Hardison Lewis S, Wright Edward, Pizon Anthony F
Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, PO Box 800774, Charlottesville, VA, 22908-0774, USA,
J Med Toxicol. 2014 Mar;10(1):51-6. doi: 10.1007/s13181-013-0319-6.
Phosgene is a rare exposure with strong clinical implications. We report a phosgene exposure that resulted in the patient's death.
A 58 year-old man arrived to the emergency department 1 hour after exposure to phosgene with complaints of a sore throat. Initial vital signs were blood pressure 175/118 mmHg, heart rate 98/min, respirations 12/min, and oxygen saturation of 93% on room air. Physical exam revealed few scattered rhonchi, without signs of distress. Initial arterial blood gases (ABG's) revealed pH 7.42, pCO2 43 mmHg, pO2 68 mmHg, HCO3 27 meq/L, and oxygen saturation of 93% on room air. Initial chest x-ray 2 hours after the exposure demonstrated clear lung fields. Approximately 2.5 hours after the exposure, he began complaining of dyspnea, restlessness and his oxygen saturation dropped below 90%. He received nebulized albuterol, 1 gram intravenous methylprednisolone, and 100 % oxygen via face mask. Minimal improvement was noted and he was intubated. The post intubation chest x-ray, 3.5 hours after the exposure, revealed diffuse alveolar infiltrates. Acetylcysteine, terbutaline, and IV steroids were administered without improvement. The patient died 30 hours after exposure.
There are many misunderstandings concerning phosgene due to its rare presentation. Traditional treatment modalities are often unproven in human trials and were unsuccessful in this case.
This case highlights the significant toxicity that results from phosgene exposure and the challenges of the limited treatment modalities. There is concern for the use of this agent in chemical terrorism.
光气是一种罕见的暴露源，具有重大临床意义。我们报告一例因光气暴露导致患者死亡的病例。
一名58岁男性在接触光气1小时后因咽痛被送至急诊科。初始生命体征为血压175/118 mmHg，心率98次/分钟，呼吸频率12次/分钟，室内空气环境下氧饱和度为93%。体格检查发现少量散在的哮鸣音，无窘迫体征。初始动脉血气分析显示pH 7.42，pCO2 43 mmHg，pO2 68 mmHg，HCO3 27 meq/L，室内空气环境下氧饱和度为93%。暴露后2小时的初始胸部X线显示肺野清晰。暴露后约2.5小时，他开始诉说呼吸困难、烦躁不安，氧饱和度降至90%以下。他接受了雾化沙丁胺醇、1克静脉注射甲泼尼龙以及通过面罩给予100%氧气。改善甚微，随后他被插管。暴露后3.5小时插管后的胸部X线显示弥漫性肺泡浸润。给予乙酰半胱氨酸、特布他林和静脉类固醇治疗后仍无改善。患者在暴露后30小时死亡。
由于光气表现罕见，存在许多误解。传统治疗方式在人体试验中往往未经证实，且在此病例中未获成功。
本病例突出了光气暴露所致的显著毒性以及有限治疗方式带来的挑战。人们对该制剂在化学恐怖主义中的使用表示担忧。
