Chlorine Poisoning Clinical Presentation

  • Author: Daniel Noltkamper, MD, FACEP; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Apr 19, 2011
 

History

The patient may experience symptoms based on the exposure. Exposure possibilities include acute low levels, acute high levels, and chronic low levels.

Acute exposure (low levels)

Most poisonings fall into this category and are caused by household exposure to low-concentration cleaning products.

  • Eye tearing, nose and throat irritation
  • Sneezing
  • Excess salivation
  • General excitement or restlessness

Acute exposure (high levels)

Symptoms as above as well as the following:

  • Dyspnea: Upper airway swelling and obstruction may occur.
  • Violent cough
  • Nausea and vomiting (with the smell of chlorine in emesis)
  • Lightheadedness
  • Headache
  • Chest pain or retrosternal burning
  • Muscle weakness
  • Abdominal discomfort
  • Dermatitis (with liquid exposure): Corneal burns and ulcerations may occur from splash exposure to high-concentration chlorine products.

Chronic exposure

  • Acne (chloracne)
  • Chest pain
  • Cough
  • Sore throat
  • Hemoptysis
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Physical

  • Tachypnea
  • Cyanosis (most prevalent during exertion)
  • Tachycardia
  • Wheezing
  • Intercostal retractions
  • Decreased breath sounds
  • Rales (pulmonary edema)
  • Nasal flaring
  • Aphonia, stridor, or laryngeal edema
  • Ulceration or hemorrhage of the respiratory tract
  • Rhinorrhea
  • Lacrimation, salivation, and blepharospasm
  • Chloracne or tooth enamel corrosion (with chronic exposure)
  • Redness, erythema, and chemical burns to the skin from dose-dependent exposure to liquid
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Causes

  • Occupational exposures constitute the highest risk for serious exposure to high-concentration chlorine.
  • Other exposures occur during industrial or transportation accidents.
  • Wartime exposure is rare but always possible.
  • Household exposure occurs during swimming pool maintenance or inappropriate mixing of bleach cleaning agents with acids or ammonia products.
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Contributor Information and Disclosures
Author

Daniel Noltkamper, MD, FACEP  EMS Medical Director, Department of Emergency Medicine, Naval Hospital of Camp Lejeune

Daniel Noltkamper, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Gerald F O'Malley, DO  Clinical Associate Professor of Emergency Medicine, Thomas Jefferson University Hospital; Director of Research, Director, Division of Toxicology, Department of Emergency Medicine, Albert Einstein Medical Center

Gerald F O'Malley, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, American College of Osteopathic Emergency Physicians, American Osteopathic Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark Keim, MD  Senior Science Advisor, Office of the Director, National Center for Environmental Health, Centers for Disease Control and Prevention

Mark Keim, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

References

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  17. Segal E, Lang E. Toxicity, Chlorine Gas. eMedicine Journal [serial online]. 2000. [Full Text].

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  19. Traub SJ. Respiratory agent attack (toxic inhalational injury). In: Ciottone GR. Disaster Medicine. 3rd ed. Philadelphia, PA: Mosby Elsevier; 2006:573-575/ chap 93.

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  21. Vinsel PJ. Treatment of acute chlorine gas inhalation with nebulized sodium bicarbonate. J Emerg Med. May-Jun 1990;8(3):327-9. [Medline].

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  23. White CW, Martin JG. Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models. Proc Am Thorac Soc. Jul 2010;7(4):257-63. [Medline].

 
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Chest radiograph of a 36-year-old chemical worker 2 hours postexposure to chlorine inhalant. She had severe resting dyspnea during the second hour, diffuse crackles/rhonchi on auscultation, and a partial pressure of oxygen of 32 mm Hg breathing room air. The radiograph shows diffuse pulmonary edema without significant cardiomegaly (used with permission from Medical Aspects of Chemical and Biological Warfare, Textbook of Military Medicine. 1997: 256).
A section from a lung biopsy (hematoxylin and eosin stain; original magnification X 100) from a 36-year-old chemical worker taken 6 weeks postexposure to chlorine. At that time, the patient had no clinical abnormalities and a partial pressure of oxygen of 80 mm Hg breathing room air. The section shows normal lung tissues without evidence of interstitial fibrosis and/or inflammation (used with permission from Medical Aspects of Chemical and Biological Warfare, Textbook of Military Medicine. 1997: 256).
Chemical Terrorism Agents and Syndromes. Signs and symptoms. Chart courtesy of North Carolina Statewide Program for Infection Control and Epidemiology (SPICE), copyright University of North Carolina at Chapel Hill.
 
 
 
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