Brain But Not Lung Functions Impaired after a Chlorine Incident

Kilburn, Kaye H.

doi:10.2486/indhealth.41.299

Cited by 12 publications

(6 citation statements)

References 25 publications

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“…The direct interaction of chlorine and acute in ammatory response may lead to acute toxic lung injury and its complications [15]. One patient had transient unconsciousness, suggesting that chlorine may have a toxic effect on the human nervous system [19], which is consistent with what is reported in the literature [19].…”

Section: Discussionsupporting

confidence: 75%

“…Additionally, the migration and activation of in ammatory cells, such as neutrophils, in the airway epithelium and the subsequent release of oxidants and proteolytic enzymes may cause further damage to the epithelium [15]. Therefore, chlorine poisoning can cause bronchospasm and bronchitis, and in severe cases, it can cause pulmonary edema and may be accompanied by damage to other organ systems, such as the cardiopulmonary and nervous systems [9,18,19]. Acute chlorine poisoning is characterized by acute respiratory system damage [17].…”

Section: Discussionmentioning

confidence: 99%

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Chlorine poisoning caused by improper mixing of household disinfectants during the COVID-19 pandemic

Lin¹,

Wu²,

Peng

et al. 2021

Preprint

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Background During the coronavirus disease 2019 (COVID-19) pandemic, many people have abused and misused disinfectants, leading to many poisoning incidents. However, there are few clinical case reports of poisoning caused by mixed household disinfectants. This study summarized the clinical characteristics and treatment effects of chlorine poisoning caused by improper mixing of hypochlorite bleach with acidic cleaning agents to improve the understanding of the disease. Methods We retrospectively analyzed the basic data, clinical symptoms, treatment methods, imaging, and other clinical data of seven patients with chlorine poisoning, caused by an improper mixture of hypochlorite bleach and acidic cleaning agents, who were admitted to the National Army Poisoning Treatment Center. Results The seven patients (three men and four women) had an average age of 48.8 years (18–67 years). The average poisoning time (time from exposure to poison to treatment) was 57 h (4–240 h). All seven patients were involved in cleaning bathrooms during the COVID-19 pandemic. Chest computed tomography scans showed bilateral lung effusions or inflammatory changes in five patients and no obvious exudation or inflammatory changes in two. The partial pressure of oxygen decreased in six patients, and respiratory failure occurred in one. Five patients had different degrees of increase in white blood cell count. For treatment, humidified oxygen therapy, non-invasive mechanical ventilation, intravenous corticosteroids, inhaled hormone, bronchial spasmolytics, antibiotics, and other symptomatic and supportive treatments were provided. The average length of hospital stay was 7 days (4–9 days). All seven patients recovered and were discharged. Conclusions Improper mixing of house disinfectants during the COVID-19 pandemic may cause damage to the respiratory system due to chlorine poisoning. Corticosteroids may improve lung exudation in severe cases. Additionally, symptomatic supportive treatment should be performed early.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Chlorine poisoning caused by improper mixing of household disinfectants during the COVID-19 pandemic

Lin¹,

Wu²,

Peng

et al. 2021

Preprint

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“…The cause of this neuromuscular dysfunction is uncertain, but direct injury to the neuromuscular system may be involved. Seizures have been documented sporadically in chlorineexposed individuals (10,23), but our finding of ataxia and hypotonia is novel. Together with bradycardia and bradypnea, both of which may have neurologic etiologies, we believe that the neuromuscular system is significantly involved in high-level acute chlorine exposure, similar to organophosphate exposures (24), albeit not to that severity.…”

Section: Discussionmentioning

confidence: 56%

Oxygen Administration Improves Survival but Worsens Cardiopulmonary Functions in Chlorine-exposed Rats

