Nasal burn by nitric acid

Background: In some of the inflammatory disorders, such as chronic rhinosinusitis (CRS), non-allergic rhinitis (NAR), or allergic rhinitis (AR), environmental agents can incite or exacerbate the symptoms of each disease. The aim of the study was to investigate the relationship of chemical intolerance in the nasal inflammatory disorders using QEESIⓒ.

European Journal of Emergency Medicine, 2008

We report two cases of acute lung injury after the inhalation of nitric acid fumes in an industrial accident. The first patient, who was not using a respirator and standing in close proximity to the site of spillage of concentrated nitric acid, presented within 12 h with worsening dyspnea and required noninvasive ventilation for type 1 respiratory failure. The second case presented 1 day later with similar symptoms, but only required supportive treatment with high-flow oxygen. Both patients' chest radiographs showed widespread bilateral airspace shadows consistent with acute lung injury. Both received treatment with systemic steroids. They were discharged from hospital 5 days postexposure. Initial lung function test showed a restrictive pattern that normalized by 3 weeks postexposure. This case series describes the natural history after acute inhalation of nitric acid fumes, and demonstrates that the severity of lung injury is directly dependent on the exposure level. It also highlights the use of noninvasive ventilatory support in the management of such patients.

Ammonia is a gas with a urine-like odor widely used for industrial purposes. Its odor threshold is sufficiently low to acutely provide adequate warning of its presence.

The Journal of Emergency Medicine, 2010

e Abstract-Background: Nitric acid (HNO 3 ) is a solution of nitrogen dioxide (NO 2 ) in water commonly used as an industrial chemical and cleaner. Oxides of nitrogen liberated as nitric acid interact with the environment to cause inhalation injuries. The coexistence of HNO 3 with varying oxides of nitrogen likely results in the large continuum of symptoms related to HNO 3 exposure and varying times of onset-acute, subacute, and delayed. Furthermore, dyspnea and evidence of acute lung injury may not occur for several hours after exposure and can lead to rapidly progressive acute respiratory distress syndrome (ARDS). Objectives: This case illustrates to physicians and occupational health personnel that HNO 3 inhalation may initially appear benign and that onset of severe effects may be delayed. Case Report: A 66-year-old man developed delayed-onset pulmonary edema, ARDS, and fatal circulatory collapse 53 h after occupational exposure to HNO 3 . Conclusion: This case serves to increase awareness among emergency physicians, as well as occupational health personnel, that patients exposed to HNO 3 may initially be asymptomatic. Patients should be evaluated and observed regardless of the severity or benign nature of symptoms, which occur immediately after exposure, as the most severe symptoms are often delayed in onset and rapidly progressive.

1990

This study evaluates the histological changes, especially the presence of possible precancerous lesions, in the nasal mucosa ofworkers exposed to formaldehyde. Nasal biopsies of 37 workers occupationally exposed to formaldehyde for more than five years and 37 age matched referents showed a higher degree of metaplastic alterations in the former group. In addition, three cases of epithelial dysplasia were observed among the exposed. These results indicate that formaldehyde may be potentially carcinogenic to man. Combination of this finding with the inconclusive epidemiological studies suggests that formaldehyde is a weak carcinogen and that occupational exposure to formaldehyde alone is insufficient to induce nasal cancer. The inhalation of formaldehyde has been shown to induce squamous cell carcinoma in the nasal cavity of rats at exposure levels ranging from 6 to 14 3 ppm12 and mice at an exposure level of 14 3 ppm.3 Although these findings aroused considerable concern about the possible long term effects in man, epidemiological studies conducted to date have not provided unequivocal evidence that exposure can induce nasal or other types of cancer.45 Like most other types of epithelial malignancies, it is reasonable to assume that nasal cancer is preceded by preneoplastic states and that the prevalence of such lesions is considerably higher than that of cancer. Experimental studies have shown that animals exposed to formaldehyde concentrations of 2 ppm or more develop dysplasia and metaplasia of

Best Practice & Research Clinical Anaesthesiology, 2001

The use of nitrous oxide (N 2 O) in ear-nose-throat (ENT)-surgery is open to discussion. The aim of this overview is to highlight the main topics that are of particular concern to this subject. These topics are the question of waste anaesthetic gas concentrations in the operation room, the signi®cance of the diusion of nitrous oxide into the tympanic cavity and the particular problem of post-operative nausea and vomiting (PONV) in a growing outpatient surgery. The probably unavoidable occupational exposure of the ENT-surgeon to higher concentrations of this potentially toxic gas means that in the future the use of less toxic agents would be preferable in ENT. The diusion of nitrous oxide into mucosa-coated cavities such as the middle ear suggests that it should, at least, be avoided in those patients having an impaired auditory tube function. One major problem concerning the speci®c literature about PONV after N 2 O in ENT is the lack of more randomized studies.

American Journal of Medical Case Reports, 2016

A 65 year-old man presented to the Emergency Department (ED) with dyspnoea at rest, peripheral cyanosis, general paleness and a frothy fluid escaping from the nose and mouth. He also showed severe burns in his hands. He had been trying to clean a copper lamp with a 50–70% nitric acid solution at home. He was transferred to the intensive care unit (ICU). Non-invasive mechanical ventilation with PEEP was immediately applied. Treatment was started with 60 mg of furosemide intravenously (IV), and prednisolone 250 mg IV four times daily. As he responded, he was weaned off non-invasive ventilation and administered high-flow oxygen via a facemask (10 L/min). At day 5, he was transferred to the general ward. The patient was discharged from hospital at day 10 without serious pulmonary complications. He was followed-up as an outpatient for three months and respiratory function tests did not show any impairment.

Burns, 1998

Thinner sning is popular among school children in Asian countries because it is readily available at low cost. Besides its toxicity to major organs, thinner inhalation is associated with various burn accidents. Four teenagers were admitted to the Burns Unit of the Prince of Wales Hospital over the period of 1996±1997. They sustained 3±25% TBSA¯ame burn and two of them had inhalation injuries as a result of the ignition of a cigarette during thinner sning. None of them had evidence of thinner intoxication as shown by blood tests. In the management of their acute burn injuries, their hidden social and family problems were explored. With the cooperation of dierent disciplines, early psychosocial intervention was given and their behavioral and psychological disturbances were successfully managed. #

Archivos argentinos de pediatria, 2017

Esophageal or gastric injuries secondary to caustic substance ingestion is still an important issue in developing countries. Its clinical spectrum can vary from absence of mucosal injury to complications such as severe burns, strictures and perforation. Physical examination and first endoscopic evaluation are very important in the diagnosis. The objective of this study is to present 154 children who were undergone upper gastrointestinal endoscopy because of caustic substance ingestion including descaler, degreaser, unlabeled bleach, drain opener, surface cleaner, dishwasher rinse aid, hydrochloric acid. Sixty-nine children had positive oropharyngeal findings. Sixtythree children were found to have burns in the first endoscopic examination and forty of these burns were severe burn. In the follow-up, twenty children developed strictures that were undergone dilatation program. Fourteen children in the dilatation program had successful dilatation and intralesional steroid injection. How...