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Chlorine gas poisoning is 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. There may also be skin irritation or chemical burns and eye irritation or conjunctivitis. A person with chlorine gas poisoning may also have nausea, vomiting, a runny nose, or a headache.

Symptoms of mild acute poisoning include sneezing, tearing, nose irritation and throat irritation, while larger exposures can lead to significant toxicity of the respiratory tract and heart and sometimes death. Following acute poisoning, long-term sequelae often occur and chronic exposure to low levels of chlorine gas can lead to memory loss.

Holding Chlorine gas exposure may lead to a significantly shorter life span due to heart damage. Individual tolerance level for chlorine gas may be altered by several factors, such as metabolic rate, hematological disorders and barometric pressure.

Acute inflammation of the conjunctivae, pharynx, nose, trachea and bronchi are immediate effects of chlorine gas poisoning.

Chlorine gas poisoning poses severe pathological threats. The pathological effects of the poisoning includes pneumonia, pneumonitis, tracheobronchitis, pulmonary edema, multiple pulmonary thrombosis and ulcerative but the hallmark of the pathological effects is "pulmonary edema", clinically manifested as "dyspnea", hypoxia and adventitious lung sounds.

Acute poisoning

The primary manifestations of chlorine gas poisoning develop in the organ systems most dependent on oxygen use: the central nervous system and the heart. The initial symptoms of acute chlorine gas poisoning include dyspnea, nausea and vomiting, violent cough, chest pains, lightheadedness, headache and muscle weakness.

These symptoms are synonymous to those of influenza or other illnesses such as gastroenteritis or foodborne illness. Headache is the most common symptom of acute chlorine gas poisoning; it is often described as dull, frontal, and continuous. Increasing exposure produces cardiac abnormalities including fast heart rate, cardiac arrhythmia, hypotension and respiratory arrest. Less common symptoms of acute chlorine gas poisoning include hypertension, myocardial ischemia, muscle necrosis, skin lesions and pneumonia.

Chronic poisoning

Chronic exposure to relatively low levels of chlorine gas may cause persistent headaches, lightheadedness, nausea and vomiting.

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 and 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.

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

Treatment

There is no antidote for chlorine poisoning; management is supportive after evacuating people from the site of exposure and flushing exposed tissues. For harm caused by inhalation oxygen and bronchodilators may be administered.

Outcomes

Epidemiology

Society and culture

Chlorine gas was first used as a weapon in World War I. It was used several times by insurgents in the Iraqi insurgency (2003–11), and in Syria in the 2014 Kafr Zita chemical attack.

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.

In July 2015, it was reported that 8 people died and around 100 people sought treatment after the explosion of a chlorine gas storage tank at a water treatment plant in Jos, Nigeria.

References

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1. 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
2. ^ 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
3. ^ Gerald F O'Malley, GF et al. Chlorine Toxicity Medscape Drugs & Diseases, Ed. Dembek, ZF. Updated: Dec 11, 2015
4. CDC Basic Facts Page last reviewed April 10, 2013. Page last updated April 10, 2013
5. 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
6. ^ 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
7. Sarah Everts When Chemicals Became Weapons of War Chemical & Engineering News, 93(8), February 23, 2015
8. David Cloud for the New York Times. May 21, 2007 7 U.S. Soldiers Die in Iraq, 6 in Sweep of Baghdad
9. "Syria fails to remove all chemical weapons as deadline passes". Financial Times. Retrieved 12 September 2014.
10. CDC Public Health Consequences from Hazardous Substances Acutely Released During Rail Transit --- South Carolina, 2005; Selected States, 1999--2004
11. Michael Olukayode for Bloomberg News. July 25, 2015 Nigeria Says 8 People Dead After Inhaling Chlorine Gas in Jos

 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.

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