Acute respiratory distress syndrome caused by demulsifier poisoning: A case report

Abstract

Background: This case report emphasizes the potential pulmonary toxicity of demulsifier gas, which is a widely used chemical. To our knowledge, this is the first documented instance of acute respiratory distress syndrome (ARDS) induced by inhalation of demulsifier gas. This report underscores the need for increased workplace safety and awareness regarding health risks associated with demulsifiers, particularly in industrial settings. Timely diagnosis and management of ARDS are crucial for improving patient outcomes, thus making this report significant for clinical practice and occupational health literature.

Case summary: We present a rare case of acute demulsifier poisoning leading to ARDS in a previously healthy 69-year-old man. He presented with chest discomfort, shortness of breath, and dyspnea following a 30-minute exposure to demulsifier fumes in a poorly ventilated area. Chest computed tomography revealed bilateral diffuse infiltrative shadows. Based on his exposure history and clinical findings, a diagnosis of ARDS due to demulsifier poisoning was confirmed. The patient required high-flow oxygen and intravenous norepinephrine upon admission and was subsequently intubated for mechanical ventilation. Following timely and effective multidisciplinary treatment interventions including emergency care, intensive care, and respiratory medicine, he achieved positive outcomes and was ultimately discharged.

Conclusion: This case underscores the critical importance of recognizing chemical exposure risks and their potential to cause severe respiratory complications.

Keywords: Acute chemical poisoning; Acute respiratory distress syndrome; Case report; Demulsifier poisoning; Industrial processes; Pulmonary toxicity.

Figure 1

Imaging changes found in the course of acute respiratory distress syndrome management. Changes on chest computed tomography (CT) before; radiography taken on April 10^th; chest CT after treatment on April 13^th. A: The chest CT carried out in the emergency room revealed pulmonary infiltrates in both lungs; B: A follow-up chest radiography on April 10th indicated exudative lesions in both lungs; C: After 5 days of treatment, a repeat chest CT examination showed significant resolution of the pulmonary infiltrates.

Figure 2

Gradual imaging indications of improvement post-treatment in patients. Radiography taken on April 16^th; Chest computed tomography (CT) after treatment on April 19^th; Chest CT after treatment on April 27^th. A: Chest radiography taken on April 16^th, compared to that on April 9^th, indicated a significant reduction in exudative lesions in both lungs; B: The chest CT examination on April 19^th showed resolution of the exudative lesion when compared to the previous image; C: After treatment, a follow-up chest CT on April 27^th indicated significant improvement in the absorption of exudative lesions in both lungs.