Chlorine Poisoning at the Swimming Pool: An Overlooked Hazard

Decker, Walter J.; H, Koch

doi:10.3109/15563657808988245

Cited by 30 publications

(5 citation statements)

References 4 publications

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“…(8) Another retrospective study determined that in patients with acute alveolar injury treated with NIV, predictors for the need for orotracheal intubation include Acute Physiology and Chronic Health Disease Classification System II (APACHE II) score greater than 17 and respiratory rate greater than 25bpm after 1 hour of NIV. (19) Recently, a case report of severe ARDS caused by H1N1 pneumonia was reported in a patient who, similarly to ours, had no other organ dysfunctions and was managed with successful NIV.…”

Section: Discussionmentioning

confidence: 99%

Use of noninvasive ventilation in severe acute respiratory distress syndrome due to accidental chlorine inhalation: a case report

Matos¹,

Oliveira²,

M³

et al. 2017

Revista Brasileira De Terapia Intensiva

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Acute respiratory distress syndrome is characterized by diffuse inflammatory lung injury and is classified as mild, moderate, and severe. Clinically, hypoxemia, bilateral opacities in lung images, and decreased pulmonary compliance are observed. Sepsis is one of the most prevalent causes of this condition (30 - 50%). Among the direct causes of acute respiratory distress syndrome, chlorine inhalation is an uncommon cause, generating mucosal and airway irritation in most cases. We present a case of severe acute respiratory distress syndrome after accidental inhalation of chlorine in a swimming pool, with noninvasive ventilation used as a treatment with good response in this case. We classified severe acute respiratory distress syndrome based on an oxygen partial pressure/oxygen inspired fraction ratio <100, although the Berlin classification is limited in considering patients with severe hypoxemia managed exclusively with noninvasive ventilation. The failure rate of noninvasive ventilation in cases of acute respiratory distress syndrome is approximately 52% and is associated with higher mortality. The possible complications of using noninvasive positive-pressure mechanical ventilation in cases of acute respiratory distress syndrome include delays in orotracheal intubation, which is performed in cases of poor clinical condition and with high support pressure levels, and deep inspiratory efforts, generating high tidal volumes and excessive transpulmonary pressures, which contribute to ventilation-related lung injury. Despite these complications, some studies have shown a decrease in the rates of orotracheal intubation in patients with acute respiratory distress syndrome with low severity scores, hemodynamic stability, and the absence of other organ dysfunctions.

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Section: Discussionmentioning

confidence: 99%

Use of noninvasive ventilation in severe acute respiratory distress syndrome due to accidental chlorine inhalation: a case report

Matos¹,

Oliveira²,

M³

et al. 2017

Revista Brasileira De Terapia Intensiva

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“…Chlorine and chlorination by-products are known serious risk factors causing significant morbidity in industrial settings and in chlorine accidents [23][24][25][26][27][28][29][30][31][32]. In lower concentrations, chlorine is widely used as tap water and pool water disinfectant to avoid waterborne infections caused by bacteria or viruses.…”

Section: Discussionmentioning

confidence: 99%

Chlorine, Chlorination By-Products and Their Allergic and Respiratory Health Effects

Kohlhammer¹,

Heinrich

2007

CRMR

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Although chlorine and most of its derivates are known toxic agents, it has been pronounced as a safe disinfectant for water treatments. More detailed analyses and extended studies concerning chlorine safety have only started recently. The objective of this article was to review data on the use of chlorine in pool environments, the resulting chlorination by-products in these environments and their potential effects on allergic and respiratory health in humans.The MEDLINE database search comprised articles from 1966 to August 2006. Additional studies were identified by searching references of already published articles. A total of twenty-one studies evaluating effects of chlorine and its byproducts on allergic or respiratory health were included in the analysis. Exposure to chlorination by-products through swimming pool attendance showed adverse health effects on children, subjects occupationally exposed, athletic swimmers and asthmatic subjects. These adverse effects were seen despite the presence of official directives in most countries to control and regulate the use of chlorine for water disinfection. Contact to chlorination by-products might not be the leading reason for poor respiratory health, but might not be as harmless as earlier thought. In particular, baby swimming in chlorinated pools is highly questionable.Chlorine is an extensively used agent in water treatments for drinking water and pool water. Although chlorine and most of its derivates are known toxic agents, it has been pronounced as being a safe disinfectant for water treatment [1]. Detailed analyses and extended studies have only started recently because of further concerns regarding chlorine's potential influences on human health.In a recent study, chlorinated swimming pool attendance increased lung hyper-permeability, exercise induced broncho-constriction (EIB) and asthma [2]. Bernard and colleagues hypothesized that repeated or chronic disruption of the lung epithelial barrier could facilitate the penetration of allergens in the lung [2] and could therefore result in higher rates of allergic sensitization and atopic diseases.Current hypotheses for the increasing trends of atopic diseases (allergic asthma, allergic rhinitis, atopic dermatitis) include less microbial or infectious stimulation of the immune system (hygiene hypothesis), environmental changes (indoor allergens, chemicals, microbiological compounds, changed potency of allergens) as well as changes in dietary habits and lifestyle.The objective of this article was to review international data on the use of chlorine in pool environments, the resulting chlorination by-products in these environments and their potential effects on allergic and respiratory health. SEARCH STRATEGYThe Medline database search (

