Chemical Pneumonia

Toxic exposure to chemicals causes chemical pneumonia

Chemical pneumonia is an unusual type of lung irritation. Pneumonia usually is caused by a bacteria or virus. In chemical pneumonia, inflammation of lung tissue is from poisons or toxins. Only a small percentage of the types of pneumonia are caused by chemicals.

• Many substances can cause chemical pneumonia, including liquids, gases, and small particles, such as dust or fumes, also called particulate matter. Some chemicals only harm the lungs; however, some toxic materials affect other organs in addition to the lungs and can result in serious organ damage or death.
• Aspiration pneumonia is another form of chemical pneumonia. Aspiration means that you breathe oral secretions or stomach contents into your lungs. The inflammation comes from the toxic effects of stomach acid and enzymes on lung tissue. Bacteria from the stomach or mouth can also cause bacterial pneumonia.
• Chemical pneumonia is only one type of lung inflammation. Other types of lung infections are viral pneumonia and bacterial pneumonia.

Signs and symptoms of chemical pneumonia vary greatly, and many factors can determine its seriousness. For instance, someone exposed to chlorine in a large outdoor pool may have only a cough and burning eyes. Someone else exposed to high levels of chlorine in a small room may die of respiratory failure.

Factors that determine the severity of signs and symptoms include the following:

• Type and strength of chemical
• Exposure environment: indoor, outdoor, heat, cold
• Length of exposure: seconds, minutes, hours
• Form of chemical: gas, vapor, particulate, liquid
• Protective measures used to avoid exposure to chemicals
• Prior medical condition
• Age of the person

Chemical pneumonia may have the following signs and symptoms:

Chemical Pneumonia Symptoms

• Burning of the nose, eyes, lips, mouth, and throat
• Dry cough
• Wet cough producing clear, yellow, or green mucus
• Cough producing blood or frothy pink matter in saliva
• Nausea or abdominal pain
• Chest pain
• Shortness of breath
• Painful breathing or pleuritis (an inflammation of the outside covering of the lungs)
• Headache
• Flu symptoms
• Weakness or a general ill feeling
• Delirium or disorientation

Chemical Pneumonia Signs a Doctor Might Observe

• Rapid or shallow breaths
• Rapid pulse
• Oral, nasal, or skin burns
• Pale or cyanotic skin and lips
• Heavy sweating
• Altered thinking and reasoning skills
• Unconsciousness
• Swelling of eyes or tongue
• Hoarse or muffled voice
• Chemical odors on other areas of the body
• Frothy spit from a cough
• Fever

Should any of the signs or symptoms occur, call a doctor or the local poison control center (call 1-800-222-1222 from anywhere in the United States and they will direct you to the nearest poison center). Any person with serious signs or symptoms should be transported immediately by ambulance to the nearest hospital's emergency department capable of managing someone with chemical pneumonia.

Chemical identification is helpful both for the poison control center and the doctor. All people, those with few, if any symptoms, and those with grave symptoms should have the chemical they were exposed to identified as soon as possible. This should not take precedence over medical care, however, especially for those with severe signs or symptoms.

Immediate evaluation in a hospital's emergency department is necessary for treating the following conditions:

• Unconsciousness
• Cyanosis - a blue discoloration of the mouth or skin
• Difficulty breathing
• Sudden change of voice
• Mouth or throat swelling
• Chest pain
• Shortness of breath
• Cough productive of frothy or bloody spit
• Altered thinking and reasoning skills
• Exposure to potentially deadly chemical
• Vomiting and aspiration

The poison control center may suggest other conditions the patient may have particular to the chemical that necessitate emergency care.

Diagnosis and treatment will vary depending on the patient's signs and symptoms. Frequently, the symptoms will be mild, the chemical will be well known, and the medical evaluation brief and focused.

• Sometimes serious signs and symptoms will need life-saving procedures, such as artificial ventilation, advanced cardiac life support, or complex medical therapy. In most cases, the doctor will consult local poison control experts for advice.
• The doctor must first make sure that hospital staff are not at risk for exposure so the patient may need to undergo decontamination procedures while the medical staff may need to wear protective garments while treating the patient.
• After stabilizing the patient, the next priority is to identify the chemical and consider the effects the chemical has on the lungs and the rest of the body.
• A thorough history will be obtained to include the length of exposure, area of exposure, form and concentration of the chemical, other medical problems, and symptoms. In addition to close inspection of the vital signs (heart rate, blood pressure, respiratory rate, temperature, and how much oxygen is in the blood), the doctor will evaluate, at a minimum, the eyes, nose, throat, skin, heart, lungs, and abdomen.

