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Chemical Pneumonitis Due to Exposure to Bromine Compounds: ConclusionThis case illustrates the importance of close medical follow-up after major exposures to known respiratory irritants. Bromine and brominated compounds, similar to oxides of nitrogen and phosgene, can cause delayed toxic pulmonary edema 24 to 48 hours after exposure. No precautions were taken in this case to prevent this life-threatening possibility. Chemical pneumonitis developed and progressed over the ensuing two weeks. Prednisone has been used to treat symptomatic chemical pneumonitis; whether the earlier institution of such treatment would have prevented the development of the later complications remains an unanswered question in the absence of controlled clinical trials. (more…)

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  • Bromine has a multitude of industrial applications, the largest present use being production of the anti-knock agent and fumigant, ethylene dibromide. Others include manufacture of fire retardants, flameproofing materials, and intermediate compounds in the production of film, dyes, and inks. Bromine and hydrogen bromide are potent irritants of the oral mucosa, nose, eyes, and respiratory tract. The irritative effects of bromine are so pronounced that human volunteers could not tolerate a concentration of 0.9 ppm of bromine for longer than five minutes. Some, but not all, animal experiments have shown bromine to be more toxic than chlorine. Mice exposed to bromine had periods of early (first four days) and delayed (one to two weeks) mortality, while exposure to chlorine resulted only in early mortality. Delayed mortality after bromine exposure was associated with peribronchiolar abscesses and thought to be due to the comparatively deeper tissue penetration and damage caused by bromine. Bromine may penetrate deeper into tissues than chlorine due to its greater solubility. In animals surviving the acute poisoning, histopathologic findings revealed persistent bronchiolar and bronchial spasm and delayed healing. (more…)

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  • Chemical Pneumonitis Due to Exposure to Bromine Compounds: Occupational Medicine ClinicBy late June, the patient s blood gases and PFT values returned to normal. Although dyspnea on exertion persisted and chest x-ray findings had not yet completely resolved, she was allowed to resume work. Recommendations were made to take precautions against further exposure to chemicals; the treating physician also indicated that the company should take all possible measures to avoid further accidental exposure to chemical compounds. Over the summer, the subject did not work with brominated compounds, but was exposed to other known respiratory irritants including various alkalis, aldehydes, and acids. She recalled coughing while handling some of these compounds. A one-week history of increasing shortness of breath culminated in readmission to the hospital on September 17 with additional complaints of weakness, myalgia, and fever. (more…)

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  • During the next two weeks, the subject experienced increasing shortness of breath and was referred to the company physician. On examination, he reported bibasilar crackles. Chest x-ray film (Fig 1) showed bilateral lower lobe infiltrates and a diagnosis of chemical pneumonitis was made. The patient was advised to stay home, stay away from smoke, and avoid getting respiratory infections. Over the next three days, the shortness of breath and cough worsened, and the subject developed chest tightness. A second physician was consulted who arranged hospitalization. On admission, she was afebrile, had a respiratory rate of 20 per minute, heart rate of 90 beats per minute, and blood pressure of 110/70 mm Hg. A small degree of inflammation was noted in the posterior oropharynx. Crackles were heard over both lung bases and under the right clavicle. (more…)

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  • Chemical Pneumonitis Due to Exposure to Bromine Compounds

    Mar 2, 2015 Author: Walter Mcneil | Filed under: Pneumonitis

    Chemical Pneumonitis Due to Exposure to Bromine CompoundsChemical pneumonitis, a potentially fatal condition, can be caused by exposure to a number of gases or fumes. Toxic effects of exposure to halogen gases, particularly chlorine, have been well described. Although bromine is a more potent respiratory irritant than chlorine, it is not mentioned in some of the frequently consulted texts which list the causes of acute toxic pulmonary edema, chemical pneumonitis, and/or bronchiolitis obliterans. Hydrogen bromide, reported to be approximately one third as toxic as bromine, is also not mentioned in these sources. In reviewing the last 20 years’ literature, we were unable to find reports of inorganic brominated compounds causing pulmonary disease in humans. In order to remind physicians that this may occur during accidental exposures, we wish to report the occurrence of chemical pneumonitis in a worker exposed to bromine compounds. (more…)

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