• Phosgene Exposure

    Definition

    Phosgene is an industrial chemical used in plastics and pesticides. It can also be produced when chemicals that contain chlorine are broken down or burned. Phosgene exposure can occur when someone comes in contact with this gas, liquid, or food that is contaminated with it.
    The effect of phosgene exposure will depend on how much phosgene was absorbed, what areas were affected, and how long the exposure lasted. More severe exposures may cause permanent damage to affected tissue or even death.

    Causes

    People can be exposed by:
    • Breathing air containing phosgene—phosgene is a gas at room temperature (most common)
    • Liquid phosgene or water containing phosgene comes in contact with the skin or eyes
    • Eating foods or drinking water contaminated with liquid phosgene
    Pathway to the Lungs
    Air pathway breathing
    Bacteria is inhaled through the mouth and nose and travels down into the lungs causing TB.
    Copyright © Nucleus Medical Media, Inc.

    Risk Factors

    You are at risk of exposure if you are near sources that generate it. Occupational or environmental situations with a risk of phosgene exposure include:
    • Plastic and chemical manufacturing
    • Paint stripping
    • Dry cleaning
    • Fires fueled by plastic
    • Use of chlorine-containing solvents
    • Metal cleaning
    • Welding
    • Industrial accidents
    • Bioterrorism

    Symptoms

    The most common exposure is by inhaling the gas. At first, phosgene gas exposure may only produce minor eye or throat irritation. However, symptoms tend to develop, worsen, and reappear over a period of 48 hours.
    Respiratory symptoms may include:
    • Coughing
    • Difficulty breathing
    • Choking
    • Tightness in the chest
    • Coughing up fluid that is pink in color—a sign of pulmonary edema
    Skin symptoms may include:
    • Burning pain
    • Swelling
    • Blistering
    Eye symptoms include watering or bleeding.
    General symptoms may include headache, nausea, and vomiting.
    Exposure to phosgene, regardless of the time involved, requires medical attention because some serious symptoms are delayed. If left untreated, complications, including permanent tissue damage or death, can occur.

    Diagnosis

    You will be asked about your symptoms and medical history. The doctor will ask how you were exposed and for how long. A physical exam will be done. Tests may be done depending on the type of exposure you had. This may include a thorough skin or eye exam.
    Imaging tests can help evaluate the lungs and surrounding structures for damage. Tests may include:

    Treatment

    There is no antidote for phosgene exposure. People exposed to phosgene, then taken away from the source, may begin to feel better. Monitoring for 48 hours for the development or recurrence of symptoms will be needed. Supportive care, such as oxygen or intubation, may be needed until affected tissue can heal.
    The faster you respond to exposure, the better the outcomes. Call for emergency medical services and inform them about the phosgene exposure. Steps to take before help arrives:
    • If indoors, leave the area and get into fresh air.
    • If outdoors, move to higher ground because phosgene will sink to lower ground.
    • Remove phosgene-soaked clothing as quickly as possible. Do not pull anything over your head. Instead, cut the clothing off.
      • Put clothing in a plastic bag and seal it. Put the plastic bag inside another and set it aside. Do not touch or let anyone else touch the bags until help arrives. Let them know about the plastic bags so they can properly handle them.
      • If you wear contact lenses, put them in the plastic bags with the clothes. Eyeglasses can be washed with soap and water, then worn again.
    • Wash your entire body with plenty of soap and water. Flush your eyes with plain water for 10-15 minutes for any burning, watering, or blurry vision.
    • Do not induce vomiting or drink any fluids if phosgene was swallowed.
    Enforced rest for the first 48 hours after exposure lowers the risk of rapid progression of lung complications.

    Prevention

    The best way to prevent phosgene exposure is to be aware of it and avoid it. If you work around chemicals or in industries that may put you at risk, follow protective guidelines from your company and National Occupational Safety agency.

    RESOURCES

    Centers for Disease Control and Prevention http://emergency.cdc.gov

    Occupational Health and Safety Association https://www.osha.gov

    CANADIAN RESOURCES

    Canadian Centre for Occupational Health and Safety http://www.ccohs.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Acute management overview—phosgene exposure. NIH Chemical Hazards Emergency Medical Management website. Available at: https://chemm.nlm.nih.gov/phosgene%5Fhospital%5Fmmg.htm. Updated January 14, 2015. Accessed June 10, 2016.

    Facts about phosgene. Centers for Disease Control and Prevention website. Available at: http://emergency.cdc.gov/agent/phosgene/basics/facts.asp. Updated April 12, 2013. Accessed June 10, 2016.

    Phosgene general information. UK Health Protection Agency website. www.gov.uk/ https://government/uploads/system/uploads/attachment%5Fdata/file/341399/hpa%5Fphosgene%5Fgeneral%5Finfo%5Fv1.pdf. Accessed June 10, 2016.

    Toxic inhalation injury. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T906193/Toxic-inhalational-injury. Updated March 5, 2015. Accessed June 10, 2016.

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