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| {{Infobox medical condition | {{Infobox medical condition (new) | ||
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| name = Chlorine poisoning | ||
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| synonyms = Chlorine gas toxicity | ||
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| '''Chlorine gas poisoning''' is illness resulting from the effects of exposure to ] beyond the ]. | '''Chlorine gas poisoning''' is an illness resulting from the effects of exposure to ] beyond the ]. | ||
| ==Signs and symptoms== | ==Signs and symptoms== | ||
| The signs of acute chlorine gas poisoning are primarily respiratory, and include ] and cough; listening to the lungs will generally reveal ]. There will generally be sneezing, nose irritation, and throat |
The signs of acute chlorine gas poisoning are primarily respiratory, and include ] and cough; listening to the lungs will generally reveal ]. There will generally be sneezing, nose irritation, burning sensations, and throat irritations. There may also be skin irritations or chemical burns and eye irritation or conjunctivitis. A person with chlorine gas poisoning may also have nausea, vomiting, or a headache.<ref name=Jones2010rev>Jones R, Wills B, Kang C. Chlorine gas: an evolving hazardous material threat and unconventional weapon. West J Emerg Med. 2010 May;11(2):151-6. {{PMID|20823965}} </ref><ref name=White2010rev>White CW, Martin JG. Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models. Proc Am Thorac Soc. 2010 Jul;7(4):257-63. Review. {{PMID|20601629}} </ref><ref name=medscapeOver>Gerald F O'Malley, GF et al. Medscape Drugs & Diseases, Ed. Dembek, ZF. Updated: Dec 11, 2015</ref> | ||
| Chronic exposure to relatively low levels of chlorine gas may cause pulmonary problems like acute wheezing attacks, chronic cough with phlegm, and asthma.<ref name=White2010rev/> | Chronic exposure to relatively low levels of chlorine gas may cause pulmonary problems like acute wheezing attacks, chronic cough with phlegm, and asthma.<ref name=White2010rev/> | ||
| ==Causes== | ==Causes== | ||
| Occupational exposures constitute the highest risk of toxicity and common domestic exposures result from the mixing of ] with ] such as ], ] |
Occupational exposures constitute the highest risk of toxicity and common domestic exposures result from the mixing of ] with ] such as ], ] or ]. They also occur as a result of the chlorination of table water. Other exposure risks occur during industrial or transportation accidents. Wartime exposure is rare.<ref name=White2010rev/><ref name=medscapeOver/> | ||
| ===Dose toxicity=== | ===Dose toxicity=== | ||
| Humans can smell chlorine gas at ranges from 0.1–0.3 ppm. According to a review from 2010: "At 1–3 ppm, there is mild |
Humans can smell chlorine gas at ranges from 0.1–0.3 ppm. According to a review from 2010: "At 1–3 ppm, there is mild mucous membrane irritation that can usually be tolerated for about an hour. At 5–15 ppm, there is moderate mucous membrane irritation. At 30 ppm and beyond, there is immediate chest pain, shortness of breath, and cough. At approximately 40–60 ppm, a toxic pneumonitis and/or acute pulmonary edema can develop. Concentrations of about 400 ppm and beyond are generally fatal over 30 minutes, and at 1,000 ppm and above, fatality ensues within only a few minutes."<ref name=White2010rev/> | ||
| ==Mechanism== | ==Mechanism== | ||
| The concentration of the inhaled gas and duration of exposure and water contents of the tissues exposed are the key determinants of toxicity; moist tissues like the eyes, throat, and lungs are the most susceptible to damage.<ref name=CDCbasic>CDC Page last reviewed April 10, 2013. Page last updated April 10, 2013</ref> | The concentration of the inhaled gas and duration of exposure and water contents of the tissues exposed are the key determinants of toxicity; moist tissues like the eyes, throat, and lungs are the most susceptible to damage.<ref name=CDCbasic>CDC Page last reviewed April 10, 2013. Page last updated April 10, 2013</ref> | ||
