Chlorine poisoning | |
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Other names | Chlorine gas toxicity |
Specialty | Emergency medicine |
Chlorine gas poisoning is an illness resulting from the effects of exposure to chlorine beyond the threshold limit value.
The signs of acute chlorine gas poisoning are primarily respiratory, and include difficulty breathing and cough; listening to the lungs will generally reveal crackles. There will generally be sneezing, nose irritation, burning sensations, and throat irritations. There may also be skin irritations or chemical burns and eye irritation or conjunctivitis. A person with chlorine gas poisoning may also have nausea, vomiting, or a headache. [1] [2] [3]
Chronic exposure to relatively low levels of chlorine gas may cause pulmonary problems like acute wheezing attacks, chronic cough with phlegm, and asthma. [2]
Occupational exposures constitute the highest risk of toxicity and common domestic exposures result from the mixing of chlorine bleach with acidic washing agents such as acetic, nitric or phosphoric acid. They also occur as a result of the chlorination of table water. Other exposure risks occur during industrial or transportation accidents. Wartime exposure is rare. [2] [3]
Humans can smell chlorine gas at ranges from 0.1–0.3 ppm. According to a review from 2010: "At 1–3 ppm, there is mild mucous membrane irritation that can usually be tolerated for about an hour. At 5–15 ppm, there is moderate mucous membrane irritation. At 30 ppm and beyond, there is immediate chest pain, shortness of breath, and cough. At approximately 40–60 ppm, a toxic pneumonitis and/or acute pulmonary edema can develop. Concentrations of about 400 ppm and beyond are generally fatal over 30 minutes, and at 1,000 ppm and above, fatality ensues within only a few minutes." [2]
The concentration of the inhaled gas and duration of exposure and water contents of the tissues exposed are the key determinants of toxicity; moist tissues like the eyes, throat, and lungs are the most susceptible to damage. [4]
Once inhaled, chlorine gas diffuses into the epithelial lining fluid (ELF) of the respiratory epithelium and may directly interact with small molecules, proteins and lipids there and damage them, or may hydrolyze to hypochlorous acid and hydrochloric acid which in turn generate chloride ions and reactive oxygen species; the dominant theory is that most damage is via the acids. [2] [3] [5] [6]
Tests performed to confirm chlorine gas poisoning and monitor patients for supportive care include pulse oximetry, testing serum electrolyte, blood urea nitrogen (BUN), and creatinine levels, measuring arterial blood gases, chest radiography, electrocardiogram (ECG), pulmonary function testing, and laryngoscopy or bronchoscopy. [3]
There is no antidote for chlorine poisoning; management is supportive after evacuating people from the site of exposure and flushing exposed tissues. For lung damage caused by inhalation, oxygen and bronchodilators may be administered. [6]
There is no way to predict outcomes. Most people with mild to moderate exposure generally recover fully in three to five days, but some develop chronic problems such as reactive airway disease. Smoking or pre-existing lung conditions like asthma appear to increase the risk of long term complications. [1]
In 2014, the American Association of Poison Control Centers reported about 6,000 exposures to chlorine gas in the US in 2013, compared with 13,600 exposures to carbon monoxide, which was the most common poison gas exposure; [7] the year before they reported about 5,500 cases of chlorine gas poisoning compared with around 14,300 cases of carbon monoxide poisoning. [8]
There have been many instances of mass chlorine gas poisonings in industrial accidents.
Phosgene is an organic chemical compound with the formula COCl2. It is a toxic, colorless gas; in low concentrations, its musty odor resembles that of freshly cut hay or grass. It can be thought of chemically as the double acyl chloride analog of carbonic acid, or structurally as formaldehyde with the hydrogen atoms replaced by chlorine atoms. Phosgene is a valued and important industrial building block, especially for the production of precursors of polyurethanes and polycarbonate plastics.
