Accidental inhalation injury of phosgene gas leading to acute respiratory distress syndrome
A 25 year old nonsmoker and non alcohalic male laborer suffered inhalation injury to phosgene gas after accidental leakage while working in a pesticide manufacturing factory. Immediately after exposure he experienced lacrimation, nausea, and dry cough with burning sensation in his mouth and throat. After six hours of exposure he developed breathlessness. The patient did not complain of chest pain, hemoptysis orthopnoea or Paroxysmal Nocturnal Dyspnoea. Initially he was admitted to the nearby hospital and managed conservatively. However within 24 hrs his condition worsened and he developed severe respiratory distress thus he was referred to our hospital, a tertiary care referral center for respiratory and intensive care. At the time of admission he was conscious and oriented to time place and person. He was febrile having temperature of 100 F, tachycardia of 130/min and tachyopnea of 36/min. using accessory muscle of respiration. His SpO2 was 80% without oxygen. On chest auscultation bilateral coarse crepitations were present. His cardiovascular and abdominal examination did not reveal any abnormality. His laboratory investigation revealed total leukocyte count 24000/cmm, with majority of polymorphs. His biochemical, renal and hepatic parameters were within normal limits. His X-ray chest was suggestive of bilateral hilar fluffy shadow characteristic batwing appearance []. He was given high flow oxygen therapy with face mask. After 30 minutes arterial blood gas analysis showed acidemia and hypoxia. Noninvasive ventilation was tried but within an hour shifted to invasive ventilatory support. Antibiotic therapy in the form of third generation cephalosporin was started prophylacticaly along with supportive therapy. He remained hemodynamic stable throughout ICU stay. His Endotracheal aspirate culture was sent immediately after intubation and after 48 hours of ventilatory support. Both the culture reports were sterile. He gradually improved with treatment and was successfully weaned off from ventilator on 6th day of ICU stay. He was shifted to general ward on 8th day and was discharged from the hospital on 10th day. He regularly came in follow up every week and recovered completely after 6 weeks.