Successful extracorporeal life support after potentially fatal pulmonary oedema caused by inhalation of nitric and hydrofluoric acid fumes
Summary Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating. Despite aggressive respiratory support, one succumbed to respiratory failure 3.5 h after inhalation. The other patient also rapidly progressed...
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| Published in | Resuscitation Vol. 75; no. 1; pp. 184 - 188 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
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Shannon
Elsevier Ireland Ltd
01.10.2007
Elsevier |
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| Abstract | Summary Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating. Despite aggressive respiratory support, one succumbed to respiratory failure 3.5 h after inhalation. The other patient also rapidly progressed to respiratory failure. Extracorporeal life support (ECLS) was started 5 h after exposure at the ED. During ECLS, hypoxia improved, but pulmonary oedema shown by chest radiography became aggravated. N -Acetyl cysteine and calcium gluconate were given i.v. on the first day of admission and nebulised for 48 h after exposure. Pulmonary secretions were significantly reduced 24 h after the nebulising therapy began. Ultimately, the patient was discharged without serious pulmonary or neurological complications after 28 days of hospitalisation. In this case, early ECLS, nebulised antioxidant and antidote were available to treat potentially fatal pulmonary oedema after exposure to nitric and hydrofluoric acid fumes. |
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| AbstractList | Summary Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating. Despite aggressive respiratory support, one succumbed to respiratory failure 3.5 h after inhalation. The other patient also rapidly progressed to respiratory failure. Extracorporeal life support (ECLS) was started 5 h after exposure at the ED. During ECLS, hypoxia improved, but pulmonary oedema shown by chest radiography became aggravated. N -Acetyl cysteine and calcium gluconate were given i.v. on the first day of admission and nebulised for 48 h after exposure. Pulmonary secretions were significantly reduced 24 h after the nebulising therapy began. Ultimately, the patient was discharged without serious pulmonary or neurological complications after 28 days of hospitalisation. In this case, early ECLS, nebulised antioxidant and antidote were available to treat potentially fatal pulmonary oedema after exposure to nitric and hydrofluoric acid fumes. Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating. Despite aggressive respiratory support, one succumbed to respiratory failure 3.5 h after inhalation. The other patient also rapidly progressed to respiratory failure. Extracorporeal life support (ECLS) was started 5 h after exposure at the ED. During ECLS, hypoxia improved, but pulmonary oedema shown by chest radiography became aggravated. N-Acetyl cysteine and calcium gluconate were given i.v. on the first day of admission and nebulised for 48 h after exposure. Pulmonary secretions were significantly reduced 24 h after the nebulising therapy began. Ultimately, the patient was discharged without serious pulmonary or neurological complications after 28 days of hospitalisation. In this case, early ECLS, nebulised antioxidant and antidote were available to treat potentially fatal pulmonary oedema after exposure to nitric and hydrofluoric acid fumes. Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating. Despite aggressive respiratory support, one succumbed to respiratory failure 3.5h after inhalation. The other patient also rapidly progressed to respiratory failure. Extracorporeal life support (ECLS) was started 5h after exposure at the ED. During ECLS, hypoxia improved, but pulmonary oedema shown by chest radiography became aggravated. N-Acetyl cysteine and calcium gluconate were given i.v. on the first day of admission and nebulised for 48 h after exposure. Pulmonary secretions were significantly reduced 24 h after the nebulising therapy began. Ultimately, the patient was discharged without serious pulmonary or neurological complications after 28 days of hospitalisation. In this case, early ECLS, nebulised antioxidant and antidote were available to treat potentially fatal pulmonary oedema after exposure to nitric and hydrofluoric acid fumes. |
| Author | Lee, Sung-Woo Choi, Sung-Hyuk Kim, Kwang Ja Shin, Jae Seung Kim, Nak-Hoon Hong, Yun-Sik Park, Jon-Su |
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| Cites_doi | 10.1016/j.lfs.2004.11.027 10.1093/ajhp/62.8.828 10.1378/chest.97.2.487 10.1006/phrs.1999.0549 10.1016/S0300-9572(97)00029-4 10.1016/0735-6757(88)90053-8 |
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| Keywords | Calcium gluconate N-Acetylcysteine Pulmonary oedema Nitric acid Extracorporeal life support Hydrofluoric acid Thiol Intensive care Calcium Acetylcysteine Inorganic element Inhalation Mucolytic Fumes Resuscitation |
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| References | Hajela, Janigan, Landrigan (bib6) 1990; 97 Caravati (bib7) 1988; 6 Lachmanova, Hnilickova, Povysilova (bib8) 2005; 77 Lee, Chen, Lee (bib10) 2005; 62 Morcillo, Estrela, Cortijo (bib9) 1999; 40 Brush (bib3) 2004 Seamens, Seger, Meredith (bib5) 2001 Nelson (bib4) 1998 Bur, Wagner, Roggla (bib1) 1997; 35 Rao, Hoffman (bib2) 1998 Caravati (10.1016/j.resuscitation.2007.04.004_bib7) 1988; 6 Brush (10.1016/j.resuscitation.2007.04.004_bib3) 2004 Seamens (10.1016/j.resuscitation.2007.04.004_bib5) 2001 Morcillo (10.1016/j.resuscitation.2007.04.004_bib9) 1999; 40 Bur (10.1016/j.resuscitation.2007.04.004_bib1) 1997; 35 Hajela (10.1016/j.resuscitation.2007.04.004_bib6) 1990; 97 Lachmanova (10.1016/j.resuscitation.2007.04.004_bib8) 2005; 77 Lee (10.1016/j.resuscitation.2007.04.004_bib10) 2005; 62 Nelson (10.1016/j.resuscitation.2007.04.004_bib4) 1998 Rao (10.1016/j.resuscitation.2007.04.004_bib2) 1998 |