| Once inhaled, chlorine gas diffuses into the epithelial lining fluid (ELF) of the ] and may directly interact with small molecules, proteins and lipids there and damage them, or may ] to ] and ] which in turn generate chloride ions and ]; the dominant theory is that most damage is via the acids.<ref name=White2010rev/><ref name=medscapeOver/><ref name=Mechanism2010rev>Squadrito GL, Postlethwait EM, Matalon S. Elucidating mechanisms of chlorine toxicity: reaction kinetics, thermodynamics, and physiological implications. Am J Physiol Lung Cell Mol Physiol. 2010 Sep;299(3):L289-300. Review. PMID |
Once inhaled, chlorine gas diffuses into the epithelial lining fluid (ELF) of the ] and may directly interact with small molecules, proteins and lipids there and damage them, or may ] to ] and ] which in turn generate chloride ions and ]; the dominant theory is that most damage is via the acids.<ref name=White2010rev/><ref name=medscapeOver/><ref name=Mechanism2010rev>Squadrito GL, Postlethwait EM, Matalon S. Elucidating mechanisms of chlorine toxicity: reaction kinetics, thermodynamics, and physiological implications. Am J Physiol Lung Cell Mol Physiol. 2010 Sep;299(3):L289-300. Review. {{PMID|20525917}} </ref><ref name=ATSDRtreatment>Agency for Toxic Substances and Disease Registry via the CDC. Page last reviewed: October 21, 2014. Page last updated: October 21, 2014</ref> | ||
| ==Diagnosis== | ==Diagnosis== | ||
| Tests performed to confirm chlorine gas poisoning and monitor patients for supportive care include pulse oximetry, testing serum electrolyte, blood urea nitrogen (BUN), and creatinine levels, measuring arterial blood gases, chest radiography, electrocardiogram (ECG), pulmonary function testing, and laryngoscopy or bronchoscopy.<ref name=medscapeOver/> | |||
| ==Treatment== | ==Treatment== | ||
| There is no antidote for chlorine poisoning; management is ] after evacuating people from the site of exposure and flushing exposed tissues. For lung damage caused by inhalation oxygen and ] may be administered.<ref name=ATSDRtreatment/> | There is no antidote for chlorine poisoning; management is ] after evacuating people from the site of exposure and flushing exposed tissues. For lung damage caused by inhalation, oxygen and ] may be administered.<ref name=ATSDRtreatment/> | ||
| ==Outcomes== | ==Outcomes== | ||
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| ==Epidemiology== | ==Epidemiology== | ||
| In 2014, the ] reported |
In 2014, the ] reported about 6,000 exposures to chlorine gas in the US in 2013, compared with 13,600 exposures to ], which was the most common poison gas exposure;<ref>Mowry JB, et al 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol. 2015;53(10):962-1147. {{PMID|26624241}}. Page 1089</ref> the year before they reported about 5,500 cases of chlorine gas poisoning compared with around 14,300 cases of carbon monoxide poisoning.<ref>Mowry JB, et al. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol. 2014 Dec;52(10):1032-283. {{PMID|25559822}} Page 1225</ref> | ||
| ==Mass poisoning incidents== | |||
| ==Society and culture== | |||
| ===Wartime=== | |||
| Chlorine gas was first ] in World War I.<ref name=CEN2015>Sarah Everts Chemical & Engineering News, 93(8), February 23, 2015</ref> It was used ] by insurgents in the ],<ref>David Cloud for the New York Times. May 21, 2007 </ref> and in Syria in the ].<ref>{{cite web|url=http://www.ft.com/cms/s/0/5685e9c0-cdf3-11e3-9dfd-00144feabdc0.html#axzz30AxkhyIc|title=Syria fails to remove all chemical weapons as deadline passes|work=Financial Times|accessdate=12 September 2014}}</ref> | |||
