INHALED
POISONS
the LUNGS
large surface area and
good blood supply
excellent route for
absorption and
distribution of toxic gases
Absorption occurs via the
capillary-alveolar
membrane in the lungs
INHALED GASES
CLASES EXAMPLES
Ammonia, chlorine, suphur dioxide, ozone, phosgene,
Irritants
halogens, acrolein
Nitrogen, hydrogen, methane, liquid petroleum gas,
Simple Asphyxiants
propane, carbon dioxide, dichlorotetraflouroethane
Carbon monoxide, hydrogen, cyanide, nitriles, hydrogen
Chemical Asphyxiants
sulphides
Central nervous system Aliphatic hydrocarbons, chlorinated hydrocarbons,
depressants acetone, ethyl ether, benzene
Carbon disulphide, mercury, acrylamide, n-hexane, methyl
Neurotoxic agents
n-butyl ketone
Carbon tetrachloride, chloroform, allyl alcohol,
Hepatotoxic agents
bromobenzene
Nephrotoxic agents Carbon tetrachloride, chloroform, trichloroethylene
Agents damaging blood Nitrobenzene, arsine, naphthalene
Agents damaging bone
Benzene, trinitrotoluene
marrow
Carcinogens Vinyl chloride, 2-naphthylamine, bis(chloromethyl)ether
Besides causing irritation and injury to the lungs,
inhalation of gases in some, may even lead to
significant systemic poisoning involving vital organs
such as the brain, kidney and liver.
Exposure to these substances however may produce
varied effects.
The nature, extent and severity of the effects to be
observed may depend on:
the types of gas involved
its solubility
concentration
extent and duration of exposure
Poorly ventilated exposure site will very likely cause
more significant effects especially in individuals
who have preexisting lung diseases.
ASPHYXIANTS
Simple & Chemical asphyxiants
Simple asphyxiants
nonirritating, chemically inert gases
naturally occurring atmospheric components
When present in high concentration, they displace
oxygen in inspired air with the gas, causing a
decrease in oxygen concentration available for gas
exchange
Examples: carbon dioxide and methane
Carbon dioxide (CO2)
Colorless, odorless gas
used in the food industry in the carbonation of
beverages, in fire extinguishers as an 'inerting'
agent and in the chemical industry
Signs and symptoms of toxicity
increased respiratory rate, tachycardia, cardiac
arrhythmias and impaired consciousness (higher
concentrations)
Concentrations >10% may cause convulsions, coma
and death.
Clinical management
removal of the casualty from the toxic environment
administration of oxygen
In severe cases, assisted ventilation may be
required.
Dry ice burns are treated similarly to other
cryogenic burns, requiring thawing of the tissue
and suitable analgesia.
Methane
colorless, odorless and flammable gas
utilized as fuel and in chemical reactions to produce
commercially used chemicals such as carbon
tetrachloride, carbon black and as a source of
hydrogen
reacts at high temperatures with steam to yield the
hydrogen used in the manufacturing of explosives
and ammonia-based fertilizers
Signs and symptoms of toxicity
headaches
heart palpitations
cognitive impairment (poor judgement, memory
loss)
dizziness
loss of motor coordination
flu-like symptoms (mental uneasiness, lethargy,
discomfort)
Clinical management
removal of the casualty from the toxic environment
administration of oxygen
Chemical asphyxiants
interfere with the body's ability to utilise oxygen
They either prevent oxygen delivery or inhibit the
utilization of oxygen by the cells
Carbon monoxide (CO)
highly toxic, colourless, odourless, flammable gas
produced industrially for use in the manufacture of
numerous organic and inorganic chemical products
present in the exhaust gases of internal-
combustion engines and furnaces as a result of
incomplete conversion of carbon or carbon-
containing fuels to carbon dioxide
Mechanism of toxicity
Following inhalation, Bound carbon Prevention of unloading
carbon monoxide monoxide increases of oxygen at the
rapidly binds to hemoglobin affinity for tissues, further
hemoglobin to produce oxygen at the other reducing oxygen
carboxyhemoglobin oxygen-binding sites delivery
Signs and symptoms of toxicity
headache, dyspnea, lethargy, confusion, and
drowsiness
seizures, coma, and death (higher exposure levels)
Clinical management
prompt removal from the source of carbon
monoxide
institution of 100% oxygen by nonrebreathing face
mask or endotracheal tube
In patients with severe intoxication, oxygenation in
a hyperbaric chamber is recommended.
