title: Successful extracorporeal life support after potentially fatal pulmonary oedema caused by inhalation of nitric and hydrofluoric acid fumes.
abstract: Two patients presented with potentially fatal pulmonary oedema after accidental exposure to nitric and hydrofluoric acid fumes during electroplating. Despite aggressive respiratory support, one succumbed to respiratory failure 3.5h after inhalation. The other patient also rapidly progressed to respiratory failure. Extracorporeal life support (ECLS) was started 5h after exposure at the ED. During ECLS, hypoxia improved, but pulmonary oedema shown by chest radiography became aggravated. N-Acetyl cysteine and calcium gluconate were given i.v. on the first day of admission and nebulised for 48 h after exposure. Pulmonary secretions were significantly reduced 24 h after the nebulising therapy began. Ultimately, the patient was discharged without serious pulmonary or neurological complications after 28 days of hospitalisation. In this case, early ECLS, nebulised antioxidant and antidote were available to treat potentially fatal pulmonary oedema after exposure to nitric and hydrofluoric acid fumes.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Republic of Korea.
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Shin
authors.forename: Sung-Woo
authors.initials: SW
authors.lastname: Lee
authors.forename: Nak-Hoon
authors.initials: NH
authors.lastname: Kim
authors.forename: Jon-Su
authors.initials: JS
authors.lastname: Park
authors.forename: Kwang Ja
authors.initials: KJ
authors.lastname: Kim
authors.forename: Sung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.forename: Yun-Sik
authors.initials: YS
authors.lastname: Hong
mesh_terms: D000328:Adult; D000395:Air Pollutants, Occupational / Q000009:adverse effects; D004595:Electroplating; D053834:Explosive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D017809:Fatal Outcome; D006801:Humans; D006858:Hydrofluoric Acid / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D017942:Nitric Acid / Q000008:administration & dosage / Q000009:adverse effects*; D016273:Occupational Exposure / Q000009:adverse effects; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000628:therapy*
chemical_list: D000395:Air Pollutants, Occupational; D053834:Explosive Agents; D017942:Nitric Acid; D006858:Hydrofluoric Acid