Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-28T22:58:08.441Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical Presentations and Outcomes of Industrial Chlorine Gas Exposure Incidence in Oman

Published online by Cambridge University Press:  13 November 2020

Muhammad Faisal Khilji Open the ORCID record for Muhammad Faisal Khilji [Opens in a new window]
Muhammad Faisal Khilji*
Affiliation:
Department of Emergency Medicine, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
*
Correspondence: Dr. Muhammad Faisal Khilji, Specialist Department of Emergency Medicine, Sultan Qaboos University Hospital, P. O. Box 38, P. C .123, AL –Khod, Muscat, Sultanate of Oman, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The main objective was to study different clinical presentations and outcomes of patients after acute industrial chlorine gas exposure in Oman with evaluation of overall incident management to help develop a chemical exposure incident protocol.

Methods:

This was a retrospective observational study of 15 patients exposed to chlorine gas after an accidental chlorine gas leak in a metal melting factory in Oman.

Results:

Six (40%) patients were admitted and nine (60%) patients were discharged from the emergency department (ED) after initial management. The important post-chlorine gas exposure clinical symptoms were eye irritation (66.6%), cough (73.3%), shortness of breath (40.0%), chest discomfort (66.6%), rhinorrhea (66.6%), dizziness (40.0%), vomiting (46.6%), sore throat (13.3%), and stridor (53.3%). Important signs included tachycardia (40.0%), tachypnea (40.0%), wheeze (20.0%), and use of accessory muscles for breathing (20.0%). Signs and symptoms of eye irritation, rhinorrhea, tachycardia, tachypnea, wheeze, and use of accessory muscles for breathing have shown significant correlation with outcome (admission) having P value of <.05.

Conclusion:

In the presented acute chlorine gas exposure incidence, 15 exposed persons were brought to the ED, out of which six were admitted and nine were discharged after symptomatic treatment. Signs and symptoms of eye irritation, rhinorrhea, tachycardia, tachypnea, wheeze, and use of accessory muscles of breathing show significant relation with the outcome of admission.

