Chlorine

CAS RN: 7782-50-5

Treatment Overview

0.4.3 INHALATION EXPOSURE
  • A) MANAGEMENT OF MILD TOXICITY
    • 1) Provide supplemental oxygen to maintain PaO2 of 60 mmHg or greater. Bronchodilators (inhaled albuterol or other beta-agonists, and anticholinergics) have been used frequently for the management of respiratory symptoms. Lidocaine (1% solution) added to nebulized albuterol results in both analgesic and cough suppressant actions. Nebulized sodium bicarbonate (3.75%) has been used in case series and is suggested by some experts. Perform an ophthalmologic exam (including visual acuity and slit lamp) in any patient with persistent eye irritation.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) Aggressive use of inhaled beta-agonists, lidocaine, and nebulized sodium bicarbonate for bronchospasm. Corticosteroids may also be useful for severe bronchospasm. Early intubation for laryngospasm or severe respiratory distress. Treat respiratory failure with positive-pressure ventilation. Positive end-expiratory pressure (PEEP) (8 to 10 mmHg) and inverse ratio ventilation may be beneficial in acute lung injury.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: Remove the individual from the toxic environment. Administer humidified oxygen if respiratory irritation develops. Remove contaminated clothing.
    • 2) HOSPITAL: Irrigate exposed eyes with copious amounts of normal saline. Remove contaminated clothing and wash exposed skin with water.
  • D) AIRWAY MANAGEMENT
    • 1) Perform endotracheal intubation if indicated (eg, persistent hypoxemia, severe bronchospasm, stridor, severe respiratory distress, or laryngeal edema).
  • E) ANTIDOTE
    • 1) There is no specific antidote.
  • F) ENHANCED ELIMINATION
    • 1) There is no role for this procedure.
  • G) PATIENT DISPOSITION
    • 1) HOME CRITERIA: Patients who are asymptomatic and those who have mild, transient irritation (eye, skin, or respiratory) may be observed at home.
    • 2) OBSERVATION CRITERIA: Patients with more than transient eye or pulmonary irritation should be sent to a healthcare facility for treatment and observation.
    • 3) ADMISSION CRITERIA: Patients with persistent respiratory symptoms after 4 to 6 hours should be admitted. Patients with severe respiratory distress or upper airway injury should be admitted to an intensive care unit.
    • 4) CONSULT CRITERIA: Consult critical care personnel if patient exhibits severe and protracted respiratory distress. Consult an ophthalmologist for patients with ocular burns. Consult a medical toxicologist or poison center for patients with persistent symptoms.
  • H) PITFALLS
    • 1) Distinguishing toxic air levels from permissible air levels may be difficult until irritative symptoms are present. History of chlorine exposure may be difficult to obtain in some settings (eg, swimming pools, mixing of cleaning products).
  • I) TOXICOKINETICS
    • 1) Chlorine is a greenish-yellow, noncombustible gas at room temperature and atmospheric pressure. The intermediate water solubility of chlorine accounts for its effect on the upper airway and the lower respiratory tract. In addition, the density of the gas is greater than that of air, causing it to remain near ground level and increasing exposure time. The odor threshold for chlorine is approximately 0.3 to 0.5 parts per million (ppm).
  • J) DIFFERENTIAL DIAGNOSIS
    • 1) This should include diseases or exposures that produce acute respiratory distress (eg, inhalation of acid or alkaline mists, asthma, COPD).
0.4.4 EYE EXPOSURE
  • A) MANAGEMENT OF MILD TOXICITY
    • 1) Perform an ophthalmologic exam (including visual acuity and slit lamp) in any patient with persistent eye irritation.
  • B) DECONTAMINATION
    • 1) PREHOSPITAL: Irrigate exposed eyes with normal saline.
    • 2) HOSPITAL: Irrigate exposed eyes with copious amounts of normal saline. In cases of suspected ocular injury, determine initial pH using a reagent strip. Continue irrigation with 0.9% saline until the pH returns to 7 to 8.
0.4.5 DERMAL EXPOSURE
  • A) OVERVIEW
    • 1) DECONTAMINATION
      • a) PREHOSPITAL: Remove contaminated clothing and wash exposed skin with water.
      • b) HOSPITAL: Remove contaminated clothing and wash exposed skin with water.
Find more information on this substance at: PubChem, PubMed