AMERICAN JOURNAL OF INDUSTRIAL MEDICATION 29: 209-2 14 (1 996)

Chronic Lung Disease Secondary to Ammonia Inhalation Injury: A Report on Three Cases Rafael E. de la Hoz, MARYLAND, MPH, Donald P. Schlueter, MD, and William N. Rom, MD, MPH Inhalation of extremely hydrosoluble toxicants, like hydrogen, can be linked to chronic chest diseases, which were partially characterized. We present the cases of 3 patients who were evaluated two years after massive exposure to ammonia in occupational settings. They will presented with chronic dyspnea, and clinical images consistent with limited lung problems, obstructive chest disease, and bronchial hyper-reactivity and little airways disease, respectively. The findings in 94 reported cases of inhalation injury due to significant exposure to freezing mixture are analyzed; in thirty five cases girl for at least 1 year was readily available. The range of chronic pulmonary diseases connected with ammonia inhalation injury is usually reviewed, and suggestions for appropriate diagnostic evaluation are made. zero 1996 Wilev-Liss, Inc.

KEYWORDS: ammonia, chest diseases, work-related diseases, asthma

INTRODUCTION

Overexposure to freezing mixture in the work-related setting may be associated with a range of anatomic and efficient abnormalities in the respiratory tract which have been sporadically reported in the medical literature [Slot, 1938; Caplin, 1941; Brille ainsi que al., 1957; Lepine and Soucy, 1962; Derobert ain a]., 1964; Levy ainsi que a]., 1964; Sestier ain al., 1969; Kass ainsi que al., 72; Walton, 1973; Sobonya, 1977; Close ainsi que al., 80; Hoeffleret ing., 1982; Flury et al., 1983; Bernstein and Bemstein, 1989; Leduc et ing., 19921. In those who make it through an acute episode, the injury to the respiratory tract can result in disabling serious pulmonary disease. In this daily news we explain the situations of 3 men who had been all examined ap-

proximately 2 years after exposure to large amounts of freezing mixture in occupational settings. They each presented with complaints of continual respiratory symptoms, which in some cases are seen to elude n r portrayal by im routine screening [Close et approach., 1980; Walton, 19731. Following describing their very own clinical demonstration, we discuss the different diagnostic means available to assess the long lasting anatomic and physiopathological implications of breathing injuries.

CIRCUMSTANCE REPORTS

Circumstance 1

Mister. A was obviously a 30-year-old Afro-American man who was referred intended for evaluation in June 1983, 2% years after his exposure to a top concentration of anhydrous ammonia gas by a transportation equipment manufacturer where he performed as the motor engine testing owner. The gas leaked coming from a refrigeration system in a room subsequent to the one where he was working. This individual immediately observed burning of his eye, upper airways, and skin, as well as cough and pleuritic chest pain. This individual tried to aid another employee, and this individual estimated his exposure timeframe to be roughly 15 rnin. He was admitted to a regional hospital, in which he was observed to have conjunctivitis and rhinopharyngitis. The upper body radiograph was normal, as well as the resting space air arterial blood gas revealed a pH of seven. 39,

Section of Environmental Medicine, Ny University University of Medicine and Chest Support and Occupational Medicine Medical center, Bellevue Medical center, New York (R. E. M. ). Trademark Pulmonary and Critical Attention Medicine, Medical College of Wisconsin, Milwaukee (D. G. S. ). Departments of drugs and Environmental Medicine; Ny University College of Medicine, and Chest Service, Bellevue Medical center, New York (W. N. Ur. ). Talk about reprint needs to Rafael E. de la Hoz, M. D., Bellevue Hospital Centre, Occup. Scientif. Clin. -Room CD349, 1st Avenue at 27th Road, New York, NYC 10016. Approved for syndication March 19, 1995.

0 1996 Wiley-Liss, Inc.

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m e la Hoz et al.

STAND I. Pulmonary Function Tests in 3 Patients Subjected to High Concentrations of Hydrogen Case no .

No . you No . 2

06/83 (27) 2 . 82 (73%) a few. 66 (78%) 77% 4. 32 (66%) 0. 83 (45%) 19% 27. 2 (90%) six. 34 49 84 26 08/89 (30)...

References: REFERRALS

American Thoracic Society (1986): Evaluation of impairmenUdisability supplementary to respiratory disorders