| : {{Main|Chlorine#Use as a weapon}} | |||
| * In 1915, the German Army used chlorine against Allied soldiers in the 2nd ]. | |||
| * In 2007 ] by insurgents in the ],<ref>David Cloud for the New York Times. May 21, 2007 </ref> | |||
| * In 2014 ] in ], ].<ref>{{cite news|url=http://www.ft.com/cms/s/0/5685e9c0-cdf3-11e3-9dfd-00144feabdc0.html#axzz30AxkhyIc|title=Syria fails to remove all chemical weapons as deadline passes|work=Financial Times|date=27 April 2014|access-date=12 September 2014}}</ref> | |||
| ===Industrial accidents=== | |||
| There have been many instances of mass chlorine gas poisonings in industrial accidents. In the US, a freight train derailed in South Caroline in 2005, releasing an estimated 11,500 gallons of chlorine gas. As a result, nine persons died, and at least 529 persons sought medical care. In 2004 in Texas a freight train accident release 90,000 pounds of chlorine gas and other toxic chemicals. Forty-four persons were injured, including three who died. In August 2002 in Missouri, approximately 16,900 pounds of chlorine gas were released from a railroad tanker car when a flex hose ruptured during unloading at a chemical plant. Sixty-seven persons were injured.<ref name=Jones2010rev/><ref>CDC </ref> | |||
| ====United States==== | |||
| There have been many instances of mass chlorine gas poisonings in industrial accidents. | |||
| * In 2002 in ], a flex hose ruptured during unloading a ] at a chemical plant, releasing approximately {{convert|16900|lb}} of chlorine gas. 67 persons were injured.<ref name=Jones2010rev/> | |||
| * In 2004 in ], ], a ] accident released {{convert|9400|gal}} of chlorine gas and other toxic chemicals. At least 40 people were injured and three died, including two residents and the train conductor.<ref>{{Cite book|title=Collision of Union Pacific Railroad train MHOTU-23 with BNSF Railway Company train MEAP-TUL-126-D with subsequent derailment and hazardous materials release, Macdona, Texas, June 28, 2004|date=2006|publisher=United States National Transportation Safety Board|oclc=75276300|url=https://www.ntsb.gov/investigations/AccidentReports/Reports/RAR0603.pdf}}</ref> | |||
| * In 2005 in ] a freight train derailed, releasing an estimated {{convert|11500|USgal}} of chlorine. Nine people died, and at least 529 persons sought medical care.<ref>CDC </ref> | |||
| ====Globally==== | |||
| In |
* In 2015, In ], the explosion of a chlorine gas storage tank at a ] in ] killed eight people.<ref>Michael Olukayode for Bloomberg News. July 25, 2015 </ref> | ||
| * In 2017, chlorine gas was released in ], ], Canada, after chemicals were mixed improperly at a water treatment plant. In 2020 the ] was fined $150,000 (CAD) for the incident.<ref>The Canadian Press. September 11, 2020 </ref> | |||
| * In 2017, in ], at least 475 people, including nine firemen, suffered respiratory and other symptoms after a chlorine gas leak in the southwestern Iranian province of ].{{cn|date=July 2021}} | |||
| *In 2020, on March 6, an incident occurred at EPCL (Engro Polymer and Chemicals Limited) Port Qasim, ], where over 50 people were hospitalized as a result of chlorine gas leakage. No fatalities were reported.<ref>{{Cite web|url=https://www.samaa.tv/news/pakistan/2020/03/port-qasim-chemical-leak-karachi/|title=Over 50 hospitalised after chemical leak at Karachi Engro factory {{!}} SAMAA|website=Samaa TV|date=6 March 2020 |language=en-US|access-date=2020-03-06}}</ref> | |||
