Inhalation of chlorine gas results in injury to the respiratory tract and can be deadly.
Mechanism of exposure: industrial, accidental, chemical warfare
Mechanisms of injury: chlorine mixed with water can form hydrochloric acid and hydrochlorous acid. Hydrochlorous acid can release nascent oxygen (O-) which results in free radicals.
Examination: vital signs, respiratory exam, chest X-ray and pulse oximetry
Clinical Symptoms |
Exam |
Severity |
none |
normal |
none |
coughing, minimal respiratory symptoms, no increase respiratory effort |
normal pulse oximetry |
mild |
hypoxia, increased respiratory effort |
abnormal pulse oximetry, normal chest X-ray |
moderate |
hypoxia, respiratory distress, ARDS |
abnormal pulse oximetry, abnormal chest X-ray |
severe |
Severity |
Observation Period |
Therapy |
none |
none (can be discharged after assessment) |
none |
mild |
up to 6 hours |
inhaled beta-agonists |
moderate |
admit for observation for >= 12 hours |
inhaled beta-agonists, inhaled steroids, oxygen supplement, inhaled ipratropium |
severe |
admit to ICU |
consider intubation, consider mechanical ventilation, inhaled beta-agonists, inhaled or intravenous steroids, ipratropium |
Prolonged exposure can result in edema of the upper airway with potential for airway obstruction. Intubation may be necessary to preserve the airway.
Specialty: Toxicology, Pulmonology