Chlorine Gas Exposure Manifesting Acute Lung Injury

Abstract

Unintentional exposure to chlorine at swimming pools is not uncommon and can occur through various exposure scenarios, such as chlorine leak from pipes or reservoirs, or inappropriate flushing of chlorination/sanitation lines. Although mixing bleach (sodium hypochlorite) with acids accounts for many household chlorine exposure accidents, such an exposure is rare at swimming pools. Clinical manifestations of chlorine inhalation can range from mild upper airway irritation to life-threatening toxic effects, such as pulmonary edema/acute respiratory distress syndrome. We reported an incident of chlorine exposure generated from mixing sodium hypochlorite and hydrochloric acid at a swimming pool. Among the 7 victims, 6 presented with dyspnea, dry cough, sore throat and eye irritation. These six patients were discharged within 1 day. A 15-year-old girl however developed hypoxemia and acute lung injury primarily involved right middle and lower lungs in addition to symptoms of airway irritation. She was discharged 5 days later after receiving both bronchodilator and intravenous steroid therapy. Her clinical manifestations were discussed along with a review of existing literature reports on chlorine inhalation.