Chlorine poisoning

Chlorine in the toxicological diagnostics algorithm

Clinical and toxicological diagnostics in acute poisonings are based on a sequential assessment of organ systems. Changes in the breathing pattern directly indicate the nature of the toxic effect. While central nervous system depressants (alcohols, tranquilizers, barbiturates) cause respiratory depression, and stimulants (camphor, salicylates) provoke frequent and deep breathing, inhalation exposure to chlorine (as well as petroleum derivatives) leads to the development of toxic pulmonary edema.

Comprehensive status assessment also includes analyzing neurological status, heart rate (tachycardia or bradycardia), mucous membrane condition, and visual assessment of biological secretions. In inhalation injuries, respiratory disorders and signs of upper airway irritation come to the forefront.

General principles of first aid and cessation of exposure

The primary task in poisoning with pulmonotoxic substances is the immediate cessation of contact with the toxin.

• The victim must be fitted with a gas mask to block any further intake of vapors.
• Removing the gas mask is permitted only outside the chemical contamination zone and solely after the danger of exposure to vapors desorbing from contaminated clothing has been eliminated.
• In case of pronounced irritation of the mucous membranes, copious rinsing of the eyes, nasal cavity, and mouth with clean water is indicated.
• Additionally, inhalations of an anti-smoke mixture or phicilin are used. If these measures do not bring relief, narcotic analgesics (e.g., 1% morphine solution) are administered.

Prevention of toxic pulmonary edema

The course of chlorine poisoning is characterized by the presence of a latent period, during which it is extremely important to minimize the body's oxygen demand and reduce energy expenditure. This directly affects the duration of the symptom-free interval and the severity of subsequent edema.

1. Rest: Ensuring maximum physical and psycho-emotional rest.
2. Body position: The victim should be placed in a warm room in a sitting or semi-sitting position.
3. Restrictions: During the evacuation phase (within the latent period), it is necessary to keep the patient warm while strictly restricting the intake of any food and fluids.

Specifics of medical manipulations

Therapeutic tactics for chlorine exposure have a number of critical limitations, the non-observance of which can lead to fatal consequences.

Oxygen therapy Oxygen is administered only in the presence of clear clinical signs of hypoxia. The oxygen concentration in the breathing mixture must not exceed 35–40%. The procedure is carried out in 20-minute cycles with rest intervals. It is strictly forbidden to perform oxygen therapy during the latent period of chlorine poisoning, as excess oxygen enhances the toxic effects of the poison.

Reduction of circulating blood volume (CBV) To reduce filtration pressure in the pulmonary capillaries, venesection of 250–300 ml is used. This measure is effective in the latent period, but only under the condition of stable blood pressure. An alternative is "bloodless phlebotomy" — the application of venous tourniquets to the limbs, which allows for the rapid pooling of up to 500 ml of blood. However, this method requires continuous monitoring, as it can worsen acidosis and provoke thrombosis. In mass casualty settings, this method is unacceptable.

Class and exam questions

What else to study on this topic

• Features of olfactory diagnostics (specific odors of cyanides, hydrogen sulfide, arsenic)
• Differential diagnosis of convulsive syndrome in intoxications
• Toxic action and methods for detecting sulfur dioxide
• The effect of autonomic poisons on mucous secretion (xerostomia and hypersalivation)
• Changes in the color of biological fluids as a marker of the chemical nature of a toxin

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.