Phosgene
Revision as of 14:16, 14 February 2017 by Rossdonaldson1 (talk | contribs)
Not to be confused with phosgene oxime (CX)
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