Chlorine Poisoning

Chlorine is a chemical substance often used for the disinfecting of various surfaces, as it prevents the growth of bacteria. It is also found in common products used for cleaning around the house, serving the same purpose. Chlorine poisoning occurs when a person ingests or inhales chlorine. It is important to understand that chlorine is a poisonous ingredient and that chlorine poisoning requires immediate medical intervention.

If it happens that a person inhales chlorine, the gas has a powerfully irritating effect on the lungs and the airways. It is soluble in the water inside the body, leading to respiratory tract damage. One of the most encountered situations of chlorine poisoning is occupational hazard. A person can suffer from chronic poisoning, ingesting or inhaling small but harmful quantities of chlorine or can be exposed to large doses of chlorine at once, suffering from its serious toxicity and health problems such as pulmonary edema.

What are the Symptoms of Chlorine Poisoning?

Chlorine poisoning can lead to serious symptoms, affecting different organs and systems within the body:

• Difficult breathing
• Constriction in the throat – this can add to the already difficult breathing.
• Pulmonary edema – this is fluid accumulating in the lungs, leading to shortness of breath as well.
• Modification of pH – organ damage.
• Vision loss.
• Pain/burning sensation felt in the oral area – it can affect the tongue, lips but also the eyes or the ears.
• Gastrointestinal modifications:
  • Stools with blood
  • The chlorine, by ingestion, can burn the esophagus
  • Abdominal pain of severe intensity
  • Vomiting – with/without blood.
• Cardiovascular collapse – this can occur after a rapid drop in the blood pressure.
• By direct contact of the skin with the chlorine, the skin can present modifications ranging from a simple irritation to severe burns and even necrosis.

Specific symptoms can suggest acute/chronic exposure or high/low level exposure:

Acute exposure – low level

• Irritation of oral area
• Sneezing
• Sialorrhea
• State of agitation.

Acute exposure – high level

• Dyspnea
• Coughing (violently)
• Vomiting (preceded by nausea)
• Headaches, fainting
• Pain/burning sensation in the chest
• Overall weakness and abdominal pain
• Skin burns/ulcerations (direct exposure with chlorine).

Chronic exposure – this usually occurs with low to moderate levels of chlorine:

• Specific acne
• Retrosternal pain
• Cough – with/without blood
• Irritated throat.

Causes of Chlorine Poisoning

There are several situations in which a person can suffer from chlorine poisoning, such as:

• Inhalation or ingestion of household products that contain chlorine – this is especially valid if the chlorine is mixed with another cleaning product (the gas released is poisonous).
• Harmful chlorine gas is released when there is a large body of water, such as a pool, that has been covered for a long time and a person decides to remove the cover.
• High concentrations of chlorine in the swimming pool.
• Occupational hazard – if a person works with chlorine, depending on the level of exposure (high/low), that person can either suffer from acute or chronic chlorine poisoning.
• Children are highly prone to chlorine poisoning by ingestion, especially if the household cleaning products are left unsupervised or in area that is easy to reach.

Diagnosis

Chlorine poisoning is a medical emergency and, often times, the person will first be administered emergency treatment before making the actual diagnosis. The most important sign that can help the diagnosis of chlorine poisoning is pulmonary edema, as this leads to difficult breathing.

Among the investigations that can be performed to establish the diagnosis of chlorine poisoning, one can find:

• Pulse oximetry – monitors the saturation with oxygen (indication of oxygen levels in the blood). Arterial blood gases can also be investigated, to determine if the chlorine poisoning has started to affect the blood circulation or not.
• X-rays – pulmonary, so as to determine whether there is pulmonary edema or not.
• ECG – to investigate cardiac function and prevent cardiovascular collapse.
• Testing of the pulmonary function.
• Other investigations might include: determining serum electrolytes, urea nitrogen in the blood and creatinine levels, the latter showing the functioning of the kidneys.
• If there is a suspicion of inhalation/ingestions, the doctor can either perform a laryngoscopy and bronchoscopy, to assess the internal damage done by the chlorine exposure.

Treatment

In case of severe chlorine poisoning, the most important thing is to maintain the patient stable. This means that the vital signs will be monitored, including the pulse, the breathing and the blood pressure. Supportive care – respiratory and cardiac – is going to be offered in case there is a risk of cardiac collapse.

Among the other treatments that might be offered for the symptoms of chlorine poisoning, one can find:

• Activated charcoal – this often used in cases of poisoning, as this substance is capable of absorbing the poisonous ingredient from the gastrointestinal tract.
• In case of difficult breathing, respiratory support might be offered by intubating the patient and connecting him/her to a ventilator.
• Intravenous fluids are going to be administered to keep the patient hydrated and prevent vascular collapse.
• Specific medicine can be administered in an attempt to reverse the effects of the chlorine poisoning.
• In case the skin presents burns or ulcerations after direct contact with chlorine, surgical debridement is going to be performed. In case of less severe burns, the skin might be just washed and protected from potential irritants.
• If the chlorine has been ingested, the gastric lavage is going to be performed, in order to remove the poisonous substance from the stomach.

Prevention

Every day, hundreds of children are taken to the emergency room after they have ingested chlorine. The best prevention method for chlorine poisoning is to keep the household cleaning products out of reach for children. This does not mean to store them in a closet, where the children can easily find them. One should consider keeping these products locked, so that they cannot be accessed by children.

Also, in case of occupational hazard, there are specific protection methods that should be followed in order to avoid or reduce the chlorine exposure. Using a protection mask, goggles and gloves (or any other protective equipment) is essential if you are working in a medium with high levels of chlorine.