Occupational acute argon gas poisoning: A case report.

RATIONALE: Intentional or unintentional exposure to asphyxiating gases is a significant public health concern worldwide. Argon poisoning is fatal, and its onset is primarily due to neurological damage. PATIENT CONCERNS: A 22-year-old man was admitted to the hospital for argon gas poisoning. While working in a plant containing argon gas, he suddenly lost consciousness, recovered consciousness slightly after on-site treatment, answered questions, and had impaired memory, sensory dullness, normal cognition, and symptoms of dizziness and headache. DIAGNOSIS: Asphyxiating gas poisoning (argon gas poisoning), metabolic encephalopathy, and hepatic insufficiency. INTERVENTIONS: Immediately after admission, the patient was treated with nasal cannula oxygen 3 L/min and hyperbaric oxygen therapy once a day. Mecobalamin tablets 500 µg were given orally 3 times a day. Oral Ginkgo biloba extract tablets 40 mg 3 times a day. OUTCOME: The patient was discharged after treatment with hyperbaric oxygen therapy and nerve-nourishing drugs, with no discomfort, clear consciousness, and good memory, and was followed up by telephone for 2 consecutive months, and the patient is now in good condition with no discomfort. LESSON: This case describes the pathogenesis, neurological damage, and rescue process of argon gas poisoning. Argon poisoning was found to damage bilateral cerebellar hemispheres and bilateral hippocampal regions, affecting the patient's consciousness and memory, and was found to cause abnormal liver function and heart rate disorders.

Recent sulfur mustard attacks in Middle East and experience of health professionals.

Sulfur mustard (SM) is a vesicant chemical warfare agent which affects ocular, respiratory, and cutaneous system. In this study, we aimed to share recent experiences on medical management of chemical casualties that were exposed to SM in Middle East. We reported medical management of 17 contaminated patients. After the evacuation from the hot zone, all chemical casualties should be transferred to the designated intensive care units. After detailed medical decontamination and stabilization, biological samples should be collected from all chemical casualties as soon as possible for the verification of the exposure. Medical history and existing symptoms reveal the clinical diagnosis of SM exposure. Medical management of SM casualties should focus on "good nursing care" including treatment of pain and itching, fluid and electrolyte replacement therapy, respiration and nutrition support. Despite of improved clinical skills, treatment of SM lesions is still non-specific which aims to relieve symptoms and to prevent infections. Existing diagnostic capabilities and treatment approaches could be improved by sharing recent clinical experiences on medical management of SM casualties where there are still important major gaps.

Impact of the Aliso Canyon Gas Leak on Respiratory-Related Conditions Among US Department of Veterans Affairs (VA) Users.

BACKGROUND: The largest gas leak in United States history occurred October 2015 through February 2016 near Porter Ranch (PR), California, and prompted the temporary relocation of nearby residents because of health concerns related to natural gas exposure. METHODS: A retrospective cohort study was conducted using US Department of Veterans Affairs (VA) administrative and clinical data. On the basis of zip codes, we created two groups: PR (1920 patients) and San Fernando Valley (SFV) (15 260 patients) and examined the proportion of outpatient visits to VA providers with respiratory-related diagnoses between October 2014 and September 2017. RESULTS: We observed an increase in the proportion of visits in the PR group during the leak (7.0% vs 6.1%, P<0.005) and immediately after the leak (7.7% vs 5.3%, P<0.0001). For both groups, we observed a decrease in respiratory diagnoses one year after the leak (7.0% to 5.9%, P<0.05 PR; 6.1% to 5.7%, P<0.01 SFV). CONCLUSION: Exposure to natural gas likely led to the observed increase in respiratory-related diagnoses during and after the PR gas leak. Early relocation following natural gas leaks may mitigate respiratory exacerbations. (Disaster Med Public Health Preparedness. 2019;13:419-423).

Mental health status following severe sulfur mustard exposure: a long-term study of Iranian war survivors.

INTRODUCTION: This study aimed to describe the mental health status of sulfur mustard-exposed survivors suffering from severe respiratory and ophthalmological problems. METHODS: Out of 450 invited Iran-Iraq War survivors of sulfur mustard exposure with severe symptoms, 350 participated in this cross-sectional study. Mental health status was assessed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria. Fisher exact test, Pearson chi-square test, and chi-square test were used to assess any relationship, and the independent-sample t test was employed to compare differences between the veterans with ocular and pulmonary injuries. RESULTS: There were 60.9% (n = 213) survivors who suffered from mental disorders. Among them, 39.7% (n = 139) were previously untreated and required the initiation of psychiatric treatment. The prevalence of anxiety and mood disorders among all survivors was 40.6% (n = 142) and 32.0% (n = 112), respectively. The most common anxiety and mood disorders were posttraumatic stress disorder (32.9%, n = 115) and major depressive disorder (22.3%, n = 78), respectively. Psychiatric disorders were more prevalent in cases with severe pulmonary chemical injury than in subjects with severe ophthalmologic chemical injury. Significant relationships were found between the types of psychiatric disorders and age, education, and occupation (P < .05). CONCLUSION: The psychiatric morbidity in the chemically injured populations was remarkable and significantly different between the populations. The prevalence of mental illness in these groups highlights the need for the appropriate provision of mental health services.