Once these steps have been taken, further evaluation may vary depending on the status of the person injured, the type of chemical exposure, and other factors.

In the following sections examples of chemical pneumonia are discussed, and how a doctor might evaluate each case are presented. This is in no way a complete list of all the possible chemical exposures that might result in pneumonia. Thousands of chemicals exist that may result in pneumonia or other serious toxicity.

Example case 1

• A 38-year-old oil refinery worker is exposed to a concentrated mist of sulfur dioxide in an enclosed room while repairing a pipe. He immediately complains of burning eyes, nose, and mouth. He also complains of difficulty breathing. He is transported to the nearest emergency department by EMS personnel. Coworkers contain the gas and alert local authorities.
• When the patient arrives in the emergency department, he appears sick. He is having a difficult time breathing. His heart rate and respiratory rate are very fast and his oxygen level is low. The doctor finds that there was a brief, but intense, exposure and that the patient almost passed out. His coworkers confirm exposure to sulfur dioxide and that no other chemicals were present.
• The worker's clothes are removed and he is decontaminated. The doctor notes irritated eyes, fast pulse, and harsh sounds in the lungs. The doctor talks with authorities at the site to confirm the chemical exposure. The local poison control center is contacted for assistance.
• Now the patient is finding breathing even more difficult. Despite an oxygen mask, his lungs have been severely damaged and are not functioning to receive oxygen to support his vital organs. The patient becomes delirious, and the doctor provides artificial ventilation to assist him in receiving enough oxygen.
• The patient is on a ventilator for a few days and improves. His lungs slowly recover, but never return to normal. Safety personnel at the refinery are able to limit any future hazards.

Example case 2

• A young boy is rescued from a house fire. He has no visible burns, but his nasal hairs are singed and there's soot in his mouth. He is breathing well and has stable vital signs.
• The doctor notes clear lungs and no swelling in the mouth or nose. Chest and neck X-rays are normal. The child is admitted for observation. He develops no problems and is discharged the next day.

Example case 3

• A 13-year-old girl attempts suicide by drinking lighter fluid. Her mother sees this and forces her to vomit, then rushes her to the hospital. The doctor notes a fast heart rate and respiratory rate, and that her clothing smells of lighter fluid. The nurse removes the girl's clothes and cleans off the lighter fluid. The patient denies taking any drugs or chemicals other than the lighter fluid.
• After decontamination, a chest X-ray shows a mild, diffuse pneumonia. The local poison control center notes that lighter fluid can cause a chemical pneumonia and other problems.
• The patient is admitted to the hospital and watched closely. Her pneumonia worsens slightly; however, she does not require artificial ventilation. After ten days she is discharged to a psychiatric hospital. Her lungs are left with a moderate amount of scarring.
• These are only examples. Many chemicals other than these cause chemical pneumonia.

A person's decision to seek medical care depends on the severity of signs and symptoms and other factors of exposure. If a person accidentally inhales a chemical, he or she will likely want some medical advice. The best advice is to the local poison control center for help. If symptoms are serious, the patient will require immediate treatment at a hospital emergency department.

Home care may be the most important aspect of medical management.

• Quickly get away from the offending chemical or area of exposure. If possible, avoid exposing others to the same chemical. Once you're away from the area, consider further decontamination, such as removing your clothes and showering.
• Alert the appropriate authorities to avoid further casualties.
• Identify and contain the chemical if it safe to do so. Otherwise, keep all people away from the area until trained personnel can safeguard the site.
• Medical evaluation may involve local police, fire department, emergency medical services (EMS), and hazardous materials personnel.

Evaluation and treatment for chemical pneumonia vary. Almost everyone will have measurements of blood pressure, oxygen level, heart rate, and respiratory rate.

In many people with chemical pneumonia, treatment is primarily observation. Sometimes symptoms develop over time and the amount of damage done won't be known for several hours.

Many treatments are possible, including the following:

• IV fluids
• Oxygen by mask or tube
• Breathing treatment with medicine to open breathing tubes
• Steroid medications by IV or mouth
• Nonsteroidal anti-inflammatory medications by mouth
• Pain medications by IV or mouth
• Artificial ventilation (help breathing)
• Preventive antibiotics (sometimes)
• Antidotes (usually poison control and a toxicologist are consulted. Use of antidotes are rare.

Prognosis depends on the chemical exposure and person's medical condition. For example, an elderly person with lung disease exposed to moderate amounts of vaporized ammonium chloride might suffer more serious problems as compared to a young athlete with no lung problems. In general, the more severe the symptoms, the more likely the patient will suffer short- and long-term complications.

• Short-term complications include other organ injury in addition to possible death.
• Long-term complications include lung scarring and recurrent pneumonia.