Chlorine (CL2)

Route of Exposure

• Inhalation
• Skin or eye contact
• Ingestion

• Eye and nasal irritation, sore throat, coughing
• Respiratory distress, airway obstruction, pulmonary edema
• Immediate onset of rapid breathing, blue discoloration of the skin, wheezing, rales, hemoptysis.
• Pulmonary injury may progress over several hours. Lung collapse may occur.
• Reactive airways dysfunction syndrome (RADS), a chemical irritant-induces type of asthma.

      Cardiovascular:

• Tachycardia & initial hypertension followed by hypotension.
• With massive chlorine inhalation, excess of chloride ions in the blood causing acid-base imbalance.

• Acidosis, Acid-Base imbalance
• Children more vulnerable to toxicants interfering with base metabolism

• Skin irritation, burning pain, inflammation and blisters.
• Liquefied chlorine can result in frostbite injury

• Burning discomfort, spasmodic blinking, involuntary closing of eyelids, redness, conjunctivitis and tearing. Corneal burns at high concentrations.

• Routine laboratory studies for all exposed patients include CBC, glucose, and electrolyte determinations.
• Patients who have respiratory complaints may require pulse oximetry (or ABG measurements) and chest radiography.
• Massive inhalation may be complicated by hyperchloremic metabolic acidosis; in addition to electrolytes, monitor blood pH.

• Hospital personnel are at minimal risk of secondary contamination from patients exposed only to chlorine gas.
• Clothing or skin soaked with industrial-strength bleach or similar solutions may be corrosive to personnel and may release harmful chlorine gas.

• Evaluate and support airway, breathing, and circulation. Administer supplemental oxygen by mask.
  In cases of respiratory compromise secure airway and respiration via endotracheal intubation. If not possible, surgically secure an airway.
• Treat patients who have bronchospasm with aerosolized bronchodilators.
• Cardiac sensitizing agents may be appropriate. Chlorine poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents.
• Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25-0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed cautioning for myocardial variability.
• Patients who are comatose, hypotensive, or having seizures or cardiac arrhythmias treated in the conventional manner.

• Consider hospitalizing patients who have a suspected significant exposure or have eye burns or serious skin burns.