The lethal effects are dependent not only on the inhaled concentration but also on the duration of exposure, and death is due to cardiopulmonary failure ( 6). Chlorine inhalation can be acutely fatal and this effect appears to be dose dependent, with the greatest number of fatalities occurring in the immediate vicinity of a spill. Such events have raised concerns that chlorine will be used more frequently in the near future as a weapon of opportunity by terrorists, globally as well as within the United States.Ĭhlorine is a known pulmonary irritant gas that causes acute damage in the respiratory system after inhalation ( 5). In the ongoing Syrian civil war, the intentional use of chlorine to cause widespread casualties was seen in the towns of Kafr Zita, Harasta, and Damascus in April 2014. Since then, due to its readiness and availability, it has been used on numerous occasions. Over 14 million tons of chlorine are produced and transported on freight trains and highways annually in the United States ( 2, 3), increasing the potential for accidents or misuse.Ĭhlorine was first used as a chemical weapon in Ypres, France, during the First World War ( 4). It is a highly reactive oxidant gas that is commonly used in the bleaching of paper, production of hydrocarbon solvents, and disinfection of swimming pools, and as a chemical weapon ( 1). Although oxygen administration will be helpful in the treatment of acute hypoxemia after chlorine inhalation, caution must be exercised if there is evidence of respiratory acidosis, as oxygen treatment alone can worsen respiratory failure.Ĭhlorine (Cl 2) is a yellow-green gas that is slightly water soluble and about two times heavier than air. In our studies, we found that oxygen administration after chlorine gas inhalation exposure in rats improved survival but worsened other morbidity measures that correlate with deleterious outcomes in the clinical setting. Intentional chlorine gas attacks are on the rise globally, without any known efficacious treatments to improve outcomes after exposure. Oxygen should be used with caution after massive chlorine inhalation, and the need for early assisted ventilation should be assessed in victims. Oxygen administration can improve short-term survival but appears to worsen respiratory failure, with no improvement in cardiac output or neuromuscular dysfunction. Massive chlorine inhalation causes severe acute respiratory failure and multiorgan damage. In addition, oxygen did not improve neuromuscular abnormalities, cardiac output, or respiratory distress associated with chlorine exposure. However, oxygen administration worsened the severity of acute respiratory failure in chlorine-exposed rats compared with controls, with increased respiratory acidosis (pH 6.91 ± 0.04 versus 7.06 ± 0.01 at 2 h) and increased hypercapnia (180.0 ± 19.8 versus 103.2 ± 3.9 mm Hg at 2 h). Oxygen improved survival to 6 hours (87% versus 42%) and prevented observed seizure-related deaths. Massive chlorine inhalation caused severe acute respiratory failure, hypoxemia, decreased cardiac output, neuromuscular abnormalities (ataxia and hypotonia), and seizures resulting in early death. Oxygen saturation, vital signs, respiratory distress and neuromuscular scores, arterial blood gases, and hemodynamic measurements were obtained hourly. In this work, adult rats were exposed to chlorine gas (LD 58–67) in a whole-body exposure chamber, and given oxygen (0.8 F i O 2) or air (0.21 F i O 2) for 6 hours after baseline measurements were obtained. No countermeasures are available for massive chlorine exposure and supportive-care measures lack controlled trials. Survivors usually require hospitalization after massive exposure. Massive chlorine inhalation can cause death within 4 hours of exposure. Unfortunately, its use as a chemical weapon has increased in recent years. Chlorine is a highly reactive gas that can cause significant injury when inhaled.
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