Document Type : Case Report


Emergency Department, Hospital Kuala Lumpur, Malaysia


Introduction: Most household cleaners contain chlorine, an irritating chemical commonly used to purify water. The inhalation of chlorine causes chemical pneumonitis and the treatment of inhalation injuries from this chemical is difficult due to the lack of evidence and human studies. We will discuss a case of a man, who developed chemical pneumonitis after being exposed to chlorine fumes while cleaning swimming pool.
Case Presentation: A 30-year-old man showed up after being exposed to 33% hydrochloric fumes at work and developed coughing, sore throat, and dyspnea immediately. He received initial treatment at nearby clinic and referred to the emergency department (ED). In ED, he was in respiratory distress. His respiratory rate (RR) was 28 breaths per minute and oxygen saturation was 81% with a 15 L/min non-rebreathing mask. Lung auscultation showed crepitation in both lower zones with expiratory rhonchi. Noninvasive ventilation (NIV) support was initiated with continuous nebulization of salbutamol, ipratropium bromide, and sodium bicarbonate. His initial blood gases showed type 1 respiratory failure. He was then intubated for severe acute respiratory distress syndrome (ARDS). The patient was then admitted to the intensive care unit (ICU) for further treatment and discharged after 18 days of hospitalization.
Conclusion: Acute exposure to chemical irritants can cause asthma exacerbation, chronic bronchitis, bronchial hypersensitivity, and ARDS. There are no biomarkers for the inhalation of HCL gas. Medical history, clinical symptoms, and radiographic findings are decisive factors in the diagnosis. Treatment usually focuses on supportive care such as oxygen therapy, broncholytic therapy, and sodium bicarbonate, inhaled or systemic corticosteroids.


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