AN UNUSUAL CAUSE OF

ACUTE LUNG INJURY

C.Vignesh Kumar
Toxicology

CASE HISTORY
42 year old female, a k/c/o Carcinoma

cervix on radiotherapy
Exposure to fire inside radiotherapy unit
for about an hour
Presented with acute onset
breathlessness since the exposure with
productive cough
No loss of consciousness, Seizures, Skin
burns

CASE HISTORY
Diagnosed to have Carcinoma Cervix
and on EBRT for the past 5 months
Admitted in IOG for Intracavitary RT
No other comorbid illness
Married, Divorcee, Nullipara
Family history: Not contributory

EXAMINATION
Conscious, Oriented, Afebile
Dyspneic, Tachypneic
Oral cavity: Saliva with soot particles
No skin burns
No Cyanosis
Pulse : 110/min
BP : 110/70

EXAMINATION
CVS : NAD
RS : B/L extensive rhonchi & rales
P/A : NAD
CNS : NFND

SPUTUM

INVESTIGATIONS
O2 Saturation: 78% in room air
92% with oxygen
CBC & Peripheral Smear: Microcytic
hypochromic Anaemia
RFT : WNL
LFT : WNL
ECG : Sinus Tachycardia

Arterial Blood Gas

: 7.439
pH
: 55.5 mm Hg
pO2
: 41.7 mm Hg
pCO2
: 27.6
HCO3
: 3.5
BE
O2 Saturation : 89.9%

CHEST X-RAY

TREATMENT
Bed Rest
Oxygen by Mask
Intravenous Antibiotics
Intravenous Steroids
Bronchodilators

CT CHEST

INVESTIGATIONS
Sputum C/S : Klebsiella (ESBL)
Sensitive to Cephalosporins,
Amikacin

USG Abdomen : Normal study

FOLLOW UP X-RAYS (DAY 4)

FOLLOW UP X-RAYS (DAY 7)

FOLLOW UP X-RAYS (DAY 11)

COURSE OF ILLNESS
Clinical Improvement
Radiological improvement
Steroids tapered
Discharged after 13 days

CONSTITUENTS OF SMOKE
Heated Air
Suspended solids, Liquids
Gases
Fumes
Aerosols , Vapours

COMBUSTION PRODUCTS
Wood,Cotton

Petroleum
Plastics

Wool
Rubber

CO,Acrolein,Methane,
Formaldehyde,
Acetaldehyde,
CO,Acrolein, Acetic acid,
Formic acid
CN,HCl,NH3,Phosgene,Nitro
gen
oxides,Aldehyde,Chlorine
CO, CN, Phosgene, Chlorine
H2S, SO2

COMBUSTION PRODUCTS
Simple asphyxiants- CO2
Chemical asphyxiants- CO,HCN,H2S,
Nitrogen
Irritants

Oxides of

IRRITANTS
High water solubility

-Acrolein, SO2,
NH3, HCl
Intermediate solubility -Chlorine,
Isocyanate
Low water solubility -Oxides of
Nitrogen
Phosgene

SOOT
Carbon
Adsorbed acids, Aldehydes,
Sulphur dioxide
Hydrogen chloride
Chlorine
Phosgene

FACTORS AFFECTING
RESPIRATORY TRACT INJURY
Water solubility
Concentration
Duration of Exposure
Particle Size
Respiratory Rate
Absence of protective reflexes
Preexisting disease

PATHOGENESIS
Reactive Oxygen species
Inflammatory Mediators
Increased Microvascular Permeability
Denaturation of Proteins, Nucleic acid
Deactivation of Surfactant
Impaired mucociliary clearance
Impaired phagocytosis

CLINICAL FEATURES
Voice change
Stridor
Rhonchi
Rales
Tachypnea
Tachycardia
CNS manifestations (R/O Alcoholism, Head
injury)

INVESTIGATIONS
ABG
Carboxyhemoglobin levels
Methemoglobin levels
Chest X ray
Pulmonary Function Tests
Xenon Ventilation Studies

MANAGEMENT
Airway management
Beta 2 agonists
Corticosteroids
Mechanical Ventilation
Chest Physiotherapy
Therapeutic Bronchoscopy

MANAGEMENT
Hyperbaric Oxygen
Cyanide Antidote
Methylene Blue

THANK YOU