| *In 2022, on June 27, a tank holding chlorine gas in the port of ], ], ]. 14 people were killed and more than 260 were injured.<ref>{{cite web | url=https://www.jordannews.jo/Section-109/News/Update-11-dead-over-250-injured-after-chlorine-gas-tank-ruptures-at-Aqaba-Port-18621 | title=Update: 13 dead, over 260 injured after chlorine gas tank ruptures at Aqaba Port - Jordan News | Latest News from Jordan, MENA | date=27 June 2022 }}</ref> | |||
| ==References== | ==References== | ||
| ⚫ | {{Reflist}} | ||
| {{Research help|Med}} | |||
| ⚫ | {{Reflist |
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| ==Further reading== | |||
| ⚫ | {{CDC|article=Public Health Consequences from Hazardous Substances Acutely Released During Rail Transit --- South Carolina, 2005; Selected States, 1999--2004|url= |
||
| * {{cite journal | last1=Beach | first1=F. X. M. | last2=Jones | first2=E. S. | last3=Scarrow | first3=G. D. | title=Respiratory effects of chlorine gas | journal=Occupational and Environmental Medicine | publisher=BMJ | volume=26 | issue=3 | date=1 July 1969 | issn=1351-0711 | doi=10.1136/oem.26.3.231 | pages=231–236| pmid=5794948 | pmc=1008943 | s2cid=36220465 }} | |||
| * {{cite journal | last1=Black | first1=J. E. | last2=Glenny | first2=E. T. | last3=McNee | first3=J. W. | title=Observations on 685 Cases of Poisoning by Noxious Gases Used by the Enemy | journal=BMJ | volume=2 | issue=2848 | date=31 July 1915 | issn=0959-8138 | doi=10.1136/bmj.2.2848.165 | pages=165–167| pmid=20767740 | pmc=2302752 }} | |||
| * {{cite journal | last1=Das | first1=Rupali | last2=Blanc | first2=Paul D. | title=Chlorine Gas Exposure and the Lung: A Review | journal=Toxicology and Industrial Health | publisher=SAGE Publications | volume=9 | issue=3 | year=1993 | issn=0748-2337 | doi=10.1177/074823379300900304 | pages=439–455| pmid=8367885 | bibcode=1993ToxIH...9..439D | s2cid=41284283 }} | |||
| * {{cite journal | last1=Chen | first1=Jing | last2=Mo | first2=Yiqun | last3=Schlueter | first3=Connie F. | last4=Hoyle | first4=Gary W. | title=Inhibition of chlorine-induced pulmonary inflammation and edema by mometasone and budesonide | journal=Toxicology and Applied Pharmacology | publisher=Elsevier BV | volume=272 | issue=2 | year=2013 | issn=0041-008X | doi=10.1016/j.taap.2013.06.009 | pages=408–413| pmid=23800689 | pmc=4005342 | bibcode=2013ToxAP.272..408C }} | |||
| * {{citation | last1=Fang | first1=Boliang | last2=Qian | first2=Suyun | last3=Li | first3=Zheng | last4=Gao | first4=Hengmiao | last5=Xu | first5=Wenmiao | last6=Ding | first6=Nan | title=Case report: Acute respiratory distress syndrome and shock caused by severe chlorine gas poisoning was successfully cured by venous-arterial extracorporeal membrane oxygenation | publisher=Authorea, Inc. | date=10 September 2020 | doi=10.22541/au.159969877.77536109| s2cid=242964247 }} | |||
| * {{cite journal | last1=Govier | first1=P. | last2=Coulson | first2=J.M. | title=Civilian exposure to chlorine gas: A systematic review | journal=Toxicology Letters | publisher=Elsevier BV | volume=293 | year=2018 | issn=0378-4274 | doi=10.1016/j.toxlet.2018.01.014 | pages=249–252| pmid=29355691 | s2cid=38779390 }} | |||
| * {{cite journal | last1=Zellner | first1=Tobias | last2=Eyer | first2=Florian | title=Choking agents and chlorine gas – History, pathophysiology, clinical effects and treatment | journal=Toxicology Letters | publisher=Elsevier BV | volume=320 | year=2020 | issn=0378-4274 | doi=10.1016/j.toxlet.2019.12.005 | pages=73–79| pmid=31811912 | s2cid=208870299 }} | |||
| ⚫ | {{CDC|article=Public Health Consequences from Hazardous Substances Acutely Released During Rail Transit --- South Carolina, 2005; Selected States, 1999--2004|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5403a2.htm}} | ||
| == External links == | |||
| {{Medical resources | |||
| | DiseasesDB = | |||
| | ICD10 = {{ICD10|T|59.4}} | |||
| ⚫ | | ICD9 = | ||
| | eMedicineSubj = | |||
