Presentation
History
Symptoms may vary depending on the degree of exposure. Exposure possibilities include acute low levels, acute high levels, and chronic low levels.
Acute exposure (low levels)
Most poisonings fall into this category and are caused by household exposure to low-concentration cleaning products. Manifestations are as follows:
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Eye tearing, nose and throat irritation
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Sneezing
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Excess salivation
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General excitement or restlessness
Acute exposure (high levels)
In addition to the symptoms seen with low-level exposure, high-level exposure may result in the following:
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Dyspnea: Upper airway swelling and obstruction may occur
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Violent cough
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Nausea and vomiting (with the smell of chlorine in emesis)
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Lightheadedness
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Headache
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Chest pain or retrosternal burning
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Muscle weakness
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Abdominal discomfort
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Dermatitis (with liquid exposure): Corneal burns and ulcerations may occur from splash exposure to high-concentration chlorine products
Chronic exposure
Manifestations of chronic exposure include the following:
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Acne (chloracne)
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Chest pain
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Cough
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Sore throat
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Hemoptysis
Next:
Physical Examination
Findings on physical examination may include the following:
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Tachypnea
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Cyanosis (most prevalent during exertion)
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Tachycardia
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Wheezing
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Intercostal retractions
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Decreased breath sounds
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Rales (pulmonary edema)
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Nasal flaring
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Aphonia, stridor, or laryngeal edema
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Ulceration or hemorrhage of the respiratory tract
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Rhinorrhea
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Lacrimation, salivation, and blepharospasm
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Chloracne or tooth enamel corrosion (with chronic exposure)
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Redness, erythema, and chemical burns to the skin from dose-dependent exposure to liquid
Superheated chlorine gas from an industrial fire or chemical warehouse explosion may carry the danger of direct thermal injury to the mucous membranes of the eyes, mouth, and respiratory tract in addition to the chemical effects.
Previous
Media Gallery
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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.
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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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