![]() ![]() Treatment is based on the assumption that clinical benefit and cessation of tissue damage will occur with neutralization of the acidic byproducts created by inhaled chlorine gas. ![]() Some patients were observed to experience rapid and dramatic relief of signs and symptoms. Although controlled clinical trials are lacking, in several published anecdotal case reports and case series, nebulized sodium bicarbonate solution has demonstrated safety and efficacy when administered for chlorine gas inhalation. Link to clinical studies Studies involving multiple populations Whether chlorine gas is released accidentally as a byproduct of a chemical reaction or intentionally as an unconventional weapon, adjunctive NSB therapy appears to be safe and effective for the treatment of potential pulmonary injuries. Similar therapeutic benefits from NSB administration have been observed in other studies (Douidar, 1997 Aslan et al., 2006 Howard et al., 2007 Cevik, 2009). Gradual improvement occurred in all admitted patients with no observation of adverse effects. ![]() A small number of patients (n=17) were admitted to the hospital, receiving either a one-time dose of NSB or concomitant NSB therapy with inhaled beta-agonists and intravenous steroids. In a larger retrospective study (n=86) on the treatment of chlorine gas inhalation with 5% NSB, the clinical condition of 53 patients clearly improved upon release from the ED (Bosse, 1994). No clinical deterioration to sodium bicarbonate therapy was observed. The effects of NSB treatment were immediate and long-lasting, with complete relief of symptoms within 24 hours. After brief exposure to chlorine, three patients who presented to the emergency department (ED) with mild symptoms were given 4 ml of a 3.75% NSB solution (Vinsel, 1990). In a sheep model, 4% inhaled NSB improved arterial blood gas values after chlorine gas inhalation without altering microscopic pathology (Chisholm et al., 1989). NSB neutralizes the hypochlorous and hydrochloric acids that form when chlorine gas comes into contact with water in the airways (Vinsel, 1990 Jones et al., 2010). Although there is no specific antidote for treatment of chlorine gas exposure, nebulized sodium bicarbonate (NSB) has demonstrated efficacy and safety as an adjunctive treatment for chlorine gas-related pulmonary injuries. Symptoms of chlorine gas inhalation can occur very rapidly and range from dyspnea and nonproductive cough to pulmonary edema and acute respiratory distress syndrome (ARDS) (Chisholm et al., 1989 Vinsel, 1990). Chlorine gas is more commonly released in industrial or residential settings, such as through swimming pool or home-cleaning preparations (Bosse, 1994). Summary of clinical and non-clinical studiesĬhlorine gas, a toxic pulmonary irritant, has been used as a chemical warfare agent by the Germans during World War I, and most recently, by insurgents during the Iraq War. Chlorine gas: an evolving hazardous material threat and unconventional weapon. Theoretically, inhaled bicarbonate can neutralize hypochlorous and hydrochloric acids, decreasing severity of lung injury. Nebulized sodium bicarbonate may be another adjunctive treatment for chlorine pulmonary exposures. Product label Sodium Bicarbonate injection, solution Last revised: August 2012 Bicarbonate anion is considered "labile" since at a proper concentration of hydrogen ion (H +) it may be converted to carbonic acid (H 2CO 3) and thence to its volatile form, carbon dioxide (CO 2) excreted by the lung. Plasma concentration is regulated by the kidney through acidification of the urine when there is a deficit or by alkalinization of the urine when there is an excess. Bicarbonate (HCO 3-) is a normal constituent of body fluids and the normal plasma level ranges from 24 to 31 mEq/liter. Sodium (Na +) is the principal cation of the extracellular fluid and plays a large part in the therapy of fluid and electrolyte disturbances. Sodium bicarbonate in water dissociates to provide sodium (Na +) and bicarbonate (HCO 3-) ions. Intravenous sodium bicarbonate therapy increases plasma bicarbonate, buffers excess hydrogen ion concentration, raises blood pH and reverses the clinical manifestations of acidosis. Evidence-based medicine for Chemical Defense - including efficacy and safety A. Inhaled sodium bicarbonate neutralizes the hydrochloric acid that is formed when phosgene or chlorine gas react with the water in the respiratory tree. Nebulized sodium bicarbonate serves as a useful adjunct in the treatment of patients with pulmonary injuries resulting from phosgene and chlorine gas inhalation exposures. Sodium bicarbonate is a nonspecific antidote effective in the treatment of a variety of poisonings by means of a number of distinct mechanisms. Chemical Defense therapeutic area(s) - including key possible uses Name of Chemical Defense therapeutic agent/device ![]()
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