title: ARDS after accidental inhalation of zinc chloride smoke.
abstract: Five soldiers were injured by inhalation of hexite smoke (ZnCl2) during military training. Two soldiers, not wearing gas masks breathed hexite for 1 or 2 min, they slowly developed severe adult respiratory distress syndrome (ARDS) over the ensuing 2 weeks. This slow, progressive clinical course has not been previously described. In both patients, an increased plasma zinc concentration was measured 3 weeks after the incident. Intravenous and nebulized acetylcysteine increased the urinary excretion of zinc, and briefly decreased the plasma levels. In an attempt to arrest collagen deposition in the lungs, L-3,4 dehydroproline was administered. Both patients died of severe respiratory failure (25 and 32 days after inhalation). At autopsy diffuse microvascular obliteration, widespread occlusion of the pulmonary arteries and extensive interstitial and intra-alveolar fibrosis was observed. Three soldiers wearing ill fitting gas masks, immediately developed severe coughing and dyspnea. They improved, and 12 months after exposure their lung function tests were nearly normal, but they still had slight dyspnea on exercise.
authors.affiliation: Department of Anesthesia, Herlev Hospital, University of Copenhagen, Faculty of Medicine, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Hjortsø
authors.forename: J
authors.initials: J
authors.lastname: Qvist
authors.forename: M I
authors.initials: MI
authors.lastname: Bud
authors.forename: J L
authors.initials: JL
authors.lastname: Thomsen
authors.forename: J B
authors.initials: JB
authors.lastname: Andersen
authors.forename: F
authors.initials: F
authors.lastname: Wiberg-Jørgensen
authors.forename: N K
authors.initials: NK
authors.lastname: Jensen
authors.forename: R
authors.initials: R
authors.lastname: Jones
authors.forename: L M
authors.initials: LM
authors.lastname: Reid
authors.forename: W M
authors.initials: WM
authors.lastname: Zapol
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002712:Chlorides / Q000506:poisoning*; D006801:Humans; D008168:Lung / Q000032:analysis / Q000098:blood supply / Q000473:pathology; D008889:Military Personnel; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000473:pathology; D015032:Zinc / Q000032:analysis / Q000506:poisoning*; D017967:Zinc Compounds
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D002712:Chlorides; D017967:Zinc Compounds; C016837:zinc chloride; D015032:Zinc; D000111:Acetylcysteine