Quiz: chlorine gas inhalation injury

November 15, 2013, 5:53 pm


Acute Chlorine Gas Inhalation and the Utility of Nebulized Sodium Bicarbonate. Vajner JE, Lung D. J Med Toxicol 2013;9:259-265.

Reference — no abstract available

This well done paper — from the series “Case Files of the University of California San Francisco Medical Toxicology Fellowship — contains a case report and a review of the literature regarding treatment of chlorine gas inhalation injury.

The following quiz will cover some of the main points made by the authors. Click on the question to reveal the answer.


  1. Mixture of household cleaning products containing acid and bleach (sodium hypochlorite)
  2. Industrial accidents and exposures
  3. Swimming pool chlorine accidents

Chlorine has intermediate water solubility. This results in irritation and injury both to the upper airway (oro- and nasopharynx) and lower airway (alveoli).

Sore throat, chest pain, wheezing, eye and nose irritation, nausea; hypoxia, rales, and noncardiogenic pulmonary edema can also occur.

The authors argue that although steroids would not be expected to improve outcome from the direct effects of chemical injury, many victims who present with wheezing have underlying reactive airway disease and may benefit from a short course of steroids. They suggest that there have been no reported adverse reactions from use of steroids in these situations.

There is suggestive evidence that inhaled sodium bicarbonate can provide accelerated symptom relief in these patients , and there have been no reported adverse effects from its use.

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