Acute Irritant or Inhalant Toxicity

A number of acute pulmonary exposures each year are related to inhaled exposures to irritant chemicals. For example, when certain household chemicals such as bleach and ammonia are mixed, chlorine gas can be produced. Chlorine and chlorinated chemicals cause direct injury to tissues throughout the respiratory tract, including the bronchial mucosa. Injury can fill the alveolar sacs with fluid in a noncardiac form of pulmonary edema, or "chemical pneumonitis."

The large surface area of the alveolar sacs in close approximation to the pulmonary capillary system also provides a portal of entry to systemic toxicity from certain inhaled agents. For example, organophosphate and carbamate chemicals, whether used as nerve gas or as agricultural pesticides, can be absorbed readily throughout the respiratory tract. More than 5000 persons died within a week after inhaling methyl isocyanate gas released from a factory in Bhopal, India, in 1984. Pulmonary toxicity can also occur as a consequence of systemic exposures. For example, patients exposed to the toxic pesticide paraquat through skin absorption or by ingestion through the gastrointestinal tract often die from pulmonary hemorrhage or progressive pulmonary fibrosis.

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