Methyl isocyanate (MIC) is an organic compound with the molecular formula CH3NCO. Synonyms are isocyanatomethane and methyl carbylamine. Methyl isocyanate is an intermediate chemical in the production of carbamate pesticides (such as carbaryl, carbofuran, methomyl, and aldicarb). It has also been used in the production of rubbers and adhesives. As an extremely toxic and irritating compound, it is very hazardous to human health. MIC was the principal toxicant involved in the Bhopal gas disaster, which short-term killed 4,000–8,000 people and caused permanent injury and premature deaths to tens of thousands more. It is also a very potent lachrymatory agent.
Hydrogen sulfide is a chemical compound with the formula H2S. It is a colorless chalcogen-hydride gas, and is poisonous, corrosive, and flammable, with trace amounts in ambient atmosphere having a characteristic foul odor of rotten eggs. Swedish chemist Carl Wilhelm Scheele is credited with having discovered the chemical composition of purified hydrogen sulfide in 1777.
Nitrogen dioxide is a chemical compound with the formula NO2. One of several nitrogen oxides, nitrogen dioxide is a reddish-brown gas. It is a paramagnetic, bent molecule with C2v point group symmetry. Industrially, NO2 is an intermediate in the synthesis of nitric acid, millions of tons of which are produced each year, primarily for the production of fertilizers.
Vinyl chloride is an organochloride with the formula H2C=CHCl. It is also called vinyl chloride monomer (VCM) or chloroethene. This colorless compound is an important industrial chemical chiefly used to produce the polymer polyvinyl chloride (PVC). Vinyl chloride monomer is among the top twenty largest petrochemicals (petroleum-derived chemicals) in world production. The United States remains the largest vinyl chloride manufacturing region because of its low-production-cost position in chlorine and ethylene raw materials. China is also a large manufacturer and one of the largest consumers of vinyl chloride. Vinyl chloride is a flammable gas that has a sweet odor and is carcinogenic. It can be formed in the environment when soil organisms break down chlorinated solvents. Vinyl chloride that is released by industries or formed by the breakdown of other chlorinated chemicals can enter the air and drinking water supplies. Vinyl chloride is a common contaminant found near landfills. Before the 1970s, vinyl chloride was used as an aerosol propellant and refrigerant.
Carbon monoxide poisoning typically occurs from breathing in carbon monoxide (CO) at excessive levels. Symptoms are often described as "flu-like" and commonly include headache, dizziness, weakness, vomiting, chest pain, and confusion. Large exposures can result in loss of consciousness, arrhythmias, seizures, or death. The classically described "cherry red skin" rarely occurs. Long-term complications may include chronic fatigue, trouble with memory, and movement problems.
Ethylbenzene is an organic compound with the formula C6H5CH2CH3. It is a highly flammable, colorless liquid with an odor similar to that of gasoline. This monocyclic aromatic hydrocarbon is important in the petrochemical industry as a reaction intermediate in the production of styrene, the precursor to polystyrene, a common plastic material. In 2012, more than 99% of ethylbenzene produced was consumed in the production of styrene.
Chemical pneumonitis is inflammation of the lung caused by aspirating or inhaling irritants. It is sometimes called a "chemical pneumonia", though it is not infectious. There are two general types of chemical pneumonitis: acute and chronic.
Hyperoxia occurs when cells, tissues and organs are exposed to an excess supply of oxygen (O2) or higher than normal partial pressure of oxygen.
Abrin is an extremely toxic toxalbumin found in the seeds of the rosary pea, Abrus precatorius. It has a median lethal dose of 0.7 micrograms per kilogram of body mass when given to mice intravenously. The median toxic dose for humans ranges from 10 to 1000 micrograms per kilogram when ingested and is 3.3 micrograms per kilogram when inhaled.
