Severe lung injury following inhalation of nitric acid fumes

Abstract

Objective: We present a rare case of survival following inhalation of nitric acid fumes and its decomposi tion products, which resulted in severe pulmonary edema and Acute Respiratory Distress Syndrome (ARDS). Successful outcome followed ventilatory support and use of steroids. Design: Case report. Setting: Terti ary-level medical intensive care unit. Patient: A single case of inhalation of nitric oxide fumes. Interven tion: Ventilatory support and addition of steroids. Measurement and main results: Improvement and discharge. Conclusion: Inhalation of nitric acid fumes and its decomposition gases such as nitrogen diox ide results in delayed onset of severe pulmonary edema deteriorating into ARDS. Intensive respiratory management, ventilatory support, and steroids can help in survival.

Nitrogen Oxide Inhalation Lung Injury From an Industrial Explosion: A Case Report and Review of the Literature

“…More recent reports underscore the broad severity spectrum: dose-dependent severe cases after NO₂ explosion [ 9 ], delayed onset after occupational exposure [ 27 ], histologically confirmed secondary organizing pneumonia [ 28 ], and VV-ECMO-supported survival in severe ARDS [ 9 , 11 , 29 ]. Additional case reports have described severe lung injury and acute respiratory distress syndrome following nitric acid fume exposure [ 7 , 8 ]. These highlight both the life-threatening potential and the variability of NOx injury.…”

Nitrogen Oxide Inhalation Lung Injury From an Industrial Explosion: A Case Report and Review of the Literature

“…More recent reports underscore the broad severity spectrum: dose-dependent severe cases after NO₂ explosion [ 9 ], delayed onset after occupational exposure [ 27 ], histologically confirmed secondary organizing pneumonia [ 28 ], and VV-ECMO-supported survival in severe ARDS [ 9 , 11 , 29 ]. Additional case reports have described severe lung injury and acute respiratory distress syndrome following nitric acid fume exposure [ 7 , 8 ]. These highlight both the life-threatening potential and the variability of NOx injury.…”

Acute lung injury following exposure to nitric acid

“…Toxic exposure to nitrogen dioxide has generally occurred in four circumstances: Exposure to silo gases, welding, combustion of nitrogen-containing materials, and spills of nitric acid. [ 1 ]…”

“…This delayed effect has been well described in almost all cases of nitric acid and nitrogen dioxide inhalation injury reports. [ 1 ] Hajela et al, have reported three deaths owing to rapidly progressing pulmonary edema of delayed onset after inhalation of fumes due to accidental nitric acid exposure.…”

“…Use of high-frequency ventilation and reduction of the mean and peak airway pressures have been recommended. [ 1 5 ]…”

“…after exposure the patient can develop bronchiolitis obliterans. [ 1 ] Most such cases resolve. As most of these incidents have been sporadic and accidental, follow-up of the cases is not thorough.…”

Nitrogen Oxide Inhalation Lung Injury From an Industrial Explosion: A Case Report and Review of the Literature

“…More recent reports underscore the broad severity spectrum: dose-dependent severe cases after NO₂ explosion [ 9 ], delayed onset after occupational exposure [ 27 ], histologically confirmed secondary organizing pneumonia [ 28 ], and VV-ECMO-supported survival in severe ARDS [ 9 , 11 , 29 ]. Additional case reports have described severe lung injury and acute respiratory distress syndrome following nitric acid fume exposure [ 7 , 8 ]. These highlight both the life-threatening potential and the variability of NOx injury.…”

Acute lung injury following exposure to nitric acid

“…Toxic exposure to nitrogen dioxide has generally occurred in four circumstances: Exposure to silo gases, welding, combustion of nitrogen-containing materials, and spills of nitric acid. [ 1 ]…”

“…This delayed effect has been well described in almost all cases of nitric acid and nitrogen dioxide inhalation injury reports. [ 1 ] Hajela et al, have reported three deaths owing to rapidly progressing pulmonary edema of delayed onset after inhalation of fumes due to accidental nitric acid exposure.…”

“…Use of high-frequency ventilation and reduction of the mean and peak airway pressures have been recommended. [ 1 5 ]…”

“…after exposure the patient can develop bronchiolitis obliterans. [ 1 ] Most such cases resolve. As most of these incidents have been sporadic and accidental, follow-up of the cases is not thorough.…”

Nitrogen Oxide Inhalation Lung Injury From an Industrial Explosion: A Case Report and Review of the Literature

“…More recent reports underscore the broad severity spectrum: dose-dependent severe cases after NO₂ explosion [ 9 ], delayed onset after occupational exposure [ 27 ], histologically confirmed secondary organizing pneumonia [ 28 ], and VV-ECMO-supported survival in severe ARDS [ 9 , 11 , 29 ]. Additional case reports have described severe lung injury and acute respiratory distress syndrome following nitric acid fume exposure [ 7 , 8 ]. These highlight both the life-threatening potential and the variability of NOx injury.…”

Acute lung injury following exposure to nitric acid

“…Toxic exposure to nitrogen dioxide has generally occurred in four circumstances: Exposure to silo gases, welding, combustion of nitrogen-containing materials, and spills of nitric acid. [ 1 ]…”

“…This delayed effect has been well described in almost all cases of nitric acid and nitrogen dioxide inhalation injury reports. [ 1 ] Hajela et al, have reported three deaths owing to rapidly progressing pulmonary edema of delayed onset after inhalation of fumes due to accidental nitric acid exposure.…”

“…Use of high-frequency ventilation and reduction of the mean and peak airway pressures have been recommended. [ 1 5 ]…”

“…after exposure the patient can develop bronchiolitis obliterans. [ 1 ] Most such cases resolve. As most of these incidents have been sporadic and accidental, follow-up of the cases is not thorough.…”