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Not to be confused with phosgene oxime (CX)


Phosgene poster ww2.jpg
  • phosgene (COCl2) is a highly toxic, colorless gas or liquid
  • Classified as a pulmonary chemical agent, chemical weapon
  • gained infamy in WWI - responsible for 85% of deaths due to chemical weapons
  • pulmonary irritant
  • major complication is non-cardiogenic pulmonary edema
  • used in chemical reactions - large scale exposures usually 2/2 industrial accidents
    • manufacturers of dyes, resins, coal tar, pesticides
  • Denser than air, settles in low-lying places – trenches/basements
  • Rapid olfactory fatigue can occur leading to prolonged exposure
  • Exposure may be secondary to fire at textile factory/house, metalwork, or burning Freon


  • acrylation reaction with amino, hydroxyl, and sulfhydryl goups
  • membrane structural changes, protein denaturation, depletion of glutathione
  • increased vascular permeability leads to noncardiogenic pulmonary edema

Clinical Features

  • some people may note a smell of freshly cut hay or grass
  • eye and throat symptoms may occur at very low concentrations
  • unpredictable latent phase
  • development of noncardiogenic pulmonary edema
  • Symptoms may take 2-24 hours to develop

Symptoms by Concentration

  • Low: mild cough, chest tightness, shortness of breath
  • Moderate: Lacrimation
  • High: Non-cardiogenic pulmonary edema within 2 to 6 hours after exposure with death within 24-48 hours

Differential Diagnosis

Chemical weapons


  • high index of suspicion, ask about work history/exposures
  • no combination of labs/xrays can predict whether pt will develop pulmonary edema
  • latent phase can be 30 min - 72hrs but significant exposures usually developed pulmonary symptoms within 24 hrs



See Also