 6 h, and 24 h post-exposure and stored in RNAlater(®) until processing. Total RNA was isolated, processed, and hybridized to Affymetrix GeneChip(®) Porcine Genome Arrays. Differences in gene expression were observed with respect to sampling time. Ingenuity Pathways Analysis revealed seven common biological functions among the top ten functions of each time point, while canonical pathway analysis revealed 3 genes (IL-6, IL1A, and IL1B) were commonly shared among three significantly altered signaling pathways. The transcripts encoding all three genes were identified as common potential therapeutic targets for Phase II/III clinical trial, or FDA-approved drugs. The present study shows transcriptional profiling of cutaneous wounds induced by chlorine exposure identified potential targets for developing therapeutics against chlorine-induced skin injury.
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Acute health effects after exposure to chlorine gas released after a train derailment. Am J Emerg Med 2009; 27:1-7. [PMID: 19041527 DOI: 10.1016/j.ajem.2007.12.006] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 12/05/2007] [Accepted: 12/08/2007] [Indexed: 11/22/2022] Open
Abstract
In January 2005, a train derailment on the premises of a textile mill in South Carolina released 42 to 60 tons of chlorine gas in the middle of a small town. Medical records and autopsy reports were reviewed to describe the clinical presentation, hospital course, and pathology observed in persons hospitalized or deceased as a result of chlorine gas exposure. Eight persons died before reaching medical care; of the 71 persons hospitalized for acute health effects as a result of chlorine exposure, 1 died in the hospital. The mean age of the hospitalized persons was 40 years (range, 4 months-76 years); 87% were male. The median duration of hospitalization was 4 days (range, 1-29 days). Twenty-five (35%) persons were admitted to the intensive care unit; the median length of stay was 3 days. Many surviving victims developed significant pulmonary signs and severe airway inflammation; 41 (58%) hospitalized persons met PO2/FiO2 criteria for acute respiratory distress syndrome or acute lung injury. During their hospitalization, 40 (57%) developed abnormal x-ray findings, 74% of those within the first day. Hypoxia on room air and PO2/FiO2 ratio predicted severity of outcome as assessed by the duration of hospitalization and the need for intensive care support. This community release of chlorine gas caused widespread exposure and resulted in significant acute health effects and substantial health care requirements. Pulse oximetry and arterial blood gas analysis provided early indications of outcome severity.
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Abstract
INTRODUCTION An incident involving the release of chlorine gas from the pump room at a local swimming pool resulted in 54 patients seeking treatment in the emergency departments (EDs) of two local, tertiary-level hospitals in Singapore. The hospital hazardous materials (HAZMAT) disaster plan was activated. This report describes how one of the EDs organized in response to the disaster. EVENT Of the 54 people seeking treatment, 36 were treated in the ED at the Singapore General Hospital. The patients were decontaminated at shower facilities prior to entering the ED. The ED was reorganized to cope with existing patients, as well as the large influx of patients from the event site. A protocol was established in coordination with the local drug and poison information center to manage the patients who suffered from chlorine inhalation. Most patients were observed in the ED and subsequently discharged. Outpatient review appointments were scheduled. INJURIES Acute respiratory symptoms were the most common symptoms., Four children and four adults were admitted to the hospital, and the other patients were discharged from the ED after observation. All of the chest x-rays were normal on the day of the chlorine inhalation. There were no mortalities or significant morbidities, even up to six months after the incident. CONCLUSIONS Although this chlorine HAZMAT incident did not cause severe injuries, and only a limited number of persons required admission to the hospital, some valuable lessons were learned.
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Affiliation(s)
- Adeline Ngo
- Department of Emergency Medicine, Singapore General Hospital, Singhealth, Singapore.