Keywords

chlorinegasincidencelungtoxicity
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 1 , February 2021 , pp. 18 - 24
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Al-Wahaibi, Zeka. Health impacts from living near a major industrial park in Oman. BMC Public Health. 2015;15:524.10.1186/s12889-015-1866-3CrossRefGoogle Scholar
Vajner, JE, Lung, D. Case files of the University of California San Francisco medical toxicology fellowship: acute chlorine gas inhalation and the utility of nebulized sodium bicarbonate. J Med Toxicol. 2013;9(3):259–265.10.1007/s13181-013-0309-8CrossRefGoogle ScholarPubMed
Davy, H. On a combination of oxymuriatic gas and oxygen gas. Phil Trans R Soc London. 1832;101(1):155–162.Google Scholar
Winder, C. The toxicology of chlorine. Environ Res. 2001;85(2):105–114.CrossRefGoogle ScholarPubMed
Nemery, B, Hoet, PH, Nowak, D. Indoor swimming pools, water chlorination and respiratory health. Eur Respir J. 2002;19(5):790–793.CrossRefGoogle ScholarPubMed
Agency for Toxic Substances and Disease Registry. Toxicological Profile for Chlorine. Atlanta, Georgia USA: US Department of Health and Human Services; 2004.Google Scholar
Beveridge, R, Clarke, B, Janes, L, Savage, N, Thompson, J, Dodd, G. Canadian emergency department triage and acuity scale: implementation guidelines. Canadian J Emerg Med. 1999;1(suppl 3):S1–24.Google Scholar
Cone, DC, MacMillan, DS, Parwani, V, et al. Pilot test of a proposed chemical/biological/radiation/nuclear-capable mass casualty triage system. Prehosp Emerg Care. 2008;12(2):236–240.10.1080/10903120801907620CrossRefGoogle ScholarPubMed
Neal, DJ. Prehospital patient triage in mass casualty incidents: an engineering management analysis and prototype strategy recommendation [dissertation]. Washington DC, USA: George Washington University; 1999. http://media.proquest.com/media/pq/classic/doc/1731954011/fmt/ai/rep/NPDF?_s=g6o8u8Y7F%2F7qrSRU%2F9101jiICxg%3D. Accessed March 8, 2014.Google Scholar
Cevik, Y, Onay, M, Akmaz, I, Sezigen, S. Mass casualties from acute inhalation of chlorine gas. South Med J. 2009;102(12):1209–1213.10.1097/SMJ.0b013e3181bfdc67CrossRefGoogle ScholarPubMed
Bosse, GM. Nebulized sodium bicarbonate in the treatment of chlorine gas inhalation. J Toxicol Clin Toxicol. 1994;32(3):233–241.CrossRefGoogle ScholarPubMed
Evans, RB. Chlorine: state of the art. Lung. 2004;183:151–167.10.1007/s00408-004-2530-3CrossRefGoogle Scholar
Sexton, JD, Pronchik, DJ. Chlorine inhalation: the big picture. J Toxicol Clin Toxicol. 1998;36(1-2):87–93.CrossRefGoogle ScholarPubMed
Mohan, A, Kumar, SN, Rao, MH, Bollineni, S, Manohar, IC. Acute accidental exposure to chlorine gas: clinical presentation, pulmonary functions and outcomes. Indian J Chest Dis Allied Sci. 2010;52(3):149–152.Google ScholarPubMed
Szinicz, L. History of chemical and biological warfare agents. Toxicology. 200S;214(3):167–181.10.1016/j.tox.2005.06.011CrossRefGoogle Scholar
Martinez, TT, Long, C. Explosion risk from swimming pool chlorinators and review of chlorine toxicity. J Toxicol Clin Toxicol. 1995;33(4):346–354.CrossRefGoogle ScholarPubMed
OSHA. OSHA 2006 occupational chemical database. http://www.osha.gov/chemicaldata/chemResult.html?RecNo=650. Accessed May 2013.Google Scholar
Das, R, Blanc, PD. Chlorine gas exposure and the lung. Toxicol Ind Health. 1993;9(3):439–455.10.1177/074823379300900304CrossRefGoogle ScholarPubMed
Winder, C. The toxicology of chlorine. Environ Res. 2001;85(2):105–114.10.1006/enrs.2000.4110CrossRefGoogle ScholarPubMed
Jones, R, Wills, B, Kang, C. Chlorine gas: an evolving hazardous material threat and unconventional weapon. West J Emerg Med. 2010;11(2):151–156.Google ScholarPubMed
Van Sickle, D, Wenck, MA, Belflower, A, et al. Acute health effects after exposure to chlorine gas released after a train derailment. Am J Emerg Med. 2009;27(1):1–7.10.1016/j.ajem.2007.12.006CrossRefGoogle ScholarPubMed
Kim, JA, Yoon, SY, Cho, SY, et al. Acute health effects of accidental chlorine gas exposure. Ann Occup Environ Med. 2014;26:29.CrossRefGoogle ScholarPubMed
