Nitrogen tetroxide toxicity

Background

• N₂O₄ (NTO) is used as a propellant.
• In 1975 three astronauts on the Apollo-Soyuz Test Project were exposed to NTO during reetry and treated for pulmonary edema and chemical pneumonitis

Clinical Features

• Eye burning and tearing
• Cutaneous pruritis
• Shortness of breath
• Cough
• Pulmonary edema

Differential Diagnosis

Inhalation injury

Unintentional

• Smoke inhalation injury
  • Cyanide
  • Carbon monoxide
• Chloramine
• Hydrocarbons
• Sewer gas
  • Hydrogen Sulfide
  • Ammonia toxicity
  • Methane
  • Carbon monoxide
• Hydrazine toxicity
• Nitrogen tetroxide
• Metal fume fever

Terrorism

• Pulmonary chemical agents
  • Ammonia
  • Methyl isocyanate
  • methyl bromide
  • Hydrochloric acid
  • Chlorine
  • Phosgene
• Bioterrorism
  • Anthrax
  • Smallpox
  • Plague
  • Tularemia
  • Botulinum toxin
  • Viral hemorrhagic fever
  • Ricin

Evaluation

• Xray (if available)

Management

• Supportive care after removal from the contaminated environment.