Chlorine Toxicity Workup

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

Approach Considerations

Studies in patients with significant exposure to chlorine gas may include the following:

  • Pulse oximetry

  • Serum electrolyte, blood urea nitrogen (BUN), and creatinine levels

  • Arterial blood gases

  • Chest radiography

  • Electrocardiogram (ECG)

  • Ventilation-perfusion scan

  • Pulmonary function testing

  • Laryngoscopy or bronchoscopy

Abnormalities include hypoxia (from bronchospasm or pulmonary edema) [1] 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.

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Chest Radiography

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, [27] and adult respiratory distress syndrome (ARDS) may be seen in some cases. The radiograph below shows diffuse pulmonary edema without significant cardiomegaly.

Chest radiograph of a 36-year-old chemical worker Chest radiograph of a 36-year-old chemical worker 2 hours postexposure to chlorine inhalant. She had severe resting dyspnea during the second hour, diffuse crackles/rhonchi on auscultation, and a partial pressure of oxygen of 32 mm Hg breathing room air. The radiograph shows diffuse pulmonary edema without significant cardiomegaly. Used with permission from Medical Aspects of Chemical and Biological Warfare, Textbook of Military Medicine. 1997: 256.

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.

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Histologic Findings

The image below shows a sample of lung tissue obtained from biopsy of a patient with exposure to chlorine.

A section from a lung biopsy (hematoxylin and eosi A section from a lung biopsy (hematoxylin and eosin stain; original magnification X 100) from a 36-year-old chemical worker taken 6 weeks postexposure to chlorine. At that time, the patient had no clinical abnormalities and a partial pressure of oxygen of 80 mm Hg breathing room air. The section shows normal lung tissues without evidence of interstitial fibrosis and/or inflammation. Used with permission from Medical Aspects of Chemical and Biological Warfare, Textbook of Military Medicine. 1997: 256.
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