Successful extracorporeal life support after potentially fatal pulmonary oedema caused by inhalation of nitric and hydrofluoric acid fumes.
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.
Shin
Jae Seung
JS
Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Republic of Korea.
Lee
Sung-Woo
SW
Kim
Nak-Hoon
NH
Park
Jon-Su
JS
Kim
Kwang Ja
KJ
Choi
Sung-Hyuk
SH
Hong
Yun-Sik
YS
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*
D000395:Air Pollutants, Occupational; D053834:Explosive Agents; D017942:Nitric Acid; D006858:Hydrofluoric Acid