PHOSGENE EXPOSURE

Phosgene exposure by acute (short-term) inhalation is extremely toxic. Phosgene is a chemical that is found in pesticides and plastics. It may also be created when chlorine-containing substances are broken down or burnt. Phosgene exposure may occur when a person comes into touch with contaminated food, liquid, or gas. Humans have experienced severe respiratory consequences such as pulmonary edema, pulmonary emphysema, and death from phosgene exposure.

SYMPTOMS

Symptoms of phosgene exposure that occur immediately include:

  • Eyes and throat burning sensation
  • Blurred vision
  • Vomiting and nausea
  • Coughing
  • Watery eyes
  • Breath shortness or difficulty breathing
  • Skin contact may cause lesions similar to burns or frostbite

Large doses of phosgene would very certainly have the following negative health effects:

  • Cardiac arrest that might result in death
  • Convulsions
  • Respiratory failure that might result in death
  • Twitching
  • Loss of consciousness
  • Coma
  • Paralysis
  • Seizures

DIAGNOSIS

There is no particular laboratory test for confirming phosgene exposure; nevertheless, many methods of monitoring pulmonary health should be used. A chest x-ray, oxygen saturation, ABG, and volume status evaluation are among them (initially via vital signs and examination of mucous membranes).

An X-ray of the chest often reveals pulmonary edema symptoms, with hilar enlargement as the first finding (4-8 hours after exposure) and ill-defined patchy infiltrates. Additional tests such as the following may be needed to distinguish between pulmonary edema and ARDS.

  • ECG
  • Troponin T
  • NT pro-BNP

Those exposed to large amounts should be monitored for 24 hours due to the likelihood of delayed pulmonary edema. The major criteria to be monitored are chest radiography, physical findings, and ABG.

TREATMENT

Treatment is primarily supportive; no antidote for phosgene exposure is currently available. As with any poisoning, decontamination is critical; the patient must be removed from the contaminated surroundings and stripped of their clothes first.

If the skin or eyes have been exposed, they should be thoroughly rinsed with tepid water. A thorough rinse and wash with soap and water should be performed in locations with direct skin contact. Physical effort should be avoided after inhalation exposure, and rigorous bed rest should be imposed for 24 to 72 hours, especially if the exposure dosage was unknown or more than 25 ppm/min.

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