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Sexton JD, Pronchik DJ. Chlorine inhalation: the big picture. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 1998; 36:87-93. [PMID: 9541051 DOI: 10.3109/15563659809162593] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Causes of acute chlorine exposures from community pool accidents have many reported etiologies. This case series involves 13 children exposed to high levels of chlorine at two community pools after an unusual mishap in the chlorination maintenance procedure. CASE REPORT During maintenance, the water feeding lines to pools are normally turned off, the chemicals replaced, the water turned back on, and the chemicals then reinjected into the line. In two separate disasters in the summer of 1996, the feeding lines were not reprimed with water before the reactants, sodium hypochlorite and muriatic acid, were injected. This caused an unusually high volume of concentrated chlorinated water to be released when refed to the pool. RESULTS All patients were treated with beta agonists and humidified oxygen, and five were admitted. None received bicarbonate inhalation. An extensive literature review of chlorine inhalation injuries indicates considerable variance in opinions of the pathophysiology, clinical presentation and treatment modalities, especially steroids and bicarbonate inhalation. CONCLUSION In community pools, failure to reprime feeding lines with water after replacing and injecting chlorinating reactants may result in severe and large-scale chlorine exposures. Beta agonist administration and humidified oxygen remains the mainstay of treatment; steroid therapy and bicarbonate inhalation are still inadequately supported.
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Affiliation(s)
- J D Sexton
- Emergency Medicine Residency of the Lehigh Valley, St. Luke's Hospital, Bethlehem, Pennsylvania 18015, USA.
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Bosse GM. Nebulized sodium bicarbonate in the treatment of chlorine gas inhalation. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 1994; 32:233-41. [PMID: 8007031 DOI: 10.3109/15563659409017956] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In this two year retrospective review, 86 cases of chlorine gas inhalation from 49 medical facilities were treated with nebulized sodium bicarbonate on the recommendation of the Kentucky Regional Poison Center. Typical manifestations included cough, chest discomfort, shortness of breath, and wheezing. No patients developed pulmonary edema or respiratory insufficiency requiring ventilatory support. Sixty-three cases (73.3%) were exposures to chlorine producing acid/hypochlorite mixtures. Six (7.0%) were exposed to chlorine gas in industrial settings. Twelve (14.0%) were exposed to chlorine gas in swimming pool settings. Sixty-nine (80.2%) were treated and released from the emergency department. In 53 patients, clinical condition was clearly improved on emergency department discharge. Seventeen (19.8%) were admitted to the hospital. All admitted patients gradually improved and had a mean hospital stay of 1.4 days (range 1 to 3 days). No patients in this study deteriorated clinically after nebulized sodium bicarbonate use. Nebulized sodium bicarbonate appears safe and merits prospective evaluation in the therapy of chlorine gas inhalation.
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Affiliation(s)
- G M Bosse
- Department of Emergency Medicine, University of Louisville, Kentucky
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Abstract
Three male patients, 19 to 20 years old, were exposed to chlorine gas secondary to a leak in the chlorination system of an indoor pool. All of the patients were symptomatic with cough, chest pain, and shortness of breath. Physical examinations, arterial blood gases, and chest radiographs were normal. All patients were given a nebulized solution of 3.75% sodium bicarbonate which resulted in prompt relief of their symptoms. None of the patients suffered from prolonged symptomatology. This therapy appears to be useful in treating chlorine gas inhalation; however, it cannot be routinely recommended without prospective clinical studies evaluating its efficacy and safety.
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Affiliation(s)
- P J Vinsel
- Emergency Medicine Residency, Darnall Army Community Hospital, Ft. Hood, TX 76544
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Givan DC, Eigen H, Tepper RS. Longitudinal evaluation of pulmonary function in an infant following chlorine gas exposure. Pediatr Pulmonol 1989; 6:191-4. [PMID: 2717244 DOI: 10.1002/ppul.1950060313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- D C Givan
- Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana 46223
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Abstract
Chlorine gas inhalation is usually accompanied by pulmonary toxicity and hypoxemia; the associated acidemia, when present, has been attributed to lactic acidosis. This case report describes the development of hyperchloremic metabolic acidosis following accidental chlorine gas exposure. The mechanism postulated for the production of this acidosis is the absorption of hydrochloric acid following the reaction of chlorine gas with tissue water. This may be the first case of chlorine toxicity in which the mechanism of the acidosis has been determined.
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