Accidental phosgene gas exposure: A review with background study of 10 cases

Abstract

Here, authors present a review on clinical presentation and management of exposure of phosgene gas after reviewing the literature by searching with keywords phosgene exposure on Google, Cochrane, Embase and PubMed with a background of experience gained from 10 patients who were admitted to our institute after an accidental phosgene exposure in February 2011 nearby a city in India. Phosgene is a highly toxic gas, occupational workers may have accidental exposure. The gas can also be generated inadvertently during fire involving plastics and other chemicals and solvents containing chlorine, which is of concern to emergency responders. Phosgene inhalation may cause initially symptoms of respiratory tract irritation, patients feel fine thereafter, and then die of choking a day later because of build up of fluid in the lungs (delayed onset non-cardiogenic pulmonary edema). Phosgene exposure is associated with significant morbidity and mortality. Patients with a history of exposure should be admitted to the hospital for a minimum of 24 h for observation because of the potential for delayed onset respiratory failure and acute respiratory distress syndrome.

Keywords: Acute respiratory distress syndrome; N-acetyl-cysteine; phosgene.

Figure 1

Chest X-rays Posteroanterior view patient (3) showed bilateral fluffy infiltrates with normal cardiac shadow suggestive of non-cardiogenic pulmonary edema

Figure 2

Chest X-rays Posteroanterior view patient (6) showed bilateral fluffy infiltrates with normal cardiac shadow suggestive of non-cardiogenic pulmonary edema