Serkan TURSUN, Ayşegül ALPCAN, Yaşar KANDUR

Çocuklarda Akut Klor Zehirlenmesinin Klinik Spektrumu

Amaç: Klor gazı endüstride yaygın olarak kullanılan ve akciğerlerde güçlü bir tahriş edici olarak inhalasyon toksisitesine neden olan bir maddedir. Bu çalışmada kaza ile klor gazına maruz kalan çocuk olguların bulgularını incelemeyi amaçladık. Gereç ve Yöntemler: Ekim 2017’de, 650 öğrencinin eğitim aldığı bir okulda Cl2 gazına maruz kalmayı içeren bir kaza meydana geldi. Bulgular: Elli öğrenci temizlik sırasında meydana gelen bir kaza sonucu okul koridorunda oluşan buharı teneffüs etti. Ortalama yaşları 11.2±1.5 yıl (dağılım 2-18 yıl) olan çocukların %62’si erkekti. Acil serviste değerlendirilen hastalardan 21’i (%42) ilk muayene ve semptomatik tedaviden sonra 4-6 saat içinde taburcu edildi. Kalan 29 hasta hastaneye yatırıldı. Çoğunlukla birbirleriyle benzer olan başvuru semptomları; öksürük ve nefes darlığı (n=30, %60), bulantı ve kusma (n=6, %12), baş ağrısı (n=7, %14) ve boğaz ağrısı ( n=3, %6)’di. Otuz hastada yüksek kreatin kinaz-MB (CK-MB) vardı (ortalama 54.9±50.1 U/L); beş hastanın elektrokardiografisinde sinüs taşikardisi vardı. Takip süresi boyunca tüm hastaların kardiyak enzimleri normale döndü. Yedi hasta steroid, bronkodilatör ve nemlendirilmiş oksijen ile tedavi edildi; 11 hasta oksijen ve bronkodilatör ile tedavi edildi; kalanlar yalnızca oksijen aldı. Sonuç: Bu çalışmanın, bizim vakalarımızdaki gibi toksik maddeler üretebilecek kimyasallar hakkında farkındalığının artırılmasına katkı sağlayacağını düşünüyoruz.

Anahtar Kelimeler:

çamaşır suyu, hidroklorik asit, klor gazı, pediatrik

Clinical Spectrum of Acute Chlorine Poisoning in Children

Objective: Chlorine gas (Cl2) is a common substance used in industry, which causes toxic inhalation as a potent pulmonary irritant. Herein, we aimed to investigate the findings of pediatric cases accidentally exposed to Cl2 gas. Material and Methods: In October 2017, an accident involving Cl2 gas exposure occurred in a school where 650 students were trained. Results: Fifty students breathed in the steam generated in the school hallway as a result of an accident during cleaning The mean age of the patients was 11.2±1.5 years (range 2–18 years); 62% of the children were male. Among patients evaluated at the emergency department, 21 (42%) patients were discharged within 4-6 hours after the initial examination and symptomatic treatment. The remaining 29 patients were hospitalized. The presenting symptoms were mostly associated with one another, which included cough and dyspnea (n=30, 60%), nausea and vomiting (n=6, 12%), headache (n=7, 14%), and sore throat (n=3, 6%). Thirty patients had elevated creatine kinase-MB (CK-MB) (mean 54.9±50.1 U/L). Five patients had sinus tachycardia on electrocardiogram. During the follow-up period, cardiac enzymes of all patients returned to normal levels. Seven patients were treated with steroids, bronchodilators, and humidified oxygen; 11 patients were treated with oxygen and bronchodilators; the remainders took oxygen alone. Conclusion: We suggest that this study will contribute to raising awareness about chemicals that can produce toxic substances, as in our cases.

Keywords:

Bleach, hydrochloric acid, chlorine gas, pediatric,

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White CW, Martin JG. Chlorine gas inhalation: human clinical evidence of toxicity and experience in animal models. Proc. Am. Thorac. Soc. 2010; 7:257–263.
Deschamps D, Soler P, Rosenberg N, Baud F, Gervais P. Persistent asthma after inhalation of a mixture of sodium hypochlorite and hydrochloric acid. Chest 1994;105:1895-1896.
Winder C. The toxicology of chlorine. Environ Res. 2001; 85:105–114
Guloglu C, Kara IH, Erten PG. Acute accidental exposure to chlorine gas in the Southeast of Turkey: a study of 106 cases. Environ Res 2002;88:89-93.
Agabiti N, Ancona C, Forastiere F, Di Napoli A, Lo Presti effects of acute exposure to chlorine due to a swimming pool accident. Occup Environ Med 2001;58:399-404.
Mrvos R, Dean BS, Krenzelok EP. Home exposures to chlorine/chloramine gas: review of 216 cases. South Med J 1993;86:654-657.
Gunnarsson M, Walther SM, Seidal T, Lennquist S. Effects of inhalation of corticosteroids immediately after experimental chlorine gas lung injury. J Trauma 2000;48:101-107.
Martinez TT, Long C. Explosion risk from swimming pool chlorinators and review of chlorine toxicity. J Toxicol Clin Toxicol 1995;33:349-354.
Fleta J, Calvo C, Zuniga J, Castellano M, Bueno M. Intoxication of 76 children by chlorine gas. Hum Toxicol 1986;5:99-100.
Squadrito GL, Postlethwait EM, Matalon S. Elucidating mechanisms of chlorine toxicity: reaction kinetics, thermodynamics, and physiological implications. Am J Physiol Lung Cell Mol Physiol. 2010; 299:L289–300.
Hawkins CL, Pattison DI, Davies MJ. Hypochlorite-induced oxidation of amino acids, peptides and proteins. Amino Acids. 2003; 25:259–274.
Evans RB. Chlorine: state of the art. Lung 2005;183:151-167.
Donnelly SC, FitzGerald MX. Reactive airways dysfunction syndrome (RADS) due to chlorine gas exposure. Ir J Med Sci 1990;159:275-276.
Howard C, Ducre B, Burda AM, Kubic A. Management of chlorine gas exposure. J Emerg Nurs 2007;33:402- 404.
den Hartog GJ, Haenen GRMM, Vegt E, van der Vijgh WJF, Bast A. Efficacy of HOCl scavenging by sulfur-containing compounds: antioxidant activity of glutathione disulfide? Biol Chem. 2002; 383:709–713.