title: Case with bromine exposure leading to respiratory insufficiency.
abstract: A 21-year-old male had a chemical burn on the right forearm when he inadvertently spilled bromine during an experiment. Since he inhaled vaporized bromine and had dyspnea and pharyngalgia, he arrived at our hospital in an ambulance as an emergency patient. On arrival, he kept a clear consciousness with a pulse rate of 98, body temperature of 36.8 degrees C, blood pressure of 132/80 mmHg, respiratory rate of 25, and oxygen saturation of 100%. (10 L/min of oxygen were administered.) He had marked dry coughs. His clothes had a foreign odor with mucosal irritation. Arterial blood gas analysis and blood biochemistry were normal. Based on these findings, he was diagnosed with chemical airway damage and bulbar conjunctiva from the exposure to bromine and a chemical burn on the right forearm. His respiratory condition became worse after admission, resulting in pulmonary edema. He was endotracheally intubated and controlled with an artificial ventilator on Day 3 after his injury. He was continuously treated with steroids and sivelestat sodium hydrate, which gradually improved his respiration. He was released from the artificial ventilator and extubated on Day 7. Although dyspnea associated with body movement and hoarseness persisted after extubation, the symptoms decreased and he was discharged on Day 41. This rare case is worth attention because serious respiratory insufficiency requiring artificial ventilation due to pulmonary edema from bromine exposure has not been reported in Japan.
authors.affiliation: Department of Emergency Medicine, Tokyo Women's Medical University.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Inagaki
authors.forename: Masatake
authors.initials: M
authors.lastname: Ishikawa
authors.forename: Munekazu
authors.initials: M
authors.lastname: Takeda
authors.forename: Masaru
authors.initials: M
authors.lastname: Abe
authors.forename: Kazuto
authors.initials: K
authors.lastname: Imai
authors.forename: Taiichiro
authors.initials: T
authors.lastname: Kadoyama
authors.forename: Joji
authors.initials: J
authors.lastname: Kurokawa
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Soga
authors.forename: Takao
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Tadashi
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D001966:Bromine / Q000009:adverse effects*; D002057:Burns, Chemical / Q000209:etiology; D002059:Burns, Inhalation / Q000209:etiology*; D005998:Glycine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D019570:Inhalation Exposure; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage; D011654:Pulmonary Edema / Q000209:etiology; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy; D013449:Sulfonamides / Q000627:therapeutic use; D014835:Volatilization
chemical_list: D013449:Sulfonamides; D011239:Prednisolone; C069195:sivelestat; D001966:Bromine; D005998:Glycine; D008775:Methylprednisolone