Case Report
Year 2019,
Volume: 2 Issue: 4, 25 - 27, 31.12.2019
Abstract
Amaç
Sodyum hipoklorit (çamaşır suyu) ve hidroklorik asit ( tuz ruhu) ülkemizde temizlik amacı ile sık olarak kullanılır. Bu iki sıvının karıştırılması sonucunda zehirli klor gazı ortaya
çıkmaktadır. Klor gazının inhalasyonu, mukoz membranlarda irrirasyon, pulmoner gaz değişiminin engellenmesi ve pulmoner ödem nedeniyle ciddi solunum sıkıntısına neden olabilir. Nadiren kardiyovasküler sisteme de zarar verebilir.
Olgu
Bilinen kalp veya solunum hastalığı teşhisi konmamış 81 yaşında bir erkek hasta acil servise klor gazı maruziyeti nedeniyle lakrimasyon ve burun akıntısı şikayeti ile başvurdu. Aktif kardiyak şikayeti olmayan hastada troponin pozitifliği saptandı. Takibe alınan hastada takiplerinde troponin değerinde artış olması ve akut koroner sendrom dışlanamaması nedeni ile hastaya yapılan koroner anjiyografide koroner arterler plaklı olarak izlendi. Troponin yüksekliği sodyum hipoklorit ve hidroklorik asit karışımının inhalasyonuna bağlandı.
Sonuç
Klor gazına maruz kalma genellikle solunum sistemine zarar vermektedir. Bunun yanında, aritmi, akut koroner sendrom, kalp yetmezliği ve hatta ölüm gibi kardiyovasküler etkiler de görülebilir. Acil tıp doktorları klor gazına maruz kalan hastalarda kardiyovasküler etkilere dikkat etmeli ve kalp hastalığı öyküsü olmasa bile kardiyak hasarın gelişebileceğini düşünmelidir.
References
- 1.Gorguner M, Aslan S, Inandi T, Cakir Z. Reactive airways dysfunction syndrome in housewives due to a bleach-hydrochloric acid mixture. Inhal Toxicol 2004;16(2):87-91.
- 2.Guloglu C, Kara IH, Erten PG. Acute accidental exposure to chlorine gas in the Southeast of Turkey: a study of 106 cases.Enviromental research. 2002; 88(2);89-93.
- 3. Avsarogulları L, İkizceli İ, Sozuer EM, Akdur O, Yucel M, Durukan P, et al. Akut klor gazı inhalasyonları: Olgu serisi - Turk J Emerg Med 2006;6(1):12- 15.
- 4. Babu RV, Cardenas V, Sharma G. Acute respiratory distress syndrome from chlorine inhalation during a swimming pool accident: a case report and review of the literature. Journal of intensive care medicine. 2008; 23(4) 275-80.
- 5. White CW, Martin JG. Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models. Proceedings of the American Thoracic Society 2010;7(4):257-63.
- 6. Kose A, Kose B, Acikalin A, Gunay N, Yildirim C. Myocardial infarction, acute ischemic stroke, and hyperglycemia triggered by acute chlorine gas inhalation. Am J Emerg Med. 2009;27:e1021–e1024.
- 7. Zaky A, Ahmad A, Dell’Italia LJ, Jahromi L, Reisenberg LA, Matalon S, et al. Inhaled matters of the heart. Cardiovascular regenerative medicine. 2015;2
- 8. Al B, Bozkurt S, Yıldırım C, Zengin S, Togun İ, Eralp A, et al. Histopathological study of short and long-term pulmonary effects of nebulized sodium bicarbonate treatment in chlorine gas exposured rats. Türkiye Klinikleri J Med Sci 2010;30(2):650-8.
- 9. Govier P, Coulson JM. Civilian exposure to chlorine gas: A systematic review. Toxicology letters 2018;293:249-252.
- 10. Carlisle M, Lam A, Svendsen ER, Aggarwal S, Matalon S. Chlorineinduced cardiopulmonary injury. Annals of the New York Academy of Sciences. 2016;1374(1):159-67.
- 11. Menaouar A, Anglade D, Baussand P, Pelloux A, Corboz M, Lantuejoul S, et al. Chlorine gas induced acute lung injury in isolated rabbit lung. European Respiratory Journal. 1997;10(5):1100-7.
- 12. Ahmad S, Ahmad A, Hendry-Hofer TB, Loader JE, Claycomb WC, Mozziconacci O, et al. Sarcoendoplasmic reticulum Ca2+ ATPase. A critical target in chlorine inhalation–induced cardiotoxicity. American journal of respiratory cell and molecular biology. 2015;52(4):492-502.