| ⚫ | | eMedicineTopic = | ||
| | MeshID = | |||
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| {{Poisoning and toxicity}} | {{Poisoning and toxicity}} | ||
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Latest revision as of 20:31, 27 October 2024
 | This article's lead section may be too short to adequately summarize the key points. Please consider expanding the lead to provide an accessible overview of all important aspects of the article. (October 2024) |
| Chlorine poisoning | |
|---|---|
| Other names | Chlorine gas toxicity |
| Specialty | Emergency medicine |
Chlorine gas poisoning is an illness resulting from the effects of exposure to chlorine beyond the threshold limit value.
Signs and symptoms
The signs of acute chlorine gas poisoning are primarily respiratory, and include difficulty breathing and cough; listening to the lungs will generally reveal crackles. There will generally be sneezing, nose irritation, burning sensations, and throat irritations. There may also be skin irritations or chemical burns and eye irritation or conjunctivitis. A person with chlorine gas poisoning may also have nausea, vomiting, or a headache.
Chronic exposure to relatively low levels of chlorine gas may cause pulmonary problems like acute wheezing attacks, chronic cough with phlegm, and asthma.
Causes
Occupational exposures constitute the highest risk of toxicity and common domestic exposures result from the mixing of chlorine bleach with acidic washing agents such as acetic, nitric or phosphoric acid. They also occur as a result of the chlorination of table water. Other exposure risks occur during industrial or transportation accidents. Wartime exposure is rare.
Dose toxicity
Humans can smell chlorine gas at ranges from 0.1–0.3 ppm. According to a review from 2010: "At 1–3 ppm, there is mild mucous membrane irritation that can usually be tolerated for about an hour. At 5–15 ppm, there is moderate mucous membrane irritation. At 30 ppm and beyond, there is immediate chest pain, shortness of breath, and cough. At approximately 40–60 ppm, a toxic pneumonitis and/or acute pulmonary edema can develop. Concentrations of about 400 ppm and beyond are generally fatal over 30 minutes, and at 1,000 ppm and above, fatality ensues within only a few minutes."
Mechanism
The concentration of the inhaled gas and duration of exposure and water contents of the tissues exposed are the key determinants of toxicity; moist tissues like the eyes, throat, and lungs are the most susceptible to damage.
Once inhaled, chlorine gas diffuses into the epithelial lining fluid (ELF) of the respiratory epithelium and may directly interact with small molecules, proteins and lipids there and damage them, or may hydrolyze to hypochlorous acid and hydrochloric acid which in turn generate chloride ions and reactive oxygen species; the dominant theory is that most damage is via the acids.
Diagnosis
Tests performed to confirm chlorine gas poisoning and monitor patients for supportive care include pulse oximetry, testing serum electrolyte, blood urea nitrogen (BUN), and creatinine levels, measuring arterial blood gases, chest radiography, electrocardiogram (ECG), pulmonary function testing, and laryngoscopy or bronchoscopy.
Treatment
There is no antidote for chlorine poisoning; management is supportive after evacuating people from the site of exposure and flushing exposed tissues. For lung damage caused by inhalation, oxygen and bronchodilators may be administered.
Outcomes
There is no way to predict outcomes. Most people with mild to moderate exposure generally recover fully in three to five days, but some develop chronic problems such as reactive airway disease. Smoking or pre-existing lung conditions like asthma appear to increase the risk of long term complications.
