Chloramine: Difference between revisions
(Chloramine) |
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== | ==Evaluation== | ||
*History of using home cleaning agents in an enclosed space | *History of using home cleaning agents in an enclosed space | ||
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*Oxygen as need for low O2 saturation | *Oxygen as need for low O2 saturation | ||
*[[Albuterol]] | *[[Albuterol]] | ||
**2.5- | **2.5-5mg nebulized Q20 minutes or continuous nebulizer | ||
*Intravenous [[steroids]] | *Intravenous [[steroids]] | ||
**[[Dexamethasone]] | **[[Dexamethasone]] | ||
***0. | ***0.6mg/kg IV or PO (max 16mg) | ||
**[[Methylprednisolone]] | **[[Methylprednisolone]] | ||
***Adults- 125mg IV | ***Adults- 125mg IV | ||
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==See Also== | ==See Also== | ||
*[[Toxicology (Main)]] | *[[Toxicology (Main)]] | ||
*[[Inhalation exposure]] | |||
==External Links== | ==External Links== | ||
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<references/> | <references/> | ||
[[Category: | [[Category:Toxicology]] | ||
Latest revision as of 23:16, 22 July 2016
Background
- Derivative of ammonia with substitution of 1-3 hydrogen ions by chlorine.
- Monocholramine NH2Cl
- Dichloramine NHCl2
- Nitrogen trichloride NCl3
- Inhalation causes chloramines to react with moist mucus membranes releasing ammonia, hydrogen chloride, and oxygen free radicals[1]
- Produced with the mixing of household cleaning agents containing ammonia and bleach
- Most common form of exposure
- Thousands of exposures annually but few people seek medical attention as most exposures are mild.
Clinical Features
- Inhalation exposure
- Dyspnea
- Upper airway irritation
- Cough
- Wheezing
- Rarely; Stridor and upper airway edema
- Complications
- Chemical pneumonitis
- Non cardiogenic pulmonary edema
Differential Diagnosis
Acute dyspnea
Emergent
- Pulmonary
- Airway obstruction
- Anaphylaxis
- Angioedema
- Aspiration
- Asthma
- Cor pulmonale
- Inhalation exposure
- Noncardiogenic pulmonary edema
- Pneumonia
- Pneumocystis Pneumonia (PCP)
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Idiopathic pulmonary fibrosis acute exacerbation
- Cystic fibrosis exacerbation
- Cardiac
- Other Associated with Normal/↑ Respiratory Effort
- Other Associated with ↓ Respiratory Effort
Non-Emergent
- ALS
- Ascites
- Uncorrected ASD
- Congenital heart disease
- COPD exacerbation
- Fever
- Hyperventilation
- Interstitial lung disease
- Neoplasm
- Obesity
- Panic attack
- Pleural effusion
- Polymyositis
- Porphyria
- Pregnancy
- Rib fracture
- Spontaneous pneumothorax
- Thyroid Disease
- URI
Evaluation
- History of using home cleaning agents in an enclosed space
Management
Symptoms may be worse in patient's with asthma or COPD
- Most patients will not require any treatment
- Consider X-ray
- Oxygen as need for low O2 saturation
- Albuterol
- 2.5-5mg nebulized Q20 minutes or continuous nebulizer
- Intravenous steroids
- Dexamethasone
- 0.6mg/kg IV or PO (max 16mg)
- Methylprednisolone
- Adults- 125mg IV
- Children- 2mg/kg IV
- Dexamethasone
- Epinephrine nebulized
- Consider for patient's with stridor, voice changes, or continuous dyspnea despite aforementioned treatment
- If the exposure is severe and the patient is unstable or continues to decline despite management above then consider intubation
- Consider awake fiberoptic intubation given upper airway swelling/edema
- Prepare for cricothyrotomy simultaneously if intubation fails
Disposition
- Most patients can be observed for 4-6 hours in the ED[2]
- If asymptomatic after observation the patient can be discharged home
- Consider repeat X-ray
- Consider admission or in house observation for asthmatics/COPD patients or those with continued symptoms after 4-6 hours
See Also
External Links
References
- ↑ Tanen, David A., Kimberlie A. Graeme, and Robert Raschke. "Severe Lung Injury after Exposure to Chloramine Gas from Household Cleaners." New England Journal of Medicine N Engl J Med 341.11 (1999): 848-49. New England Journal of Medicine. Web. 16 Oct. 2015.
- ↑ US National Library of Medicine. TOXNET: Toxicology Data Network.