Cyanide
one of the toxic products of combustion produced
during house fires
used in electroplating
hydrogen cyanide may be produced during
photographic developing and petroleum refining
Mechanism of toxicity
Respiratory arrest
inactivation of the
of oxidative
enzyme inhibition of
phosphorylation
cytochrome cellular Death
and production of
oxidase respiration
adenosine
(cytochrome a3)
triphosphate
Clinical management
Hydroxocobalamin (vitamin B12a) is administered
intravenously to bind the cyanide and produce
cyanocobalamin (vitamin B12)
cyanide antidote kit
sodium nitrite to form cyanomethemoglobin
sodium thiosulfate to accelerate the production of
thiocyanate, which is much less toxic than cyanide and is
also quickly excreted in urine.
IRRITANTS
Irritants
Primary irritants - produce little systemic effects
Secondary irritants - produce both respiratory and
systemic toxicity
include hydrogen sulphide, ozone, acetylene,
methylated halogens and metal fumes
Irritants
have the ability to cause injury and induce
inflammation of the mucous membranes upon
contact
Individuals exposed to these gases may develop
signs and symptoms that are either predominantly
associated with upper or lower respiratory tract.
These depend on the solubility of the gas.
Irritants
Highly water soluble gases like ammonia affect
mainly the upper respiratory tract
Low water soluble gases like phosgene affects the
lower respiratory tract
Signs and symptoms of irritation
URT LRT
rhinitis pneumonitis
pharyngitis pulmonary edema
cough hypovolemic shock
laryngeal edema
Signs of lower respiratory tract involvement may
not necessarily be preceded by signs of upper
respiratory tract involvement.
However, injury to the upper respiratory tract may
be extended to involve the lower respiratory tract if
the exposure is prolonged.
e.g. Sulphur dioxide
Ammonia
found in refrigerators, fertilisers, household
cleaning and bleaching agents, and liniments
available as industrial ammonia solution (28%
solution) and household ammonia (5-10% solution)
has a strong penetrating odour and this can be
detected at 5 ppm
The threshold limit value (TLV), which is the
maximum tolerable concentration at an average of
8 hours workday without giving symptoms, is about
50 ppm.
effects are mostly local, causing mild irritation to
severe corrosion of the mucous membranes
400-700 ppm - skin, eyes, nose, throat and lungs
may become irritated immediately
>1000 ppm - violent coughing, sore throat,
lacrimation, dyspnea, restlessness, blurred vision,
pulmonary edema
5,000-10,000 ppm - lose consciousness, develop
severe epiglottis, larynx and trachea, caustic burns
of edema the skin/eyes, blindness and purulent
bronchitis/pneumonia
Chlorine
yellowish-green gas with an irritating odour
used in the manufacture of plastics, as bleaching
agents and for purifying water.
Exposure to the gas usually follows a leak from a
storage tank or at home as a result of accidentally
mixing sodium hypochlorite (Clorox) with industrial
acid cleaners, such as sodium acid sulphate.
TLV = 1 ppm
3-6 ppm - irritation of the skin, eyes, nose, throat and
lungs
nausea, vomiting, diaphoresis, headache, coughing, tightness
of chest, redness/watery eyes, blurred vision, agitation,
excitement, increase heart rate and blood pressure can also
develop
>50 ppm - pulmonary edema/pneumonitis, purulent
bronchitis/ pneumonia, ulcerations and necrosis of skin
and eyes
Both severe mucosal irritation and pulmonary
parenchymal damage can occur within 10 minutes of
exposure
1000 ppm - respiratory failure, coma, shock and death
Sulphur dioxide
by-product of gasoline combustion, oil refining and
paper production
a colourless gas
upon contact with water at the mucosal
membranes of the eyes and upper respiratory tract
will form sulphuric acid that produces a severe
irritation
10 to 15 ppm (for 5 to 15 minutes) - irritation of the
eyes, nose, throat; rhinorrhea, choking, cough
high concentration death
Prolonged exposure - irreversible bronchiolar
obstruction or restrictive lung disease
Hydrogen sulphide
by-product of many industrial processes and decay
of organic matter
may be found in areas around petroleum refineries,
tunnels and mines
has a "rotten eggs" odour that is easily detected at
concentration of 1 ppm.
TLV = 10 ppm
50 ppm - irritation of the eyes and respiratory tract
1000 ppm - respiratory paralysis and death