| References_xml | – start-page: 1333 year: 1998 end-page: 1337 ident: bib2 article-title: Caustics and batteries publication-title: Goldflank's Toxicologic emergency contributor: fullname: Hoffman – volume: 97 start-page: 487 year: 1990 end-page: 489 ident: bib6 article-title: Fatal pulmonary edema due to nitric acid fume inhalation in three pulp-mill workers publication-title: Chest contributor: fullname: Landrigan – volume: 62 start-page: 828 year: 2005 end-page: 833 ident: bib10 article-title: Compatibility and osmorality of inhaled publication-title: Am J Health-Syst Pharm contributor: fullname: Lee – volume: 40 start-page: 393 year: 1999 end-page: 404 ident: bib9 article-title: Oxidative stress and pulmonary inflammation: pharmacological intervention with antioxidants publication-title: Pharmacol Res contributor: fullname: Cortijo – start-page: 1453 year: 1998 end-page: 1468 ident: bib4 article-title: Simple asphyxiants and pulmonary irritants publication-title: Goldflank's Toxicologic Emergency contributor: fullname: Nelson – start-page: 1352 year: 2004 end-page: 1357 ident: bib3 article-title: Aaron CK Hydrogen fluoride publication-title: Medical toxicology contributor: fullname: Brush – volume: 6 start-page: 143 year: 1988 end-page: 150 ident: bib7 article-title: Acute hydrofluoric acid exposure publication-title: Am J Emerg Med contributor: fullname: Caravati – volume: 35 start-page: 33 year: 1997 end-page: 36 ident: bib1 article-title: Fatal pulmonary edema after nitric acid inhalation publication-title: Resuscitation contributor: fullname: Roggla – volume: 77 start-page: 175 year: 2005 end-page: 182 ident: bib8 article-title: publication-title: Life Sci contributor: fullname: Povysilova – start-page: 1019 year: 2001 end-page: 1025 ident: bib5 article-title: Hydrofluoric acid publication-title: Clinical Toxicology contributor: fullname: Meredith – volume: 77 start-page: 175 year: 2005 ident: 10.1016/j.resuscitation.2007.04.004_bib8 article-title: N-Acetylcysteine inhibits hypoxic pulmonary hypertension most effectively in the initial phase of chronic hypoxia publication-title: Life Sci doi: 10.1016/j.lfs.2004.11.027 contributor: fullname: Lachmanova – start-page: 1019 year: 2001 ident: 10.1016/j.resuscitation.2007.04.004_bib5 article-title: Hydrofluoric acid contributor: fullname: Seamens – volume: 62 start-page: 828 year: 2005 ident: 10.1016/j.resuscitation.2007.04.004_bib10 article-title: Compatibility and osmorality of inhaled N-acetylcysteine nebulizing solution with fenoterol and ipratropium publication-title: Am J Health-Syst Pharm doi: 10.1093/ajhp/62.8.828 contributor: fullname: Lee – volume: 97 start-page: 487 year: 1990 ident: 10.1016/j.resuscitation.2007.04.004_bib6 article-title: Fatal pulmonary edema due to nitric acid fume inhalation in three pulp-mill workers publication-title: Chest doi: 10.1378/chest.97.2.487 contributor: fullname: Hajela – start-page: 1453 year: 1998 ident: 10.1016/j.resuscitation.2007.04.004_bib4 article-title: Simple asphyxiants and pulmonary irritants contributor: fullname: Nelson – volume: 40 start-page: 393 year: 1999 ident: 10.1016/j.resuscitation.2007.04.004_bib9 article-title: Oxidative stress and pulmonary inflammation: pharmacological intervention with antioxidants publication-title: Pharmacol Res doi: 10.1006/phrs.1999.0549 contributor: fullname: Morcillo – volume: 35 start-page: 33 year: 1997 ident: 10.1016/j.resuscitation.2007.04.004_bib1 article-title: Fatal pulmonary edema after nitric acid inhalation publication-title: Resuscitation doi: 10.1016/S0300-9572(97)00029-4 contributor: fullname: Bur – start-page: 1333 year: 1998 ident: 10.1016/j.resuscitation.2007.04.004_bib2 article-title: Caustics and batteries contributor: fullname: Rao – start-page: 1352 year: 2004 ident: 10.1016/j.resuscitation.2007.04.004_bib3 article-title: Aaron CK Hydrogen fluoride contributor: fullname: Brush – volume: 6 start-page: 143 year: 1988 ident: 10.1016/j.resuscitation.2007.04.004_bib7 article-title: Acute hydrofluoric acid exposure publication-title: Am J Emerg Med doi: 10.1016/0735-6757(88)90053-8 contributor: fullname: Caravati |
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| Snippet | Summary Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating.... Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating. Despite... |
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| SubjectTerms | Adult Air Pollutants, Occupational - adverse effects Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Calcium gluconate Electroplating Emergency Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Explosive Agents - administration & dosage Explosive Agents - adverse effects Extracorporeal life support Extracorporeal Membrane Oxygenation - methods Fatal Outcome Humans Hydrofluoric acid Hydrofluoric Acid - administration & dosage Hydrofluoric Acid - adverse effects Intensive care medicine Male Medical sciences N-Acetylcysteine Nitric acid Nitric Acid - administration & dosage Nitric Acid - adverse effects Occupational Exposure - adverse effects Pneumology Pulmonary Edema - chemically induced Pulmonary Edema - therapy Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Pulmonary oedema |
| Title | Successful extracorporeal life support after potentially fatal pulmonary oedema caused by inhalation of nitric and hydrofluoric acid fumes |
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