Chlorine Toxicity Medication

Updated: Dec 11, 2015
  • Author: Gerald F O'Malley, DO; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Medication

Medication Summary

No antidote for chlorine gas is available. Instead, the goal of pharmacotherapy is to reduce morbidity and prevent complications. Beta-agonists, although not well studied in humans, have been widely used for the management of respiratory symptoms in chlorine gas exposure, and they have demonstrated efficacy in animal models. They should be considered a first-line agent in the setting of chlorine gas exposure and respiratory symptoms or signs.

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Beta2 Agonists

Class Summary

Beta2 agonists act on beta2 receptors to relax bronchial smooth muscle and thereby increase airway diameter. These agents have little effect on cardiac muscle contractility.

Albuterol (Proventil HFA, Ventolin HFA, ProAir HFA, VoSpire ER)

Albuterol is a beta2-agonist useful for treatment of bronchospasm. It is the preferred choice for initial treatment because of its rapid onset of action.

Terbutaline

Terbutaline is a selective beta 2-agonist that relieves bronchospasm by acting on beta 2 receptors to relax bronchial smooth muscle.

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Anticholinergics, Respiratory

Class Summary

Believed to work synergistically with bronchodilators.

Ipratropium (Atrovent)

Inhibits secretions from some respiratory mucosa; historically atropine was used in asthma, but ipratropium has fewer adverse effects.

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Xanthine Derivatives

Class Summary

These agents were historically used to treat asthma but lost favor because of their toxic effects and narrow therapeutic windows. They have largely been displaced by newer agents.

Theophylline (Theo 24, Elixophyllin, Theochron SR)

Theophylline is believed to potentiate exogenous catecholamines, stimulate endogenous catecholamine release, and relax the diaphragmatic musculature.

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Local Anesthetics, Amides

Class Summary

Inhaled topical anesthetics have been used to reduce cough and may reduce pain associated with chlorine inhalations.

Lidocaine (Xylocaine)

Lidocaine stabilizes neuronal membranes by inhibiting the ionic fluxes required for initiation and conduction of impulses. When administered by nebulizer, lidocaine acts in areas exposed to chlorine injury.

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Corticosteroids, Inhalants

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. These agents modify the body's immune response to diverse stimuli. In animal models of chlorine gas exposure, inhaled corticosteroids have been shown to improve respiratory function. Their exact mechanism of function in chlorine gas exposure is unclear.

Budesonide inhaled (Pulmicort Flexhaler)

Inhaled budesonide is a second-line agent for use in moderate-to-severe chlorine exposures.

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