Lesiones oculares provocadas por el gas mostaza (sulfuro de dicloroetilo) durante la I Guerra Mundial: clínica, terapéutica y secuelas / Eye injuries caused by mustard gas (dichloroethyl sulphide) during the 1st World War: clinical, therapeutica and sequelae

No disponible

Situación epidemiológica de intoxicación por monóxido de carbono (CO) / Epidemiological situation of carbon monoxide intoxication (CO)

El monóxido de carbono es un gas tóxico, incoloro, inodoro e insípido que se produce durante la quema de combustible. Las intoxicaciones por monóxido de carbono (CO) constituyen causa de enfermedad y muerte. Además del evento agudo, los cuadros de intoxicación graves pueden dejar secuelas cognitivas. La exposición crónica también es importante dado que puede producir sintomatología neurológica y cognitiva. Se presentan diferentes análisis de la serie histórica que va desde 2005 a la Semana Epidemiológica 38 de 2016, de las intoxicaciones por Monóxido de Carbono asistidas en la Ciudad de Buenos Aires. Los datos para la construcción de indicadores del presente informe provienen del registro de casos individuales de intoxicación por CO, en el módulo C2 de Vigilancia Clínica del Sistema Nacional de Vigilancia de la Salud (SNVS)

Case Files of the University of Massachusetts Toxicology Fellowship: Does This Smoke Inhalation Victim Require Treatment with Cyanide Antidote?

Cyanide toxicity is common after significant smoke inhalation. Two cases are presented that provide framework for the discussion of epidemiology, pathogenesis, presenting signs and symptoms, and treatment options of inhalational cyanide poisoning. An evidence-based algorithm is proposed that utilizes point-of-care testing to help physicians identify patients who benefit most from antidotal therapy.

Sudden Deaths Among Oil and Gas Extraction Workers Resulting from Oxygen Deficiency and Inhalation of Hydrocarbon Gases and Vapors - United States, January 2010-March 2015.

In 2013, an occupational medicine physician from the University of California, San Francisco, contacted CDC's National Institute for Occupational Safety and Health (NIOSH), and the Occupational Safety and Health Administration (OSHA) about two oil and gas extraction worker deaths in the western United States. The suspected cause of these deaths was exposure to hydrocarbon gases and vapors (HGVs) and oxygen (O2)-deficient atmospheres after opening the hatches of hydrocarbon storage tanks. The physician and experts from NIOSH and OSHA reviewed available fatality reports from January 2010 to March 2015, and identified seven additional deaths with similar characteristics (nine total deaths). Recommendations were made to industry and regulators regarding the hazards associated with opening hatches of tanks, and controls to reduce or eliminate the potential for HGV exposure were proposed. Health care professionals who treat or evaluate oil and gas workers need to be aware that workers might report symptoms of exposure to high concentrations of HGVs and possible O2 deficiency; employers and workers need to be aware of this hazard and know how to limit exposure. Medical examiners investigating the death of oil and gas workers who open tank hatches should consider the contribution of O2 deficiency and HGV exposure.

Myocardial infarction, acute ischemic stroke, and hyperglycemia triggered by acute chlorine gas inhalation.

Chlorine is one of the most common substances involved in toxic inhalation. Until now, several accidental exposures have been reported. The damage to the respiratory tract in the immediate phase after exposure to chlorine is well defined. Death occurs particularly due to pulmonary edema with respiratory failure and circulatory collapse. On the other hand, no association with myocardial infarction, acute stroke, severe hyperglycemia, and acute chlorine inhalation has been reported in literature. In the present study, an elderly (74-year-old) and diabetic case with myocardial infarction, acute stroke, hyperglycemia, and respiratory failure associated with acute chlorine intoxication after a diagnosis of acute chlorine poisoning and treatment in the emergency department is reported and the literature is revisited. Physicians should know that in elderly patients with a systemic disease who apply with chlorine gas inhalation, more serious complications along with damage in respiratory tract might be observed.

Acute hydrogen sulfide toxicity due to sewer gas exposure.

Hydrogen sulfide toxicity is a known risk for individuals working in the petroleum, sewer, maritime, and mining industries. Concern regarding exposure has led to the development of safety precautions and treatment guidelines. The US government imposes safety measures including self-contained breathing masks and exposure time limits to hydrogen sulfide gas. Current treatment methods, however, are not strongly supported by research. Acute exposure to hydrogen sulfide gas still poses a significant life threat. In this report, we discuss a case of a sewer worker exposed to deadly concentrations of hydrogen sulfide. Safety precautions and treatment options available to those exposed to high doses of hydrogen sulfide gas are explored.

Intoxicaçäo exógena por formol / Exógen intoxication for formaldehyde

A intoxicaçäo exógena por ingestäo de formol é responsável por distúrbios gastrointestinais decorrentes da irritaçäo e necrose de mucosas. O caso relata paciente do sexo feminino, 55 anos, em quadro depressivo, com história de ingestäo de aproximadamente 100 ml de formol, evoluindo com lesäo ulcerada de mucosa gástrica, com posterior atrofia e estenose. Realizou tratamento clínico e atualmente está em acompanhamento ambulatorial, endoscópico e psicológico.

Fatal pulmonary arterial thrombosis associated with chlorine gas poisoning.

We present a patient with accidental chlorine gas poisoning who died from pulmonary thrombosis due to a marked increase in hemostatic factors such as von Willebrand factor after recovering from the acute poisoning.

[Chemical obliterans bronchiolitis after azotic acid exposure]. / Bronsiolita obliteranta chimica dupa expunere la acid azotic.

The authors present the case of a 48 years old man having an exposure to irritant gases (azotic and lactic acids) in a closed space, inhaling them for 5 minutes. Shortly after the accident the patient displayed the signs of corneal and conjunctival burn; several days afterwards respiratory symptoms appeared: shortness of breath, dyspnea to minor efforts, then nocturnal dyspnea and orthopnea. Chest X-ray, CT scan, complex lung function tests and bronchoalveolar lavaje, together with the history of recent exposure to irritant gases led to the diagnosis of hypersensitivity obliterant bronchiolitis. Oral corticoids in dose of 60 mg/day determined a substantial clinical, radiological and functional improvement. The authors make some comments on the need of early diagnosis and efficient treatment.