Lhavi, O, Leiba, A, Dahan, Y, et al. Lessons learned from chlorine intoxications in swimming pools: the challenge of pediatric mass toxicological events. Prehosp Disaster Med. 2008;23(1):90–95.10.1017/S1049023X00005641CrossRefGoogle Scholar
Barrow, CS, Alarie, Y, Warrick, JC, Stock, MAF. Comparison of the sensory irritation response in mice to chlorine and hydrogen chloride. Arch Environ Health. 1977;32(2):68–76.CrossRefGoogle ScholarPubMed
McNulty, MJ, Chang, JCF, Barrow, CS, Casanova-Schmitz, J, Heck, HD. Sulfhydryl oxidation in rat nasal mucosal tissues after chlorine inhalation. Toxicol Lett. 1983;17(3-4):241–246.CrossRefGoogle ScholarPubMed
Schraufstaetter, IU, Browne, K, Harris, A, et al. Mechanisms of hypochlorite injury of target cells. J Clin Invest. 1990;85(2):554–562.CrossRefGoogle Scholar
Güloğlu, C, Kara, IH, Erten, PG. Acute accidental exposure to chlorine gas in the southeast of turkey: a study of 106 cases. Environ Res. 2002;88(2):89–93.10.1006/enrs.2001.4324CrossRefGoogle ScholarPubMed
Barret, L, Faure, J. Chlorine poisoning. Lancet. 1984;1(8376):561–562.10.1016/S0140-6736(84)90952-8CrossRefGoogle ScholarPubMed
Moulick, ND, Banavali, S, Abhyankar, AD, et al. Acute accidental exposure to chlorine fumes-a study of 82 cases. Indian J Chest Dis Allied Sci. 1992;34(2):85–89.Google Scholar
Kirk, MA, Deaton, ML. Bringing order out of chaos: effective strategies for medical response to mass chemical exposure. Emerg Med Clin North Am. 2007;25(2):527–548.10.1016/j.emc.2007.02.005CrossRefGoogle ScholarPubMed
Ball, LJ, Dworak, J. Disaster in Graniteville. SC Nurse. 2005;12(2):1.Google ScholarPubMed
Eldridge, D, Richardson, W, Michels, J, et al. The role of poison centers in a mass chlorine exposure. Clin Toxicol (Phila). 2005;6(43):766–767.Google Scholar
Culley, JM, Svendsen, ER, Craig, J, Tavakoli, A. A validation study of 5 triage systems using data from the 2005 Graniteville, South Carolina, chlorine spill. J Emerg Nurs. 2014;40(5):453–460.10.1016/j.jen.2014.04.020CrossRefGoogle ScholarPubMed
US Department of Health and Human Services. Chemical Hazards Emergency Management (CHEMM) Web Site. https://chemm.nlm.nih.gov/lungagents.htm. Accessed August 19, 2016.Google Scholar
Culley, JM, Richter, J, Donevant, S, Tavakoli, A, Craig, J, DiNardi, S. Validating signs and symptoms from an actual mass casualty incidence to characterized an irritant gas syndrome agent (IGSA) exposure: a first step in the development of a novel IGSA triage algorithm. J Emerg Nurs. 2017;43(4):333–338.CrossRefGoogle Scholar
Simple Triage and Rapid Treatment: START. http://citmt.org/Start/flowchart.htm. Accessed May 2020.Google Scholar
Jump START Pediatric MCI Triage Tool Web site. http://www.jumpstarttriage.com. Accessed March 8, 2014.Google Scholar
SALT mass casualty triage: concept endorsed by the American College of Emergency Physicians, American College of Surgeons Committee on Trauma, American Trauma Society, National Association of EMS Physicians, National Disaster Life Support Education Consortium, and State and Territorial Injury Prevention Directors Association. Disaster Med Public Health Prep. 2008;2(4):245-246.CrossRefGoogle Scholar
Gilboy, N, Tanabe, P, Travers, D, et al. Emergency Severity Index, Version 4: Implementation Handbook. AHRQ Publication No. 05-0046-2. Rockville, Maryland USA: Agency for Health Care Research and Quality; 2011.Google Scholar
White, CW, Martin, JG. Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models. Proc Am Thorac Soc 2010;7(4):257–263.10.1513/pats.201001-008SMCrossRefGoogle ScholarPubMed
Hoffman, R, Nelson, L, Howland, MA, Lewin, N, Goldfrank, L, Flomenbaum, N. Goldfrank’s Toxicologic Emergencies, 8th Edition. New York USA: McGraw-Hill; 2007:951.Google Scholar
Done, AK. The toxic emergency, it’s a gas. Emerg Med. 1976:305–314.Google Scholar
Brooks, SM, Weiss, MA, Bernstein, IL. Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high-level irritant exposures. Chest. 1985;88(3):376–384.10.1378/chest.88.3.376CrossRefGoogle ScholarPubMed
Gautrin, D, Boulet, LP, Boutet, M, et al. Is reactive airways dysfunction syndrome a variant of occupational asthma? J Allergy Clinical Immunology. 1994;93(1):12–22.10.1016/0091-6749(94)90228-3CrossRefGoogle ScholarPubMed