December 7th, 2014
A recent article published in the Chicago Tribune described an incident in which the entire Rosemont Hyatt Regency Hotel in Chicago was evacuated due to the intentional release of chlorine gas. The evacuation of the hotel resulted in the hospitalization of 19 people. Fortunately, there were no deaths associated with this incident probably due to the lower doses of the toxic gas involved. Immediate symptoms due to chlorine inhalation can range from a burning sensation in the nose, coughing, chest tightness and shortness of breath. Upon inhalation of higher doses of chlorine gas, the long term consequences of lung injury can lead to lung edema, respiratory distress and even death. A recent study published in the ‘American Journal of Physiol Lung Cell Mol Physiol’ demonstrated that chlorine inhalation caused sloughing of bronchial epithelium one day after chlorine exposure, which can cause pneumonitis and bronchial hyper-reactivity (1). Surprisingly, health screenings for individuals located within one mile of a 54 metric ton release of liquid chlorine following a 16 tanker car train derailment on 6 January, 2005 in Graniteville, South Carolina, USA demonstrated that even 8-10 months after the event, patients still had abnormal lung function and some even developed new pulmonary symptoms (2).
However, there are no immediate counter-measures available to date to mitigate chlorine toxicity. Current treatment regimes consist of providing supportive medical care in a hospital setting. For effective treatment, first responders and hospitals need compounds that are easily administered for the purpose of halting the cascade of events that lead to future respiratory complications. Recent work being conducted at the University of Alabama at Birmingham in the labs of Drs. Sadis Matalon and Rakesh Patel have shown that the administration of aerosolized heparin can reduce lung injury, and an intramuscular injection of nitrite can reduce mortality after chlorine exposure (3,4). The research was supported by the Counter Act Network, and therefore many will potentially benefit from the work being done at UAB and other institutions under the Counter Act umbrella.
Author: Dr. Saurabh Aggarwal MD., Ph.D. Instructor, Department of Anesthesiology, UAB, Birmingham, Al
1. Mo,Y., Chen, J., Humphrey, D. M., Jr., Fodah, R. A., Warawa, J. M., and Hoyle, G.W. (2014) Am J Physiol Lung Cell MolPhysiol, ajplung 00226 02014
2. Balte, P. P., Clark, K. A., Mohr, L. C., Karmaus, W. J., Van Sickle, D., and Svendsen, E. R. (2013) Pulm Med 2013, 325869
3. Honavar, J., Doran, S., Oh, J. Y.,Steele, C., Matalon, S., and Patel, R. P. (2014) Am J Physiol Lung Cell Mol Physiol 307, L888-894
4. Zarogiannis, S. G., Wagener, B. M.,Basappa, S., Doran, S., Rodriguez, C. A., Jurkuvenaite, A., Pittet, J. F., andMatalon, S. (2014) Am J Physiol Lung CellMol Physiol 307, L347-354