History

Clinicians should attempt to elicit an accurate history to involve the setting of exposure. This may occur as an occupational exposure, as an intentional and unintentional industrial release, or as a terrorist attack.

Physical

Physical manifestations depend on the route of exposure.

Skin - Evidence of chemical burns or dermatitis manifested by red, cracked, irritated, or bluish skin
Eyes - Pain, redness, and tearing
Respiratory - Coughing, labored breathing, rales, and rhonchi

In the large-scale exposure that occurred in Kern County, California, exposed persons reported the following signs and symptoms^[4]:

Eye pain, burning, or lacrimation (in 99% of cases)
Respiratory symptoms, including cough, dyspnea, or upper respiratory irritation (51%)
Gastrointestinal complaints such as nausea, vomiting, abdominal pain, or diarrhea (47%)
Headache (25%)

Differential Diagnoses

Jiang W, Hernandez B, Richmond D, Yanga N. Harvesters in strawberry fields: A literature review of pesticide exposure, an observation of their work activities, and a model for exposure prediction. J Expo Sci Environ Epidemiol. 2017 Jul. 27 (4):391-397. [QxMD MEDLINE Link].
Nagami H, Suenaga T, Nakazaki M. Pesticide exposure and subjective symptoms of cut-flower farmers. J Rural Med. 2017 May. 12 (1):7-11. [QxMD MEDLINE Link]. [Full Text].
Gunier RB, Bradman A, Castorina R, Holland NT, Avery D, Harley KG, et al. Residential proximity to agricultural fumigant use and IQ, attention and hyperactivity in 7-year old children. Environ Res. 2017 Oct. 158:358-365. [QxMD MEDLINE Link].
O'Malley MA, Edmiston S, Richmond D, Ibarra M, Barry T, Smith M, et al. Illness associated with drift of chloropicrin soil fumigant into a residential area--Kern County, California, 2003. MMWR Morb Mortal Wkly Rep. 2004 Aug 20. 53(32):740-2. [QxMD MEDLINE Link]. [Full Text].
Honda H, Kawashima T, Kaku N, Kawasaki K. [A case of fatal chloropicrine poisoning induced by ingestion]. Chudoku Kenkyu. 2002 Oct. 15(4):381-4. [QxMD MEDLINE Link].
Gonmori K, Muto H, Yamamoto T, Takahashi K. A case of homicidal intoxication by chloropicrin. Am J Forensic Med Pathol. 1987 Jun. 8(2):135-8. [QxMD MEDLINE Link].
Prudhomme JC, Bhatia R, Nutik JM, Shusterman DJ. Chest wall pain and possible rhabdomyolysis after chloropicrin exposure. A case series. J Occup Environ Med. 1999 Jan. 41(1):17-22. [QxMD MEDLINE Link].
Dow AgroSciences. Material Safety Data Sheet: Chloropicrin. Available at http://www.vikanemonitor.com/images/chloropicrin_msds.pdf. 7/22/99; Accessed: March 5, 2022.
Gaskin S, Heath L, Pisaniello D, Edwards JW, Logan M, Baxter C. Dermal absorption of fumigant gases during HAZMAT incident exposure scenarios-Methyl bromide, sulfuryl fluoride, and chloropicrin. Toxicol Ind Health. 2017 Jul. 33 (7):547-554. [QxMD MEDLINE Link].
Centers for Disease Control and Prevention: National Institute for Occupational Safety and Health (NIOSH). Chloropicrin (PS): Lung Damaging Agent. CDC.gov. Available at https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750034.html. May 12, 2011; Accessed: March 5, 2022.
Goldman LR, Mengle D, Epstein DM, Fredson D, Kelly K, Jackson RJ. Acute symptoms in persons residing near a field treated with the soil fumigants methyl bromide and chloropicrin. West J Med. 1987 Jul. 147(1):95-8. [QxMD MEDLINE Link].
Harber LF. The Poisonous Cloud: Chemical Warfare in the First World War. 1986. 15-40.
McEvoy GK, Litvak K, Welsh, Jr. OH. AHFS 96 Drug Information. 1996. 861-864, 2654-2657.
Smart JK. History of chemical and biological warfare fact sheets. Special Study 50; US Army Chemical and Biologic Defense Command. 1996.
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Wilhelm SN, Sheipier K, Lawrence H. Environmental fate of chloropicrin. Fumigants: Environmental Fate, Exposure, and Analysis. 1996.

Media Gallery

Chemical structure of chloropicrin.
Level A suit (DuPont Tychem 10,000).

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Author

Kermit D Huebner, MD, FACEP Research Director, Carl R Darnall Army Medical Center

Kermit D Huebner, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, Association of Military Surgeons of the US, Society for Academic Emergency Medicine, Society of United States Air Force Flight Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

David N Trickey, MD Staff Physician, Department of Emergency Medicine, Martin Army Community Hospital

David N Trickey, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zygmunt F Dembek, PhD, MS, MPH, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences; Senior Research Scientist, Data Science IV, Battelle Memorial Institute, Battelle Connecticut Operations

Zygmunt F Dembek, PhD, MS, MPH, LHD is a member of the following medical societies: American Chemical Society, American Legion, American Public Health Association, Association of Military Surgeons of the US, Council of State and Territorial Epidemiologists, Delta Omega Public Health Honorary Society, New York Academy of Sciences, Polish Legion of American Veterans, Reserve Organization of America, Society of American Federal Medical Laboratory Scientists, Veterans of Foreign Wars

Disclosure: Nothing to disclose.

Additional Contributors

Mark Keim, MD Founder, DisasterDoc, LLC; Adjunct Professor, Emory University Rollins School of Public Health; Adjunct Professor, Harvard Affiliated Disaster Medicine Fellowship

Mark Keim, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Joanne Williams, MD, to the development and writing of this article.

1 ppm*	Irritation with pain in the eyes
4 ppm	Incapacitates exposed individuals
20 ppm	Causes definite bronchial or pulmonary lesions
*Concentrations expressed in parts of material per million parts of air or water.

Chloropicrin Poisoning Clinical Presentation

History

Physical

References

Tables

Contributor Information and Disclosures

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