Phosgene poisoning treatment

Phosgene poisoning may cause respiratory and cardiovascular failure which results in low plasma volume, increased hemoglobin concentration, low blood pressure, and an accumulation of fluid in the lungs. There is no antidote for phosgene, and treatment consists of support of respiratory and cardiovascular functions. 

Freeman, S., Grodins, F.S., and Kosman, AJ. 1945. The use of helium in the treatment of phosgene poisoning. In Fasciculus on chemical warfare medicine v. II, respiratory tract. Washington, DC National Research Council, Committee on Treatment of Gas Casualities pp. 541-550. (Cited in EPA 1986)... 

Ong, S.G. 1972. Treatment of phosgene poisoning with antiserum anaphylactic shock by phosgene. Arch. Toxicol. 29 267-278. (Cited in EPA 1986)... 

Treatments that have been proposed to prevent pulmonary edema in exposed-asymptomatic persons include steroids, ibuprofen, V-acetyl cysteine, and positive pressure airway ventilation. However, there is no known antidote for phosgene poisoning, and although animal studies suggest that these treatments may be effective, no clinical data are available to verify efficacy in humans (Borak and Diller,... 

EFFECTS OF VARIOUS TREATMENTS UPON THE COURSE OF PHOSGENE POISONING... 

Although many authors do not give reliable information concerning experimental method (e.g. exposure dose, type of experimental animal used, appropriate controls, etc.), thereby making interpretation of reported results difficult, a review of the extensive literature on animal experiments and clinical observations allows a recommended course for treatment of phosgene poisoning to be proposed. 

Regrettably there is, as yet, no known antidote to phosgene poisoning. Consequently treatment is usually directed to the main symptom - toxic pulmonary oedema - the development of which is dose-related [1374]. 

In 1973, in Czechoslovakia, the release of about 400 kg of phosgene from a damaged valve of a steel pressure vessel resulted in the medical treatment of 82 workers. Of these, 52 were diagnosed as having phosgene poisoning but pulmonary oedema was manifest in only three of the effected persons [1186], none of whom died. The poisonings from this incident occurred within 200 m of the site of the accident. 

During WWI, great emphasis was placed on the value of oxygen in the treatment of phosgene poisoning. The following extract is taken from... 

C. Treatment. Cyanogen chloride poisoning should be treated in the same way as hydrogen cyanide poisoning as regards to its cyanide-like effects. Pulmonary irritation should be treated in the same way as phosgene poisoning. 

Bunting H. Changes in the oxygen saturation of the blood in phosgene poisoning. In Respiratory Tract. Vol 2. In Fasciculus on Chemical Warfare Medicine. Washington, DC Committee on Treatment of Gas Casualties, National Research Council. 1945 484-491. 

Standard cardiorespiratory resuscitation and antiarrhythmia treatment are used for acute solvent poisoning. Toxicity from carbon tetrachloride and chloroform involves the generation of phosgene (a 1914-18 war gas) which is inactivated by cysteine, and by glutathione which is formed from cysteine treatment with N-acetylcysteine, as for poisoning with paracetamol, is therefore recommended. 

Phosgene is one of the few materials used in industry for which its poisonous nature is well documented, primarily because it was used as a chemical warfare agent. The subject of major chemical hazards has been competently treated by Marshall [1327a], and the reader is directed to that source for the comprehensive treatment of this subject in terms of the control, quantification and legislation of major chemical hazards. 

Treatment. The same treatment is applied as with poisonings by phosgene... 

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