Okponyia

McGraw

Dysart

et al. 2018

Am J Respir Cell Mol Biol

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Chlorine is a highly reactive gas that can cause significant injury when inhaled. Unfortunately, its use as a chemical weapon has increased in recent years. Massive chlorine inhalation can cause death within 4 hours of exposure. Survivors usually require hospitalization after massive exposure. No countermeasures are available for massive chlorine exposure and supportive-care measures lack controlled trials. In this work, adult rats were exposed to chlorine gas (LD) in a whole-body exposure chamber, and given oxygen (0.8 Fi) or air (0.21 Fi) for 6 hours after baseline measurements were obtained. Oxygen saturation, vital signs, respiratory distress and neuromuscular scores, arterial blood gases, and hemodynamic measurements were obtained hourly. Massive chlorine inhalation caused severe acute respiratory failure, hypoxemia, decreased cardiac output, neuromuscular abnormalities (ataxia and hypotonia), and seizures resulting in early death. Oxygen improved survival to 6 hours (87% versus 42%) and prevented observed seizure-related deaths. However, oxygen administration worsened the severity of acute respiratory failure in chlorine-exposed rats compared with controls, with increased respiratory acidosis (pH 6.91 ± 0.04 versus 7.06 ± 0.01 at 2 h) and increased hypercapnia (180.0 ± 19.8 versus 103.2 ± 3.9 mm Hg at 2 h). In addition, oxygen did not improve neuromuscular abnormalities, cardiac output, or respiratory distress associated with chlorine exposure. Massive chlorine inhalation causes severe acute respiratory failure and multiorgan damage. Oxygen administration can improve short-term survival but appears to worsen respiratory failure, with no improvement in cardiac output or neuromuscular dysfunction. Oxygen should be used with caution after massive chlorine inhalation, and the need for early assisted ventilation should be assessed in victims.

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“…Additionally, the migration and activation of inflammatory cells, such as neutrophils, to the affected site, and the subsequent release of oxidants and proteolytic enzymes may cause further damage to the epithelium[ 15 ]. Therefore, chlorine poisoning can cause bronchospasm and bronchitis, and in severe cases, pulmonary edema accompanied by damage to the cardiopulmonary and nervous systems[ 9 , 18 , 19 ]. Acute chlorine poisoning is characterized by acute respiratory system damage[ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Chlorine poisoning caused by improper mixing of household disinfectants during the COVID-19 pandemic: Case series

Lin¹,

Wu²,

Peng³

et al. 2022

WJCC

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BACKGROUND Misuse of disinfectants during the coronavirus disease 2019 pandemic has led to several poisoning incidents. However, there are few clinical case reports on poisoning caused by improper mixing of household disinfectants. AIM To summarize the clinical characteristics and treatment effects of chlorine poisoning caused by improper mixing of hypochlorite bleach with acidic cleaning agents. METHODS We retrospectively analyzed baseline and clinical data, clinical symptoms, and treatment methods of seven patients with chlorine poisoning who were admitted to the National Army Poisoning Treatment Center. RESULTS Among the seven patients, the average poisoning time (exposure to admission) was 57 h (4-240 h). All patients were involved in cleaning bathrooms. Chest computed tomography scans revealed bilateral lung effusions or inflammatory changes in five patients. The partial pressure of oxygen decreased in six patients, and respiratory failure occurred in one. Five patients had different degrees of increase in white blood cell count. Humidified oxygen therapy, non-invasive mechanical ventilation, anti-inflammatory corticosteroids, antioxidants, and antibiotics were administered for treatment. The average length of hospital stay was 7 d (4-9 d). All seven patients recovered and were discharged. CONCLUSION Improper mixing of household disinfectants may cause damage to the respiratory system due to chlorine poisoning. Corticosteroids may improve lung exudation in severe cases, and symptomatic supportive treatment should be performed early.

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Brain But Not Lung Functions Impaired after a Chlorine Incident

Cited by 12 publications

References 25 publications

Chlorine poisoning caused by improper mixing of household disinfectants during the COVID-19 pandemic

Chlorine poisoning caused by improper mixing of household disinfectants during the COVID-19 pandemic

Oxygen Administration Improves Survival but Worsens Cardiopulmonary Functions in Chlorine-exposed Rats

Chlorine poisoning caused by improper mixing of household disinfectants during the COVID-19 pandemic: Case series

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