Case Files of the University of California San Francisco Medical Toxicology Fellowship: Acute Chlorine Gas Inhalation and the Utility of Nebulized Sodium Bicarbonate

Vajner, John E.; Lung, Derrick

doi:10.1007/s13181-013-0309-8

Cited by 32 publications

(17 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25 A theoretical risk of thermal injury from the neutralization process is thought to occur, but no reports have described significant clinical worsening in patients undergoing sodium bicarbonate nebulization. 17,24 Treatment with nebulized sodium bicarbonate has shown not only to improve objective measurements of pulmonary function but also quality of life scores. 17,24 Optimal dosing is still to be determined, as no study to date has assessed differing concentrations of nebulized sodium bicarbonate.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Chlorine Gas-Related Injuries From the Graniteville, South Carolina, Train Derailment

Mackie

Svendsen

Grant

et al. 2014

Disaster med. public health prep.

View full text Add to dashboard Cite

A widely produced chemical, chlorine is used in various industries including automotive, electronics, disinfectants, metal production, and many others. Chlorine is usually produced and transported as a pressurized liquid; however, as a gas it is a significant pulmonary irritant. Thousands of people are exposed to chlorine gas every year, and while large-scale exposures are uncommon, they are not rare. Symptoms are usually related to the concentration and length of exposure, and although treatment is largely supportive, certain specific therapies have yet to be validated with randomized controlled trials. The majority of those exposed completely recover with supportive care; however, studies have shown the potential for persistent inflammation and chronic hyperreactivity. This case report describes an incident that occurred in Graniteville, South Carolina, when a train derailment exposed hundreds of people to chlorine gas. This report reviews the events of January 6, 2005, and the current treatment options for chlorine gas exposure.(Disaster Med Public Health Preparedness. 2014;0:1-6).

show abstract

Section: Discussionmentioning

confidence: 99%

“…17 Several anecdotal case reports detailed improvement in respiratory status after nebulized sodium bicarbonate administration. 2,19,20,24…”

Section: Chlorinementioning

confidence: 99%

Management of Chlorine Gas-Related Injuries From the Graniteville, South Carolina, Train Derailment

Mackie

Svendsen

Grant

et al. 2014

Disaster med. public health prep.

View full text Add to dashboard Cite

show abstract

“…39 Smaller-scale incidents involving other agents, such as moderately water-soluble chlorine, have occurred from railroad transport events, 40 the common household mixing of bleach and cleaning compounds, or exposure to chemicals used in swimming pools. 41,42 Chlorine was deployed as a weapon in World War I and has been used against civilians, with devastating consequences, in the current Syrian civil war. 13 Standard treatment of exposures to such water-soluble agents is supportive, including removal from exposure, decontamination, and provision of humidified oxygen and nebulized bronchodilators as indicated 37,38 (Table 2).…”

Section: Primary Respiratory Irritantsmentioning

confidence: 99%

“…Potentially salutary, but less established, interventions include inhaled or systemic glucocorticoids and nebulized sodium bicarbonate for chlorine inhalation. 37,42 In contrast to water-soluble compounds, relatively water-insoluble respiratory irritants cause few symptoms or upper-airway signs before delayed-onset acute lung injury is manifested. Inciting agents include oxides of nitrogen (causing silo filler's disease) and phosgene.…”

