title: Mass casualties from acute inhalation of chlorine gas.
abstract: OBJECTIVE
  Chlorine gas is a potent pulmonary irritant that affects the mucous membranes and induces severe disturbances of pulmonary gas exchange within minutes of inhalation. The present study evaluated an extraordinary type of mass inhalational exposure.
  
  
  METHODS
  Clinical reports of 25 soldiers who were admitted to the emergency department of Maresal Cakmak Military Hospital, Erzurum were retrospectively evaluated. All patients were exposed to chlorine gas as a result of mixing sodium hypochlorite with hydrochloric acid during cleaning activities.
  
  
  RESULTS
  All patients were male and the mean age of patients was 22.04+/-2.98 years. The main symptoms were coughing and dyspnea in 18 patients (72%). Forced expiratory volume in 1 second (FEV1) and FEV1/forced volume capacity (FVC) ratio were found to be normal in all patients but FVC and peak expiratory flow (PEF) were below the normal range (80%) in 9 patients (36%). All patients received warmed humidified oxygen combined with nebulized salbutamol. Inhaled budesonide and nebulized sodium bicarbonate were ordered additionally for 19 patients (76%). Thirteen patients (52%) were discharged from the emergency department and 12 patients (48%) were hospitalized. No mortality was observed.
  
  
  CONCLUSIONS
  Chlorine gas is a potent pulmonary irritant that causes acute damage in both the upper and lower respiratory tract. We suggest that inhaled steroids combined with nebulized sodium bicarbonate could be a safe and effective alternative for the treatment of symptomatic patients. Education of the public about the dangers of mixing of hypochlorite bleach with acidic cleaning agents is also very important.
authors.affiliation: Department of Emergency Medicine, Ataturk Training and Research Hospital, and Department of Medical CBRN Defense, Military Medical Academy, Ankara, Turkey. yunsurcevik@yahoo.com
authors.forename: Yunsur
authors.initials: Y
authors.lastname: Cevik
authors.forename: Meral
authors.initials: M
authors.lastname: Onay
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akmaz
authors.forename: Sermet
authors.initials: S
authors.lastname: Sezigen
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage; D019819:Budesonide / Q000008:administration & dosage; D002619:Chemical Warfare Agents / Q000506:poisoning*; D002713:Chlorine / Q000506:poisoning*; D003371:Cough / Q000139:chemically induced; D004359:Drug Therapy, Combination; D004417:Dyspnea / Q000139:chemically induced; D005739:Gas Poisoning / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D005938:Glucocorticoids / Q000008:administration & dosage; D006772:Hospitals, Military; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008297:Male; D054527:Mass Casualty Incidents; D010100:Oxygen / Q000008:administration & dosage; D011659:Pulmonary Gas Exchange / Q000187:drug effects*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001993:Bronchodilator Agents; D002619:Chemical Warfare Agents; D005938:Glucocorticoids; D002713:Chlorine; D019819:Budesonide; D017693:Sodium Bicarbonate; D000420:Albuterol; D010100:Oxygen