A NEAR FATAL SWIMMING EXPERIENCE RAPID DETIORATION FROM ACUTE EXPOSURE TO CHLORINE

Abstract

1. Introduction:

Chlorine (Cl¹?) is a toxic irritant, whereby inhalation may lead to upper and lower respiratory tract injury with sinister complications such as laryngeal oedema, acute respiratory distress syndrome (ARDS) and pneumonitis.

1. Case report

A 27 years old, Chinese gentleman presented with a complaint of cough and shortness of breath 5 hours after exposure to chlorine that was being poured into the water filter of the swimming pool. Duration of exposure was 20 minutes. He also developed bilateral eye redness and minimal haemoptysis. Upon arrival he was peripherally cyanosed and tachypnoiec. His oxygen saturation was 78% under RA and. Other vital signs were stable. Lungs auscultation revealed bilateral crepitation up to midzone. Chest x-ray showed bilateral alveolar opacities. Bedside ultrasound revealed B-lines in bilateral lungs until upper zone. ABG showed a normal anion gap metabolic acidosis. Patient initially wason CPAP with a PEEP of 10 and FiO2 1.0. It was uneventful with serial ABGs showing improvement in his P/F ratio. However, 12 hours post exposure, patient was intubated for worsening type 1 respiratory failure. He was then treated as ARDS.  Improvement in his oxygenation was noted in ICU 23 hours after exposure. Patient remained ventilated for 70 hours during which his respiratory function gradually improved. He also had acute kidney injury which resolved 30 hours post exposure. He was discharged home well 6 days after exposure.

• Discussion

Chlorine inhalation in this patient resulted in ARDS that deteriorated rapidly over hours in the emergency department. His rapidly progressive ARDS would require high & incremental PEEP, nebulized sodium bicarbonate, and inhaled steroids, apart from the regular treatment of ARDS.

1. Conclusion

The symptoms of acute exposure to chlorine may develop in hours and progress rapidly. The risk of rapid deterioration entails prompt diagnosis & intensive monitoring in order to enable early pre-emptive treatment.