Severe Pulmonary Edema due to Nitric Acid Fume Inhalation at Home

Silvia Quadrelli^1, , Marco Antonio Solis Aramayo¹, Marcos Hernandez¹ and Manuel Ibarrola¹

¹Respiratory Medicine Department, Sanatorio Güemes, Buenos Aires, Argentina

Cite this paper:
Silvia Quadrelli, Marco Antonio Solis Aramayo, Marcos Hernandez and Manuel Ibarrola. Severe Pulmonary Edema due to Nitric Acid Fume Inhalation at Home. American Journal of Medical Case Reports. 2016; 4(9):312-314. doi: 10.12691/ajmcr-4-9-5

Abstract

A 65 year-old man presented to the Emergency Department (ED) with dyspnoea at rest, peripheral cyanosis, general paleness and a frothy fluid escaping from the nose and mouth. He also showed severe burns in his hands. He had been trying to clean a copper lamp with a 50–70% nitric acid solution at home. He was transferred to the intensive care unit (ICU). Non-invasive mechanical ventilation with PEEP was immediately applied. Treatment was started with 60 mg of furosemide intravenously (IV), and prednisolone 250 mg IV four times daily. As he responded, he was weaned off non-invasive ventilation and administered high-flow oxygen via a facemask (10 L/min). At day 5, he was transferred to the general ward. The patient was discharged from hospital at day 10 without serious pulmonary complications. He was followed-up as an outpatient for three months and respiratory function tests did not show any impairment.

Keywords:
nitric acid pulmonary edema inhalation

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Guidotti TL. Toxic inhalation of nitrogen dioxide: Morpholgic and functional changes. Exp Mol Pathol. 1980; 33:90-102.
[2]	McAdams AJ, Kropp S. Injury and death from fuming nitric acid. JAMA. 1955;23:1022-24.
[3]	Crapo JD, Barry BE, Chang LY, et al. Alterations in lung structure caused by inhalation of oxidants. J Toxicol Environ Hlth. 1984;13:301-321.
[4]	Ellenhorn MJ, Barceloux DG. Nitrogen oxides. In: Ellenhorn MJ, Barceloux DG, editors. Medical Toxicology, Diagnosis and Treatment of Human Poisoning. New York: Elsevier, 1988: 876-877.
[5]	Hajela R, Janigan DT, Landrigan PL, et al. Fatal pulmonary edema due to nitric acid fume inhalation in three pulp-mill workers. Chest. 1990;97:487-7.
[6]	Trieger P, Przypyszny C. Nitric acid fume pneumonia. A case report. Ind Med. 111;6:395-397.
[7]	Bur A, Fatal pulmonary edema after nitric acid inhalation. Resuscitation. 1997;35:33-36.
[8]	Murphy CM, Akbarnia H, Rose SR. Fatal Pulmonary Edema After Acute Occupational Exposure to Nitric Acid. The Journal of emergency Medicine. 2010 Jul; 39(1): 39-43.
[9]	Jae Seung Shin, Sung-Woo Lee, Nak-Hoon Kim, et al. Successful extracorporeal life support after potentially fatal pulmonary oedema caused by inhalation of nitric and hydrofluoric acid fumes. Resuscitation. 2007 Oct; 75(1): 184-188.
[10]	Durant WS, Craig DK, Vitacco MJ, et al. Adverse experiences with nitric acid at the Savannah River Site. WSRC-TR-91-22-Rev.1. DE91 016467. Aiken (SC): Westinghouse Savannah River Company; 1991:78-84.
[11]	Jayalakshmi TK, Shah S, Lobo I, et al. Acute lung injury following exposure to nitric acid. Lung India. 2009 Oct-Dec;26(4):149-150.
[12]	Banu Çevik, Ayşegül Çizen, Serhan Çolakoğlu, et al. Severe lung injury following inhalation of nitric acid fumes. International Journal of Case Reports and Images. 2011;Aug,Vol.2, No. 8.
[13]	Lalitha VP, Dahananjay PA, Saifuddin H, et al. Severe lung injury following inhalation of nitric acid fumes. Ind J Crit Care. 2005;9(4):244-7.
[14]	Commins BT, Raveney FJ, Jesson MW. Toxic gases in tower silos. Ann Occup Hyg. 1971;14:275-83.
[15]	Lipsett MJ. Oxides of nitrogen and sulfur. In: Sullivan JB, Krieger GR, eds. Clinical environmental health and toxic exposures, 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001: 818-32.