Chlorine Gas Poisoning

Chlorine gas poisoning is an illness resulting from the effects of exposure to chlorine beyond the threshold limit value.

Signs and symptoms

The signs of acute chlorine gas poisoning are primarily respiratory, and include difficulty breathing and cough; listening to the lungs will generally reveal crackles. There will generally be sneezing, nose irritation, burning sensations, and throat irritations. There may also be skin irritations or chemical burns and eye irritation or conjunctivitis. A person with chlorine gas poisoning may also have nausea, vomiting, or a headache.Jones R, Wills B, Kang C. Chlorine gas: an evolving hazardous material threat and unconventional weapon. West J Emerg Med. 2010 May;11(2):151-6.
PMC 2908650
/ref>White CW, Martin JG. Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models. Proc Am Thorac Soc. 2010 Jul;7(4):257-63. Review.
PMC 3136961
/ref>Gerald F O'Malley, GF et al
Chlorine Toxicity
Medscape Drugs & Diseases, Ed. Dembek, ZF. Updated: Dec 11, 2015

Chronic exposure to relatively low levels of chlorine gas may cause pulmonary problems like acute wheezing attacks, chronic cough with phlegm, and asthma.

Causes

While celebrating the end of examinations in the spring of 1943, sixth form students at Kesteven and Grantham Girls School spilled ink onto parquetry:

Occupational exposures constitute the highest risk of toxicity and common domestic exposures result from the mixing of chlorine bleach with acidic washing agents such as acetic, nitric or phosphoric acid. They also occur as a result of the chlorination of table water. Other exposure risks occur during industrial or transportation accidents. Wartime exposure is rare.

Dose toxicity

Humans can smell chlorine gas at ranges from 0.1–0.3 ppm. According to a review from 2010: "At 1–3 ppm, there is mild mucous membrane irritation that can usually be tolerated for about an hour. At 5–15 ppm, there is moderate mucous membrane irritation. At 30 ppm and beyond, there is immediate chest pain, shortness of breath, and cough. At approximately 40–60 ppm, a toxic pneumonitis and/or acute pulmonary edema can develop. Concentrations of about 400 ppm and beyond are generally fatal over 30 minutes, and at 1,000 ppm and above, fatality ensues within only a few minutes."

Mechanism

The concentration of the inhaled gas and duration of exposure and water contents of the tissues exposed are the key determinants of toxicity; moist tissues like the eyes, throat, and lungs are the most susceptible to damage.CD
Basic Facts
Page last reviewed April 10, 2013. Page last updated April 10, 2013

Once inhaled, chlorine gas diffuses into the epithelial lining fluid (ELF) of the respiratory epithelium and may directly interact with small molecules, proteins and lipids there and damage them, or may hydrolyze to hypochlorous acid and hydrochloric acid which in turn generate chloride ions and reactive oxygen species; the dominant theory is that most damage is via the acids.Squadrito GL, Postlethwait EM, Matalon S. Elucidating mechanisms of chlorine toxicity: reaction kinetics, thermodynamics, and physiological implications. Am J Physiol Lung Cell Mol Physiol. 2010 Sep;299(3):L289-300. Review.
PMC 2951076
/ref>Agency for Toxic Substances and Disease Registry via the CDC
Medical Management Guidelines: Chlorine
Page last reviewed: October 21, 2014. Page last updated: October 21, 2014

Diagnosis

Test performed to confirm chlorine gas poisoning and monitor patients for supportive care include pulse oximetry, testing serum electrolyte, blood urea nitrogen (BUN), and creatinine levels, measuring arterial blood gases, chest radiography, electrocardiogram (ECG), pulmonary function testing, and laryngoscopy or bronchoscopy.

Treatment

There is no antidote for chlorine poisoning; management is supportive after evacuating people from the site of exposure and flushing exposed tissues. For lung damage caused by inhalation, oxygen and bronchodilators may be administered.

Outcomes

There is no way to predict outcomes. Most people with mild to moderate exposure generally recover fully in three to five days, but some develop chronic problems such as reactive airway disease. Smoking or pre-existing lung conditions like asthma appear to increase the risk of long term complications.

Epidemiology

In 2014, the American Association of Poison Control Centers reported about 6,000 exposures to chlorine gas in the US in 2013, compared with 13,600 exposures to carbon monoxide, which was the most common poison gas exposure; the year before they reported about 5,500 cases of chlorine gas poisoning compared with around 14,300 cases of carbon monoxide poisoning.

Society and culture

In War

:
* In 1915, the German Army used chlorine against Allied soldiers in the 2nd Battle of Ypres.
* In 2007 chlorine was used by insurgents in the Iraqi insurgency (2003–11),
* In 2014 chlorine was allegedly used in Kafr Zita, Syria.

Industrial accidents

In the USA

There have been many instances of mass chlorine gas poisonings in industrial accidents.
* In 2005 in South Carolina a freight train derailed, releasing an estimated of chlorine. Nine people died, and at least 529 persons sought medical care.
* In 2004 in Texas a freight train accident released of chlorine gas and other toxic chemicals. Forty-four people were injured, including three who died.
* In 2002 in Missouri, a flex hose ruptured during unloading a train car at a chemical plant, releasing approximately of chlorine gas. Sixty-seven persons were injured.

Globally

* In 2015 In Nigeria, the explosion of a chlorine gas storage tank at a water treatment plant in Jos killed 8 people.
* In 2017 chlorine gas was released in Fort McMurray, Alberta, Canada, after chemicals were mixed improperly at a water treatment plant. In 2020 the Regional Municipality of Wood Buffalo was fined $150,000 (CAD) for the incident.
* In 2017, in Iran, at least 475 people, including nine firemen, suffered respiratory and other symptoms after a chlorine gas leak in the southwestern Iranian province of Khuzestan.
*In 2020, on 6th of March, an incident occurred at EPCL (Engro Polymer and Chemicals Limited) Port Qasim, Karachi, where over 50 people were hospitalized as a result of Chlorine gas leakage. No casualties were reported.
*In 2022, on June 27, a tank holding chlorine gas in the port of Aqaba fell and ruptured. There were 14 people killed and more than 260 were injured.

References

Further reading

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External links

{{DEFAULTSORT:Chlorine gas poisoning
Toxic effects of substances chiefly nonmedicinal as to source
Gases
Medical emergencies
Industrial hygiene