Smoke inhalation is the breathing in of harmful fumes through the respiratory tract. This can cause smoke inhalation injury which is damage to the respiratory tract caused by chemical and/or heat exposure, as well as possible systemic toxicity after smoke inhalation. Smoke inhalation can occur from fires of various sources such as residential, vehicle, and wildfires. Morbidity and mortality rates in fire victims with burns are increased in those with smoke inhalation injury. Victims of smoke inhalation injury can present with cough, difficulty breathing, low oxygen saturation, smoke debris and/or burns on the face. Smoke inhalation injury can affect the upper respiratory tract, usually due to heat exposure, or the lower respiratory tract, usually due to exposure to toxic fumes. Initial treatment includes taking the victim away from the fire and smoke, giving 100% oxygen at a high flow through a face mask, and checking the victim for injuries to the body. Treatment for smoke inhalation injury is largely supportive, with varying degrees of consensus on benefits of specific treatments.
Benzotrichloride (BTC), also known as α,α,α-trichlorotoluene, phenyl chloroform or (trichloromethyl)benzene, is an organic compound with the formula C6H5CCl3. Benzotrichloride is an unstable, colorless or somewhat yellowish, viscous, chlorinated hydrocarbon with a penetrating odor. Benzotrichloride is used extensively as a chemical intermediate for products of various classes, i.e. dyes and antimicrobial agents.
Acute beryllium poisoning is acute chemical pneumonitis resulting from the toxic effect of beryllium in its elemental form or in various chemical compounds, and is distinct from berylliosis. After occupational safety procedures were put into place following the realization that the metal caused berylliosis around 1950, acute beryllium poisoning became extremely rare.
Inhalation is a major route of exposure that occurs when an individual breathes in polluted air which enters the respiratory tract. Identification of the pollutant uptake by the respiratory system can determine how the resulting exposure contributes to the dose. In this way, the mechanism of pollutant uptake by the respiratory system can be used to predict potential health impacts within the human population.
Acute inhalation injury may result from frequent and widespread use of household cleaning agents and industrial gases. The airways and lungs receive continuous first-pass exposure to non-toxic and irritant or toxic gases via inhalation. Irritant gases are those that, on inhalation, dissolve in the water of the respiratory tract mucosa and provoke an inflammatory response, usually from the release of acidic or alkaline radicals. Smoke, chlorine, phosgene, sulfur dioxide, hydrogen chloride, hydrogen sulfide, nitrogen dioxide, ozone, and ammonia are common irritants.
The use of electronic cigarettes (vaping) carries health risks. The risk depends on the fluid and varies according to design and user behavior. In the United Kingdom, vaping is considered by some to be around 95% less harmful than tobacco after a controversial landmark review by Public Health England.
Nitrogen dioxide poisoning is the illness resulting from the toxic effect of nitrogen dioxide. It usually occurs after the inhalation of the gas beyond the threshold limit value. Nitrogen dioxide is reddish-brown with a very harsh smell at high concentrations, at lower concentrations it is colorless but may still have a harsh odour. Nitrogen dioxide poisoning depends on the duration, frequency, and intensity of exposure.
Lewisite 2(L-2) is an organoarsenic chemical weapon with the formula AsCl(CH=CHCl)2. It is similar to lewisite 1 and lewisite 3 and was first synthesized in 1904 by Julius Arthur Nieuwland. It is usually found as a mixture of 2-chlorovinylarsonous dichloride (lewisite 1) as well as bis(2-chloroethenyl) arsinous chloride (lewisite 2) and tris(2-chlorovinyl)arsine (lewisite 3). Pure lewisite 1 is an oily, colorless liquid, however, the impure mixture can appear amber to black with an odor distinct to geraniums.
On 27 June 2022, a toxic gas leak occurred at the Port of Aqaba, Jordan, when a container carrying 25 tons of chlorine fell from a crane onto a docked ship and ruptured. The incident killed at least thirteen people and injured more than 265 people.
This article incorporates public domain material from Public Health Consequences from Hazardous Substances Acutely Released During Rail Transit --- South Carolina, 2005; Selected States, 1999--2004. Centers for Disease Control and Prevention.