Chloropicrin Poisoning Medication
- Author: Kermit D Huebner, MD, FACEP; Chief Editor: Robert G Darling, MD, FACEP more...
Medication Summary
Albuterol and aminophylline may be beneficial in cases involving signs of bronchoconstriction. Use supplemental humidified oxygen in cases of respiratory compromise.
In severe respiratory compromise, ventilatory support is mandatory. If a PaO2 cannot be maintained greater than 60 mm Hg with a fraction of inspired oxygen (FIO2) less than or equal to 0.6, then add positive end-expiratory pressure in attempts to open previously closed alveoli. No specific drug therapy is available for chloropicrin toxicity.
For methemoglobinemia greater than 10-20%, consider the use of methylene blue.[5]
Sympathomimetic (adrenergic) agents
Class Summary
These agents relieve reversible bronchospasm by relaxing smooth muscles of the bronchi.
Albuterol (Ventolin)
Stimulates beta-adrenergic receptors. Main effect following oral inhalation is bronchodilation resulting from smooth muscles of bronchial tree. In event of chloropicrin intoxication, use nebulizer route of administration.
Respiratory smooth muscle relaxant
Class Summary
Aminophylline relieves bronchospasm through smooth muscle relaxation of respiratory tract, thereby increasing flow rates and vital capacity.
Aminophylline (Aminophyllin)
Theophylline compound with ethylenediamine; structurally classified as xanthine derivative. Directly relaxes smooth muscle of respiratory tract.
Antidotes
Class Summary
This agent is used to reduce methemoglobin.
Methylene blue (Urolene blue)
In reduced form, leukomethylene blue is an electron donor to reduce methemoglobin. Reduction of methylene blue is by NADPH generated by G-6-PD.
O'Malley MA, Edmiston S, Richmond D, Ibarra M, Barry T, Smith M, et al. Illness associated with drift of chloropicrin soil fumigant into a residential area--Kern County, California, 2003. MMWR Morb Mortal Wkly Rep. Aug 20 2004;53(32):740-2. [Medline]. [Full Text].
Honda H, Kawashima T, Kaku N, Kawasaki K. [A case of fatal chloropicrine poisoning induced by ingestion]. Chudoku Kenkyu. Oct 2002;15(4):381-4. [Medline].
Gonmori K, Muto H, Yamamoto T, Takahashi K. A case of homicidal intoxication by chloropicrin. Am J Forensic Med Pathol. Jun 1987;8(2):135-8. [Medline].
Prudhomme JC, Bhatia R, Nutik JM, Shusterman DJ. Chest wall pain and possible rhabdomyolysis after chloropicrin exposure. A case series. J Occup Environ Med. Jan 1999;41(1):17-22. [Medline].
Material Safety Data Sheet - Lacrythor Fumigation Warning Agent. Revised October 2006. Material Safety Data Sheet. Available at http://forthor.com/labels/chloropicrin/pic_MSDS.pdf. Accessed January 1, 2008.
Goldman LR, Mengle D, Epstein DM, Fredson D, Kelly K, Jackson RJ. Acute symptoms in persons residing near a field treated with the soil fumigants methyl bromide and chloropicrin. West J Med. Jul 1987;147(1):95-8. [Medline].
Harber LF. The Poisonous Cloud: Chemical Warfare in the First World War. 1986:15-40.
HoltraChem Manufacturing Company, LLC. Material Safety Data Sheet, Chloropicrin. July 30, 1996; revised February 28, 2000.
McEvoy GK, Litvak K, Welsh, Jr. OH. AHFS 96 Drug Information. 1996;861-864, 2654-2657.
Smart JK. History of chemical and biological warfare fact sheets. In: Special Study 50; US Army Chemical and Biologic Defense Command. 1996.
Tintinalli JE. Emergency medicine. JAMA. Jun 19 1996;275(23):1804-5. [Medline].
Wilhelm SN, Sheipier K, Lawrence H. Environmental fate of chloropicrin. In: Fumigants: Environmental Fate, Exposure, and Analysis. 1996.
| 1 ppm* | Irritation with pain in the eyes |
| 4 ppm | Incapacitates exposed individuals |
| 20 ppm | Causes definite bronchial or pulmonary lesions |
| *Concentrations expressed in parts of material per million parts of air or water. | |
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