title: Fatal pulmonary edema after nitric acid inhalation.
abstract: We report a case of acute inhalation injury of nitric acid in a 56-year old white male. The patient presented conscious and dyspnoic at the emergency department after cleaning a copper chandelier with nitric acid. He had to be intubated 2 h after admission and mechanically ventilated because of fulminant respiratory insufficiency. As all sources of mechanical ventilation failed, extracorporeal membrane oxygenation had to be established 7 h after admission. With the additional use of surfactant and low dose inhalation therapy with nitric oxide (NO), the patient could be stabilised for 3 days and lung function improved temporarily. Despite all efforts the patient died at the fourth day from refactory respiratory failure. Pathologic examination revealed massive pulmonary edema without signs of inflammation. Thus, nitric acid inhalation induced pulmonary edema appears to be a most severe situation in which even most modern therapeutic interventions fail. As, in respect of recent literature and our case no promising therapy for nitric acid inhalation pulmonary edema is available, our efforts have to be directed towards prevention of nitric acid exposure.
authors.affiliation: Department of Emergency Medicine, Vienna General Hospital, University Clinics, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Bur
authors.forename: A
authors.initials: A
authors.lastname: Wagner
authors.forename: M
authors.initials: M
authors.lastname: Röggla
authors.forename: A
authors.initials: A
authors.lastname: Berzlanovic
authors.forename: H
authors.initials: H
authors.lastname: Herkner
authors.forename: F
authors.initials: F
authors.lastname: Sterz
authors.forename: A N
authors.initials: AN
authors.lastname: Laggner
mesh_terms: D000061:Accidents, Home; D000280:Administration, Inhalation; D001688:Biological Products; D015199:Extracorporeal Membrane Oxygenation; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D017942:Nitric Acid / Q000008:administration & dosage / Q000506:poisoning*; D009569:Nitric Oxide / Q000627:therapeutic use; D010743:Phospholipids; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000628:therapy; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial
chemical_list: D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; D009569:Nitric Oxide; D017942:Nitric Acid; C068291:poractant alfa