Chlorine Toxicity Workup
- Author: Gerald F O'Malley, DO; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD more...
Studies in patients with significant exposure to chlorine gas may include the following:
Serum electrolyte, blood urea nitrogen (BUN), and creatinine levels
Arterial blood gases
Pulmonary function testing
Laryngoscopy or bronchoscopy
Abnormalities include hypoxia (from bronchospasm or pulmonary edema) and metabolic acidosis, which may be a hyperchloremic (nonanion gap) acidosis. It is postulated that this may be caused by the absorption of hydrochloric acid following the reaction of chlorine gas with mucosal water.[22, 35]
Handheld peak flow meters can be used to measure the degree of bronchospasm and follow the response to treatment. Pulmonary function tests may indicate obstructive or restrictive patterns and can provide measurements of the degree of limitation.
The chest radiograph findings are frequently normal initially but may exclude other causes of hypoxia in the differential. Abnormalities may nonspecific; however, pulmonary edema, pneumonitis, and adult respiratory distress syndrome (ARDS) may be seen in some cases. The radiograph below shows diffuse pulmonary edema without significant cardiomegaly.
CT scan of the chest can reveal the extent of interstitial pulmonary edema.
A ventilation-perfusion scan showing abnormal retention of radiolabeled xenon gas at 90 seconds suggests lower airway injury.
The image below shows a sample of lung tissue obtained from biopsy of a patient with exposure to chlorine.
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