Section: Primary Respiratory Irritantsmentioning

confidence: 99%

Hazardous Chemical Emergencies and Poisonings

2019

View full text Add to dashboard Cite

H azardous chemical emergencies and related poisonings result from various exposures, including inadvertent residential, industrial, occupational, or transportation mishaps; natural disasters; and hazardoussubstance releases that are intended to cause harm. 1-3 Up to 100,000 industrial chemicals are used each day in the United States, 4 and federal authorities estimate that more than 10,000 potentially consequential releases of hazardous substances occur annually. 4,5 In addition, numerous compounds have been developed primarily as military weapons, with exceedingly high toxicity. 6-8 Both toxic industrial chemicals and military chemical weapons are capable of causing mass casualties in a substantive release and may be deployed intentionally in the context of chemical terrorism, 8-10 targeted assassination attempts, 8,11,12 or wartime attacks on civilian populations, as tragically shown in the current Syrian war. 13,14 A toxidrome-based, emergency medical systems (EMS) approach to chemical weapons attacks was presented recently by Ciottone in the Journal. 8 (Toxidromes are constellations of clinical signs, particularly vital signs, mental status, and ocular, respiratory, neurologic, and skin findings, that are characteristic of general classes of poison.) A similar approach is useful for the myriad possible entities in nonintentional hazardous chemical incidents. We review the toxicology and hospital-based management of acute poisonings caused principally by dermal and inhalational exposure to several representative chemical-agent classes in incidents involving the release of hazardous substances or chemical attacks (Table 1). Cyanide and organophosphate poisonings are emphasized, since they can also affect individual patients in the more familiar contexts of occupational and residential exposures or ingestions with suicidal intent and since specific emergency antidotal therapy is crucial for good outcomes. Ov erv iew of Hospita l-Ba sed Emergenc y M a nagement Incidents involving the release of hazardous chemicals may result in widespread chaos and confusion, affecting the EMS response and emergency department (ED) care. 2,8 A rapid influx of multiple critically ill victims with unfamiliar illnesses, as well as numerous low-risk but understandably anxious patients, potentially far outnumbering the seriously ill, 1 poses significant challenges to hospital-based emergency care providers. Patients may bypass prehospital care and arrive at the hospital unaware of or misinformed regarding the cause of their symptoms, with the potential to chemically contaminate bystanders and staff. 2,15-17 Thus, prompt recognition of the chemical event is important so that ED staff and hospital emergency management personnel can secure hospital entrances and decontaminate contami

show abstract

“…However, SB is used actively in many drugs and substance poisoning. These drugs are mainly; type 1 and type 1C antiarrhythmics, local anesthetics, antimalarials, dextropropoxyphene, propranolol, carbamazepine, phenobarbital, chlorpropamide, salicylate, diphenhydramine, propoxyphene, amantadine, cocaine, phenothiazine, quinine, thioridazine, chlorophenoxy herbicides, venlafaxine, and chlorine gas (1,14) . There is no other accepted alternative treatment agent except SB in SCB poisoning.…”

Section: Toxicologymentioning

confidence: 99%

Is Sodium Bicarbonate Therapy Still Up To Date?

Kurt¹,

Demirkıran²,

Yüksel³

2015

Acta Med Anatol

View full text Add to dashboard Cite

Sodium bicarbonate (SB), which has a vital role in the regulation of acid-base balance of all tissues and organs, is one of the most important buffering systems of the body. SB plays an important role in the treatment of poisoning caused by numerous agents including mainly salicylate and tricyclic antidepressants. In metabolic acidosis (MA) occurred in patient with systemic and metabolic diseases, first, the primary disease should be treated and in the case of low bicarbonate levels such as diarrhea and renal tubular acidosis, missing SB should be recovered. As the kidney has an important role in acid-base balance, SB is widely used in the treatment of acute and chronic renal failure. Although there is no conclusive evidence to prevent contrast nephropathy, SB comes to the fore compared to other agents. SB is used due to MA and its effects occurring in acute renal failure. In addition, SB treatment applied to reduce the increased acid levels in chronic kidney failure may reduce mortality. While SB can be used as individualized in lactic acidosis and cardiac arrest cases, it can be used safely as a performance enhancer for athletes. SB is used widely in gastrointestinal tract diseases due to its antacid effects and its routine use is not recommended in diabetic ketoacidosis. These data demonstrate that SB is still popular and it will retain its popularity in the near future.

show abstract

Case Files of the University of California San Francisco Medical Toxicology Fellowship: Acute Chlorine Gas Inhalation and the Utility of Nebulized Sodium Bicarbonate

Cited by 32 publications

References 33 publications

Management of Chlorine Gas-Related Injuries From the Graniteville, South Carolina, Train Derailment

Management of Chlorine Gas-Related Injuries From the Graniteville, South Carolina, Train Derailment

Hazardous Chemical Emergencies and Poisonings

Is Sodium Bicarbonate Therapy Still Up To Date?

Contact Info

Product

Resources

About