Diphosgene Exposure Clinical Presentation

  • Author: Paul P Rega, MD, FACEP; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Jun 3, 2011
 

History

  • History likely reveals multiple casualties with respiratory complaints.
  • Patients report irritation of the eyes or the skin.
  • Victims likely will have been involved in a mass gathering or military event within the last 24 hours. Patients may report explosions, smoke, or a gas cloud. Patients inconsistently report the odor of newly mown hay.
  • Exposure to low concentrations of diphosgene (DP) tends to cause lacrimation and irritation of the eyes and skin.
  • Exposure to somewhat higher concentrations causes chest discomfort and dyspnea.
  • Exposure to high concentrations can quickly cause pulmonary edema with cough, dyspnea, and production of frothy sputum. Signs include tachypnea, rales, and decreased oxygen saturations.
  • Further cardiopulmonary decompensation can occur from noncardiogenic pulmonary edema, with respiratory failure, hypotension, and death.
  • Direct eye exposure to diphosgene liquid can cause corneal abrasions, ulcers, or perforation. Direct skin exposure to diphosgene liquid can cause burns.
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Physical

  • Lacrimation and irritation of the eyes and skin - Direct eye exposure to diphosgene (DP) liquid can cause corneal abrasions, ulcers, or perforation.
  • Direct skin exposure to diphosgene liquid can cause burns.
  • Chest discomfort
  • Tachycardia
  • Tachypnea
  • Dyspnea
  • Frothy sputum
  • Cough
  • Wheeze
  • Noncardiogenic pulmonary edema (decreased oxygen saturation)
  • Respiratory failure
  • Hypotension
  • Death
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Contributor Information and Disclosures
Author

Paul P Rega, MD, FACEP  Assistant Professor, Department of Public Health and Preventive Medicine, The University of Toledo College of Medicine; Assistant Professor, Department of Emergency Medicine, The University of Toledo College of Medicine; Director of Emergency Medicine Education and Disaster Management, OMNI Health Services

Paul P Rega, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians 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; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape 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.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Eric Mowatt-Larssen, MD, and Timothy Vollmer, MD, to the development and writing of this article.

References

  1. American Academy of Orthopedic Surgeons, Stewart CE. Pulmonary Agents. In: Stewart CE. Weapons of Mass Casualties and Terrorism Response Handbook. Boston: Jones & Bartlett; 2006:42 (Ch.4).

  2. Chemical Casualty Care Division USAMRICD. Medical Response to Chemical Warfare and Terrorism. 3rd ed. 1997:i-xiv, 1-8.

  3. Choking Agents. Defense Treaty Inspection Readiness Program. Available at http://dtirp.dtra.mil/tic/treatyinfo/vd_comp05.htm. Accessed June 13, 2007.

  4. Compton JAF. Diphosgene. In: Military Chemical and Biological Agents. 1987:124-134.

  5. Givens M. Phosgene and toxic gases. In: Keyes DC, Burstein LJ, et al, eds. Medical Response to Terrorism, Preparedness and Clinical Practice. Philadelphia, Pa: Lippincott Williams & Wilkins; 2005.

  6. Lillie SH, Hanlon E, Kelly JM, eds. Potential Military Chemical/Biological Agents and Compounds (FM3-11.9). Jan 2005.

  7. Micromedex. PoisinDex [Web site]. Phosgene. Accessed September 8, 2000.

  8. Nelson LS. Simple asphyxiants and pulmonary irritants. In: Goldfrank's Toxicologic Emergencies. 6th ed. 1998:1523-1538.

  9. Traub SJ. Respiratory agent attack (toxic inhalational injury). In: Ciottone GR, Anderson PD, Auf Der Heide E, Darling RG, Jacoby I, Noji E, Suner S, eds. Disaster Medicine. 3rd ed. Philadelphia, PA: Mosby/Elsevier; 2006:chap 93; 573-575.

  10. Urbanetti JS. Toxic inhalation injury. In: Textbook of Military Medicine. Part 1. 1997:247-270.

  11. US Army. Diphosgene. General Reimer Digital Library [Web site]. Accessed September 27, 2000.

 
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