- 13. Zaky A, Bradley WE, Lazrak A, Zafar I, Doran S, Ahmad A, et al. Chlorine inhalation‐induced myocardial depression and failure. Physiological reports. 2015;3(6).
Year 2019,
Volume: 2 Issue: 4, 25 - 27, 31.12.2019
Abstract
Aim
Sodium hypochlorite (bleach) and hydrochloric acid are chemicals, commonly used in household cleaning and can be dangerous when mixed with each other. As a result of the
mixture, chlorine gas is released which is poisonous. Inhalation of chlorine gas may cause severe respiratory distress due to irritation of mucous membranes, impaired pulmonary gas exchange, and pulmonary edema. Rarely, it also damages the cardiovascular system.
Case
An 81-year-old male patient, who had not been previously diagnosed with heart or respiratory disease, presented to the emergency department with a complaint of lacrimation and nasal discharge due to chlorine gas exposure. He had troponin positivity. Coronary angiography was performed due to the subsequently troponin increase. Coronary angiography revealed plaques. The cause of troponin increase was associated with the inhalation of chlorine gas.
Conclusion
Exposure to chlorine gas is commonly manifested by damage to the respiratory system. However, cardiovascular effects such as arrhythmia, acute coronary syndrome, heart
failure, or even death may also occur. Emergency medicine physicians should pay attention to these cardiovascular effects and consider that patients exposed to chlorine gas
may experience heart damage even if they do not have a history of heart disease.
References
- 1.Gorguner M, Aslan S, Inandi T, Cakir Z. Reactive airways dysfunction syndrome in housewives due to a bleach-hydrochloric acid mixture. Inhal Toxicol 2004;16(2):87-91.
- 2.Guloglu C, Kara IH, Erten PG. Acute accidental exposure to chlorine gas in the Southeast of Turkey: a study of 106 cases.Enviromental research. 2002; 88(2);89-93.
- 3. Avsarogulları L, İkizceli İ, Sozuer EM, Akdur O, Yucel M, Durukan P, et al. Akut klor gazı inhalasyonları: Olgu serisi - Turk J Emerg Med 2006;6(1):12- 15.
- 4. Babu RV, Cardenas V, Sharma G. Acute respiratory distress syndrome from chlorine inhalation during a swimming pool accident: a case report and review of the literature. Journal of intensive care medicine. 2008; 23(4) 275-80.
- 5. White CW, Martin JG. Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models. Proceedings of the American Thoracic Society 2010;7(4):257-63.
- 6. Kose A, Kose B, Acikalin A, Gunay N, Yildirim C. Myocardial infarction, acute ischemic stroke, and hyperglycemia triggered by acute chlorine gas inhalation. Am J Emerg Med. 2009;27:e1021–e1024.
- 7. Zaky A, Ahmad A, Dell’Italia LJ, Jahromi L, Reisenberg LA, Matalon S, et al. Inhaled matters of the heart. Cardiovascular regenerative medicine. 2015;2
- 8. Al B, Bozkurt S, Yıldırım C, Zengin S, Togun İ, Eralp A, et al. Histopathological study of short and long-term pulmonary effects of nebulized sodium bicarbonate treatment in chlorine gas exposured rats. Türkiye Klinikleri J Med Sci 2010;30(2):650-8.
- 9. Govier P, Coulson JM. Civilian exposure to chlorine gas: A systematic review. Toxicology letters 2018;293:249-252.
- 10. Carlisle M, Lam A, Svendsen ER, Aggarwal S, Matalon S. Chlorineinduced cardiopulmonary injury. Annals of the New York Academy of Sciences. 2016;1374(1):159-67.
- 11. Menaouar A, Anglade D, Baussand P, Pelloux A, Corboz M, Lantuejoul S, et al. Chlorine gas induced acute lung injury in isolated rabbit lung. European Respiratory Journal. 1997;10(5):1100-7.
- 12. Ahmad S, Ahmad A, Hendry-Hofer TB, Loader JE, Claycomb WC, Mozziconacci O, et al. Sarcoendoplasmic reticulum Ca2+ ATPase. A critical target in chlorine inhalation–induced cardiotoxicity. American journal of respiratory cell and molecular biology. 2015;52(4):492-502.
- 13. Zaky A, Bradley WE, Lazrak A, Zafar I, Doran S, Ahmad A, et al. Chlorine inhalation‐induced myocardial depression and failure. Physiological reports. 2015;3(6).
There are 13 citations in total.
Details
| Primary Language | English |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | December 31, 2019 |
| Published in Issue | Year 2019 Volume: 2 Issue: 4 |