Epidemiology
In 2014, the American Association of Poison Control Centers reported about 6,000 exposures to chlorine gas in the US in 2013, compared with 13,600 exposures to carbon monoxide, which was the most common poison gas exposure; the year before they reported about 5,500 cases of chlorine gas poisoning compared with around 14,300 cases of carbon monoxide poisoning.
Mass poisoning incidents
Wartime
- Main article: Chlorine § Use as a weapon
- In 1915, the German Army used chlorine against Allied soldiers in the 2nd Battle of Ypres.
- In 2007 chlorine was used by insurgents in the Iraqi insurgency (2003–11),
- In 2014 chlorine was allegedly used in Kafr Zita, Syria.
Industrial accidents
United States
There have been many instances of mass chlorine gas poisonings in industrial accidents.
- In 2002 in Missouri, a flex hose ruptured during unloading a train car at a chemical plant, releasing approximately 16,900 pounds (7,700 kg) of chlorine gas. 67 persons were injured.
- In 2004 in Macdona, Texas, a freight train accident released 9,400 US gallons (36,000 L; 7,800 imp gal) of chlorine gas and other toxic chemicals. At least 40 people were injured and three died, including two residents and the train conductor.
- In 2005 in South Carolina a freight train derailed, releasing an estimated 11,500 US gallons (44,000 L; 9,600 imp gal) of chlorine. Nine people died, and at least 529 persons sought medical care.
Globally
- In 2015, In Nigeria, the explosion of a chlorine gas storage tank at a water treatment plant in Jos killed eight people.
- In 2017, chlorine gas was released in Fort McMurray, Alberta, Canada, after chemicals were mixed improperly at a water treatment plant. In 2020 the Regional Municipality of Wood Buffalo was fined $150,000 (CAD) for the incident.
- In 2017, in Iran, at least 475 people, including nine firemen, suffered respiratory and other symptoms after a chlorine gas leak in the southwestern Iranian province of Khuzestan.
- In 2020, on March 6, an incident occurred at EPCL (Engro Polymer and Chemicals Limited) Port Qasim, Karachi, where over 50 people were hospitalized as a result of chlorine gas leakage. No fatalities were reported.
- In 2022, on June 27, a tank holding chlorine gas in the port of Aqaba, Jordan, fell and ruptured. 14 people were killed and more than 260 were injured.
References
- ^ Jones R, Wills B, Kang C. Chlorine gas: an evolving hazardous material threat and unconventional weapon. West J Emerg Med. 2010 May;11(2):151-6. PMID 20823965 PMC 2908650
- ^ White CW, Martin JG. Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models. Proc Am Thorac Soc. 2010 Jul;7(4):257-63. Review. PMID 20601629 PMC 3136961
- ^ Gerald F O'Malley, GF et al. Chlorine Toxicity Medscape Drugs & Diseases, Ed. Dembek, ZF. Updated: Dec 11, 2015
- CDC Basic Facts Page last reviewed April 10, 2013. Page last updated April 10, 2013
- Squadrito GL, Postlethwait EM, Matalon S. Elucidating mechanisms of chlorine toxicity: reaction kinetics, thermodynamics, and physiological implications. Am J Physiol Lung Cell Mol Physiol. 2010 Sep;299(3):L289-300. Review. PMID 20525917 PMC 2951076
- ^ Agency for Toxic Substances and Disease Registry via the CDC. Medical Management Guidelines: Chlorine Page last reviewed: October 21, 2014. Page last updated: October 21, 2014
- Mowry JB, et al 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol. 2015;53(10):962-1147. PMID 26624241. Page 1089
- Mowry JB, et al. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol. 2014 Dec;52(10):1032-283. PMID 25559822 PMC 4782684 Page 1225
- David Cloud for the New York Times. May 21, 2007 7 U.S. Soldiers Die in Iraq, 6 in Sweep of Baghdad
- "Syria fails to remove all chemical weapons as deadline passes". Financial Times. 27 April 2014. Retrieved 12 September 2014.