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“…Victims exposed to high concentrations of chlorine gas developed the classic early signs and symptoms of acute exposure. 9 ' 10 Brief exposure to fumes from solid chlorine products used in a pool was reported to have caused lethargy, productive cough, severe hypoxemia, tachypnea, cyanosis, retraction, and expiratory wheezes and crackles in the base of the lungs in two exposed children. 11 Acute exposure to chlorine in additional swimming pool incidents involving 13 children also was reported to have caused a fall in blood oxygen saturation, in addition to the classic signs and symptoms described above.…”

Section: Prevalencementioning

confidence: 99%

Lessons Learned from Chlorine Intoxications in Swimming Pools: The Challenge of Pediatric Mass Toxicological Events

Lehavi

Leiba

Dahan

et al. 2008

Prehosp. Disaster med.

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Abbreviations: BLS = basic life support EMS = emergency medical servicesAbstract Introduction: The classical doctrine of mass toxicological events provides general guidelines for the management of a wide range of "chemical" events. The guidelines include provisions for the: (1) protection of medical staff with personal protective equipment; (2) simple triage of casualties; (3) airway protection and early intubation; (4) undressing and decontamination at the hospital gates; and (5) medical treatment with antidotes, as necessary. A number of toxicological incidents in Israel during the summer of 2005 involved chlorine exposure in swimming pools. In the largest event, 40 children were affected. This study analyzes its medical management, in view of the Israeli Guidelines for Mass Toxicological Events.Methods: Data were collected from debriefings by the Israeli Home Front Command, emergency medical services (EMS), participating hospitals, and hospital chart reviews. The timetable of the event, the number and severity of casualties evacuated to each hospital, and the major medical and logistical problems encountered were analyzed according to the recently described methodology of Disastrous Incident Systematic Analysis ThroughComponents, Interactions, Results (DISAST-CIR). Results: The first ambulance arrived on-scene seven minutes after the first call. Emergency medical services personnel provided supplemental oxygen to the victims at the scene and en route when required. Forty casualties were evacuated to four nearby hospitals. Emergency medical services classified 26 patients as mildly injured, 13 as mild-moderate, and one as moderate, suffering from pulmonary edema. Most children received bronchodilators and steroids in the emergency room; 20 were hospitalized. All were treated in pediatric emergency rooms. None of the hospitals deployed their decontamination sites. Conclusions: Event management differed from the standard Israeli toxicological doctrine. It involved EMS triage of casualties to a number of medical centers, treatment in pediatric emergency departments, lack of use of protective gear, and omission of decontamination prior to emergency department entrance. Guidelines for mass toxicological events must be tailored to unique scenarios, such as chlorine intoxications at swimming pools, and for specific patient populations, such as children. All adult emergency departments always should be prepared and equipped for taking care of pediatric patients. Lessons learned from chlorine intoxications in swimming pools: The challenge of pediatric mass toxicological events. Prehospital Disast Med 2008;23(l):90-95. IntroductionThe classic doctrine of mass toxicological events provides general guidelines for managing "chemical" events due to a wide range of hazards (Figure 1). These guidelines cover issues such as: (1) the protection of medical staff with personal protective gear; (2) the use of a simple and rapid method for the triage of casualties; (3) early airway protection and intubation; (4) undressing and decon...

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Chlorine Poisoning at the Swimming Pool: An Overlooked Hazard

Cited by 30 publications

References 4 publications

Use of noninvasive ventilation in severe acute respiratory distress syndrome due to accidental chlorine inhalation: a case report

Use of noninvasive ventilation in severe acute respiratory distress syndrome due to accidental chlorine inhalation: a case report

Chlorine, Chlorination By-Products and Their Allergic and Respiratory Health Effects

Lessons Learned from Chlorine Intoxications in Swimming Pools: The Challenge of Pediatric Mass Toxicological Events

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