Chloropicrin Poisoning Treatment & Management

  • Author: Kermit D Huebner, MD, FACEP; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Jan 12, 2011
 

Prehospital Care

General considerations

The rescuer's protective equipment should be Level A (eg, triple gloves [polyethylene gloves and nitrile gloves over latex gloves], fully encapsulating chemical resistant suit and boots, hard hat, self-contained breathing apparatus). See the image below.

Level A suit (DuPont Tychem 10,000). Level A suit (DuPont Tychem 10,000).

Standard organic vapor filters used with gas masks or air-purifying respirators do not remove chloropicrin effectively.

Skin exposure

Immediately begin decontamination with running water. Flush for a minimum of 15 minutes.

Remove contaminated clothing, taking care not to contaminate eyes further.

Eye exposure

If possible, open victim's eyes while under gentle running water. Use sufficient force to open the eyelids. The victim must "roll" the eyes.

Flush for a minimum of 15 minutes.

Inhalation

Remove the victim to fresh air.

Provide assisted ventilation as needed to support pulmonary function.

Cover or remove gross contamination to avoid exposure to rescuers.

Ingestion

Do not induce vomiting.

Rinse mouth immediately with water.

Have the victim drink milk, egg whites, or large quantities of water if available.

Next

Emergency Department Care

Skin exposure

If not completed in the field, continue decontamination with running water for at least 15 minutes.

Eye exposure

If not completed in the field, continue flushing for at least 15 minutes.

Inhalation

Continue assisted ventilation and initiate artificial ventilation as needed to support pulmonary function.

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.

For methemoglobinemia greater than 10-20%, consider administration of methylene blue 1-2 mg/kg as 1% solution intravenously over 5 minutes, followed by a 15-30 mL flush.[5]

Ingestion

Contact poison control for the most current information.

Do not induce vomiting.

Administer large quantities of water.

Do not give diluents to a patient who is convulsing, unconscious, or unable to swallow.

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Contributor Information and Disclosures
Author

Kermit D Huebner, MD, FACEP  Research Director, Carl R Darnall Army Medical Center

Kermit D Huebner, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, Association of Military Surgeons of the US, Society for Academic Emergency Medicine, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

David N Trickey, MD  Staff Physician, Department of Emergency Medicine, Martin Army Community Hospital

David N Trickey, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

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  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

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.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Joanne Williams, MD, to the development and writing of this article.

References

  1. 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].

  2. 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].

  3. 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].

  4. 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].

  5. 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.

  6. 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].

  7. Harber LF. The Poisonous Cloud: Chemical Warfare in the First World War. 1986:15-40.

  8. HoltraChem Manufacturing Company, LLC. Material Safety Data Sheet, Chloropicrin. July 30, 1996; revised February 28, 2000.

  9. McEvoy GK, Litvak K, Welsh, Jr. OH. AHFS 96 Drug Information. 1996;861-864, 2654-2657.

  10. Smart JK. History of chemical and biological warfare fact sheets. In: Special Study 50; US Army Chemical and Biologic Defense Command. 1996.

  11. Tintinalli JE. Emergency medicine. JAMA. Jun 19 1996;275(23):1804-5. [Medline].

  12. Wilhelm SN, Sheipier K, Lawrence H. Environmental fate of chloropicrin. In: Fumigants: Environmental Fate, Exposure, and Analysis. 1996.

 
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Chemical structure of chloropicrin.
Level A suit (DuPont Tychem 10,000).
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, www.unc.edu/depts/spice/chemical.html.
Table. Symptoms According to Concentrations
1 ppm*Irritation with pain in the eyes
4 ppmIncapacitates exposed individuals
20 ppmCauses definite bronchial or pulmonary lesions
*Concentrations expressed in parts of material per million parts of air or water.
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