Diphosgene Exposure Clinical Presentation

Updated: Jan 05, 2016
  • Author: Paul P Rega, MD, FACEP; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Presentation

History

Victims of diphosgene (DP) exposure likely will have been involved in a mass gathering or military event within the last 24 hours that resulted in mass casualties with respiratory complaints. Patients may report explosions, smoke, or a gas cloud. Patients inconsistently report the odor of newly mown hay.

Presenting complaints may include the following:

  • Patients report irritation of the eyes or the skin.
  • Exposure to low concentrations of DP tends to cause lacrimation and irritation of the eyes and skin.
  • Exposure to somewhat higher concentrations causes chest discomfort and dyspnea; pulmonary edema often does not manifest until a few hours have passed, and the symptoms are aggravated by physical effort [4]
  • 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

See the list below:

  • 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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