title: Chlorine inhalation: the big picture.
abstract: BACKGROUND
  Causes of acute chlorine exposures from community pool accidents have many reported etiologies. This case series involves 13 children exposed to high levels of chlorine at two community pools after an unusual mishap in the chlorination maintenance procedure.
  
  
  METHODS
  During maintenance, the water feeding lines to pools are normally turned off, the chemicals replaced, the water turned back on, and the chemicals then reinjected into the line. In two separate disasters in the summer of 1996, the feeding lines were not reprimed with water before the reactants, sodium hypochlorite and muriatic acid, were injected. This caused an unusually high volume of concentrated chlorinated water to be released when refed to the pool.
  
  
  RESULTS
  All patients were treated with beta agonists and humidified oxygen, and five were admitted. None received bicarbonate inhalation. An extensive literature review of chlorine inhalation injuries indicates considerable variance in opinions of the pathophysiology, clinical presentation and treatment modalities, especially steroids and bicarbonate inhalation.
  
  
  CONCLUSIONS
  In community pools, failure to reprime feeding lines with water after replacing and injecting chlorinating reactants may result in severe and large-scale chlorine exposures. Beta agonist administration and humidified oxygen remains the mainstay of treatment; steroid therapy and bicarbonate inhalation are still inadequately supported.
authors.affiliation: Emergency Medicine Residency of the Lehigh Valley, St. Luke's Hospital, Bethlehem, Pennsylvania 18015, USA. SEXTONS@SLHN.ORG
authors.forename: J D
authors.initials: JD
authors.lastname: Sexton
authors.forename: D J
authors.initials: DJ
authors.lastname: Pronchik
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000818:Animals; D002648:Child; D002713:Chlorine / Q000008:administration & dosage / Q000506:poisoning*; D005739:Gas Poisoning / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D010102:Oxygen Inhalation Therapy; D013551:Swimming Pools
chemical_list: D000318:Adrenergic beta-Agonists; D002713:Chlorine