Autopsy and Case Reports
https://app.periodikos.com.br/journal/autopsy/article/doi/10.4322/acr.2021.266
Autopsy and Case Reports
Clinical Case Report

Reactive airways dysfunction syndrome following inhalation of hydrogen chloride vapor

Vanessa Simioni Faria; Soraya Abou El Hosn Cordero da Silva; Julio Flávio Meirelles Marchini

Downloads: 0
Views: 1184

Abstract

Hydrogen chloride is available commercially as an anhydrous gas or an aqueous solution, hydrochloric acid. Exposure to this gas has been associated with the development of reactive airways dysfunction syndrome. However, there are few published reports. A 37-year-old woman developed progressive bronchospasm and acute respiratory failure after cleaning an enclosed space with an unknown concentration of hydrochloric acid gas from a cleaning substance. She had no prior history of asthma or atopy. Severe bronchospasm developed, leading to hypoxemia and diffuse interstitial infiltrates, necessitating orotracheal intubation and admission to the intensive care unit. Asthma-like symptoms such as cough, wheezing, and dyspnea; requiring bronchodilators, and repeated hospitalizations are persistent a year after the accident. Pulmonary function testing showed mild airflow obstruction.

Keywords

Bronchial Hyperreactivity, Respiratory Insufficiency, Respiratory Distress Syndrome, Adult

References

1 Brooks SM, Weiss MA, Bernstein IL. Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures. Chest. 1985;88(3):376-84. http://dx.doi.org/10.1378/chest.88.3.376. PMid:4028848.

2 Cormier Y, Coll B, Laviolette M, Boulet LP. Reactive airways dysfunction syndrome (RADS) following exposure to toxic gases of a swine confinement building. Eur Respir J. 1996;9(5):1090-1. http://dx.doi.org/10.1183/09031936.96.09051090. PMid:8793474.

3 Varney VA, Evans J, Bansal AS. Successful treatment of reactive airways dysfunction syndrome by high-dose vitamin D. J Asthma Allergy. 2011;4:87-91. http://dx.doi.org/10.2147/JAA.S19107. PMid:22034572.

4 Agency for Toxic Substances and Disease Registry (ATSDR). Managing Hazardous Materials Incidents (MHMI). Hydrogen chloride. 2001 [cited 2020 Nov 20]. Available from: https://www.atsdr.cdc.gov/MHMI/mmg173.pdf

5 Permanent Committee on Technology. Safety Japan Soda Industry Association. Safe handling of hydrochloric acid. Tokyo: JSIA; 2006 [cited 2020 Nov 20]. Available from: http://www.jsia.gr.jp/data/handling_02e.pdf

6 National Research Council (US). Subcommittee on Rocket-Emission Toxicants. Assessment of exposure-response functions for rocket-emission toxicants. Washington (DC): National Academies Press (US); 1998. Appendix D, Acute toxicity of hydrogen chloride. Available from: https://www.ncbi.nlm.nih.gov/books/NBK230426/

7 Sentry Air Systems, Inc. Hydrochloric acid vapor, mist, and fume inhalation health risks. 2017 [cited 2020 Nov 20]. Available from: https://www.sentryair.com/blog/chemical-fume-control/hydrochloric-acid-vapor-mist-and-fume-inhalation-health-risks/

8 National Research Council (US). Committee on Emergency and Continuous Exposure Guidance Levels for Selected Submarine Contaminants. Emergency and continuous exposure guidance levels for selected submarine contaminants. Washington (DC): National Academies Press (US); 2009. (vol. 3).

9 Bull S. Hydrogen chloride/hydrochloric acid: toxicological overview. Health Protection Agency; 2007 [cited 2020 Nov 20]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/337689/hpa_hydrogen_chloride_toxicological_overview_v1.pdf

10 De Lange DW, Meulenbelt J. Do corticosteroids have a role in preventing or reducing acute toxic lung injury caused by inhalation of chemical agents? Clin Toxicol. 2011;49(2):61-71. http://dx.doi.org/10.3109/15563650.2011.553196. PMid:21370942.

11 Boyce SH, Simpson KA. Hydrochloric acid inhalation: who needs admission? J Accid Emerg Med. 1996;13(6):422-4. http://dx.doi.org/10.1136/emj.13.6.422. PMid:8947805.

12 Ferguson ND, Fan E, Camporota L, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38(10):1573-82. http://dx.doi.org/10.1007/s00134-012-2682-1. PMid:22926653.

13 Stevens B, Koenig JQ, Rebolledo V, Hanley QS, Covert DS. Respiratory effects from the inhalation of hydrogen chloride in young adult asthmatics. J Occup Med. 1992;34(9):923-9. PMid:1447599.

14 Kaplan HL, Anzueto A, Switzer WG, Hinderer RK. Effects of hydrogen chloride on respiratory response and pulmonary function of the baboon. J Toxicol Environ Health. 1988;23(4):473-93. http://dx.doi.org/10.1080/15287398809531129. PMid:3129573.

15 Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301-8. http://dx.doi.org/10.1056/NEJM200005043421801. PMid:10793162.

16 Boulet LP. Increases in airway responsiveness following acute exposure to respiratory irritants. Reactive airway dysfunction syndrome or occupational asthma? Chest. 1988;94(3):476-81. http://dx.doi.org/10.1378/chest.94.3.476. PMid:2842114.

17 Department for Environment, Food and Rural Affairs, Scottish Executive, National Assembly of Wales, Department of the Environment in Northern Ireland. Guidelines for halogens and hydrogen halides in ambient air for protecting human health against acute irritancy effects. United Kingdom: Royal Commission on Environmental Pollution; 1998 [cited 2020 Nov 20]. Available from: https://webarchive.nationalarchives.gov.uk/20060716141118/http://www.defra.gov.uk/environment/airquality/aqs/halogens/fullreport.pdf

18 Brooks SM, Hammad Y, Richards I, Giovinco-Barbas J, Jenkins K. The spectrum of irritant-induced asthma: sudden and not-so-sudden onset and the role of allergy. Chest. 1998;113(1):42-9. http://dx.doi.org/10.1378/chest.113.1.42. PMid:9440566.

19 Lemière C, Malo JL, Boutet M. Reactive airways dysfunction syndrome due to chlorine: sequential bronchial biopsies and functional assessment. Eur Respir J. 1997;10(1):241-4. http://dx.doi.org/10.1183/09031936.97.10010241. PMid:9032521.

20 Cockcroft DW. Environmental causes of asthma. Semin Respir Crit Care Med. 2018;39(1):12-8. http://dx.doi.org/10.1055/s-0037-1606219. PMid:29427981.

21 Chan-Yeung M. Assessment of asthma in the workplace: ACCP consensus statement. Chest. 1995;108(4):1084-117. http://dx.doi.org/10.1378/chest.108.4.1084. PMid:7555124.

22 Gautrin D, Boulet LP, Boutet M, et al. Is reactive airways dysfunction syndrome a variant of occupational asthma? J Allergy Clin Immunol. 1994;93(1):12-22. http://dx.doi.org/10.1016/0091-6749(94)90228-3. PMid:8308178.
 


Submitted date:
11/20/2020

Accepted date:
02/01/2021

Publication date:
04/20/2021

607f16eca953957fdf364bd6 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections