Diferencia entre revisiones de «Phosgene»
(Created page with "==Background== * phosgene (COCl2) is a highly toxic, colorless gas or liquid * gained infamy in WWI - responsible for 85% of deaths due to chemical weapons * pulmonary irritan...") |
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** manufacturers of dyes, resins, coal tar, pesticides | ** manufacturers of dyes, resins, coal tar, pesticides | ||
* some people may note a smell of newly mown hay | * some people may note a smell of newly mown hay | ||
===Pathophysiology=== | |||
* acrylation reaction with amino, hydroxyl, and sulfhydryl goups | |||
* membrane structural changes, protein denaturation, depletion of glutathione | |||
* increased vascular permeability leads to noncardiogenic pulmonary edema | |||
==Clinical Features== | ==Clinical Features== | ||
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* development of noncardiogenic pulmonary edema | * development of noncardiogenic pulmonary edema | ||
== | ==Differential Diagnosis== | ||
==Evaluation== | ==Evaluation== | ||
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* steroids recommended but no solid evidence for efficacy | * steroids recommended but no solid evidence for efficacy | ||
* no specific antidote exists | * no specific antidote exists | ||
==Disposition== | |||
==References== | ==References== | ||
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[[Category:Toxicology]] | |||
Revisión del 01:46 9 feb 2017
Background
- phosgene (COCl2) is a highly toxic, colorless gas or liquid
- gained infamy in WWI - responsible for 85% of deaths due to chemical weapons
- pulmonary irritant
- major complication is non-cardiogenic pulmonary edema
- used in chemical reactions - large scale exposures usually 2/2 industrial accidents
- manufacturers of dyes, resins, coal tar, pesticides
- some people may note a smell of newly mown hay
Pathophysiology
- acrylation reaction with amino, hydroxyl, and sulfhydryl goups
- membrane structural changes, protein denaturation, depletion of glutathione
- increased vascular permeability leads to noncardiogenic pulmonary edema
Clinical Features
- eye and throat symptoms may occur at very low concentrations
- unpredictable latent phase
- development of noncardiogenic pulmonary edema
Differential Diagnosis
Evaluation
- high index of suspicion, ask about work history/exposures
- no combination of labs/xrays can predict whether pt will develop pulmonary edema
- latent phase can be 30 min - 72hrs but significant exposures usually developed pulmonary symptoms within 24 hrs
Management
- supportive care
- with pulmonary edema pts may require intubation with high PEEP
- albuterol for bronchospasm
- steroids recommended but no solid evidence for efficacy
- no specific antidote exists