- Collision of Union Pacific Railroad train MHOTU-23 with BNSF Railway Company train MEAP-TUL-126-D with subsequent derailment and hazardous materials release, Macdona, Texas, June 28, 2004 (PDF). United States National Transportation Safety Board. 2006. OCLC 75276300.
- CDC Public Health Consequences from Hazardous Substances Acutely Released During Rail Transit --- South Carolina, 2005; Selected States, 1999--2004
- Michael Olukayode for Bloomberg News. July 25, 2015 Nigeria Says 8 People Dead After Inhaling Chlorine Gas in Jos
- The Canadian Press. September 11, 2020 Regional Municipality in Northern Alberta Fined for Releasing Chlorine Gas
- "Over 50 hospitalised after chemical leak at Karachi Engro factory | SAMAA". Samaa TV. 6 March 2020. Retrieved 2020-03-06.
- "Update: 13 dead, over 260 injured after chlorine gas tank ruptures at Aqaba Port - Jordan News | Latest News from Jordan, MENA". 27 June 2022.
Further reading
- Beach, F. X. M.; Jones, E. S.; Scarrow, G. D. (1 July 1969). "Respiratory effects of chlorine gas". Occupational and Environmental Medicine. 26 (3). BMJ: 231–236. doi:10.1136/oem.26.3.231. ISSN 1351-0711. PMC 1008943. PMID 5794948. S2CID 36220465.
- Black, J. E.; Glenny, E. T.; McNee, J. W. (31 July 1915). "Observations on 685 Cases of Poisoning by Noxious Gases Used by the Enemy". BMJ. 2 (2848): 165–167. doi:10.1136/bmj.2.2848.165. ISSN 0959-8138. PMC 2302752. PMID 20767740.
- Das, Rupali; Blanc, Paul D. (1993). "Chlorine Gas Exposure and the Lung: A Review". Toxicology and Industrial Health. 9 (3). SAGE Publications: 439–455. Bibcode:1993ToxIH...9..439D. doi:10.1177/074823379300900304. ISSN 0748-2337. PMID 8367885. S2CID 41284283.
- Chen, Jing; Mo, Yiqun; Schlueter, Connie F.; Hoyle, Gary W. (2013). "Inhibition of chlorine-induced pulmonary inflammation and edema by mometasone and budesonide". Toxicology and Applied Pharmacology. 272 (2). Elsevier BV: 408–413. Bibcode:2013ToxAP.272..408C. doi:10.1016/j.taap.2013.06.009. ISSN 0041-008X. PMC 4005342. PMID 23800689.
- Fang, Boliang; Qian, Suyun; Li, Zheng; Gao, Hengmiao; Xu, Wenmiao; Ding, Nan (10 September 2020), Case report: Acute respiratory distress syndrome and shock caused by severe chlorine gas poisoning was successfully cured by venous-arterial extracorporeal membrane oxygenation, Authorea, Inc., doi:10.22541/au.159969877.77536109, S2CID 242964247
- Govier, P.; Coulson, J.M. (2018). "Civilian exposure to chlorine gas: A systematic review". Toxicology Letters. 293. Elsevier BV: 249–252. doi:10.1016/j.toxlet.2018.01.014. ISSN 0378-4274. PMID 29355691. S2CID 38779390.
- Zellner, Tobias; Eyer, Florian (2020). "Choking agents and chlorine gas – History, pathophysiology, clinical effects and treatment". Toxicology Letters. 320. Elsevier BV: 73–79. doi:10.1016/j.toxlet.2019.12.005. ISSN 0378-4274. PMID 31811912. S2CID 208870299.
This article incorporates public domain material from Public Health Consequences from Hazardous Substances Acutely Released During Rail Transit --- South Carolina, 2005; Selected States, 1999--2004. Centers for Disease Control and Prevention.
External links
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