title: Possible association of benzalkonium chloride in nebulizer solutions with respiratory arrest.
abstract: OBJECTIVE
  To report a case of possible association of benzalkonium chloride in nebulizer solutions with respiratory arrest and to review the involvement of various preservative agents in paradoxical bronchoconstrictive reactions.
  
  
  METHODS
  Reference articles, case reports, and editorials are identified in the text.
  
  
  RESULTS
  Many pharmacologic agents are available for nebulization. In addition to the active drug, these nebulizer solutions may contain preservatives. We describe a case of respiratory arrest in a 64-year-old man following nebulization therapy with albuterol and ipratropium solutions. These solutions contain benzalkonium chloride as a preservative. We are aware of only one report describing two deaths associated with such a severe reaction attributable to nebulization therapy. However, many reports of milder paradoxical bronchoconstriction are available in the medical literature.
  
  
  CONCLUSIONS
  Clinicians should be aware of the possibility of paradoxical bronchoconstrictive reactions when patients are treated with nebulized bronchodilators.
authors.affiliation: Pulmonary and Internal Medicine, Ottawa General Hospital, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Boucher
authors.forename: M T
authors.initials: MT
authors.lastname: Roy
authors.forename: J
authors.initials: J
authors.lastname: Henderson
mesh_terms: D001548:Benzalkonium Compounds / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D012996:Solutions / Q000592:standards
chemical_list: D001548:Benzalkonium Compounds; D012996:Solutions