Acute lung injury following occupational exposure to nitric acid

Ji Hoon Jang; Sung Yeon Hwang; Chi Ryang Chung; Gee Young Suh; Ryoung-Eun Ko

doi:10.4266/acc.2021.01557

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Images in critical care Pulmonary Acute lung injury following occupational exposure to nitric acid: Ji Hoon Jang¹, Sung Yeon Hwang², Chi Ryang Chung^1,3, Gee Young Suh^1,4, Ryoung-Eun Ko¹; Acute and Critical Care 2021;36(4):395-396.
DOI: https://doi.org/10.4266/acc.2021.01557
Published online: November 26, 2021

¹Department of Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

²Department of Emergency Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

³Department of Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

⁴Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Corresponding author: Ryoung-Eun Ko Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3429, Fax: +82-2-3410-6956, E-mail: ryoungeun.ko@samsung.com

• Received: October 28, 2021 • Accepted: November 13, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Nitrogen dioxide is one of the compounds formed from breakdown of nitric acid and can lead to extensive damage to the pulmonary epithelium, causing both airway damage and inflammation [1-3]. A 60-year-old male presented to the emergency room complaining of deteriorating productive cough with dyspnea. The patient worked in a metal plating factory and reported 2-minute inhalation of nitric acid approximately 25 hours prior to arrival. At presentation, arterial blood gas analysis showed pH 7.37, partial pressure of carbon dioxide (PCO₂) 41 mm Hg, and partial pressure of oxygen 59 mm Hg on 15 L/min of oxygen with a non-rebreathing mask. Crackles were audible over the posterior of both lungs. The chest X-ray showed diffuse bilateral opacities (Figure 1A), and computed tomography presented bilateral peribronchial consolidation and ground glass opacity with sparing in the subpleural region (Figure 2). The patient was treated with high-flow nasal oxygen therapy and transferred to an intensive care unit. Administration of bronchodilator and methylprednisolone (70 mg/day [1 mg/kg]) was initiated. He achieved clinical improvement and was transferred to the general ward with 5 L/min via nasal cannula. The patient was discharged 7 days after admission without oxygen therapy (Figure 1B). At discharge, methylprednisolone was reduced to 30 mg/day for 1 week and eventually discontinued after further reduction to 15 mg/day.

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CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

AUTHOR CONTRIBUTIONS

Conceptualization: JHJ, REK. Data curation: JHJ, REK. Visualization: JHJ. Writing–original draft: JHJ, REK. Writing–review & editing: all authors.

Figure 1.

Chest radiograph. (A) Initial chest X-ray demonstrates diffuse bilateral opacities. (B) At hospital discharge, chest X-ray showed marked improvement.

Figure 2.

Chest computed tomography scan obtained on the day of emergency room visit presents bilateral peribronchial consolidation and ground glass opacity with sparing in the subpleural region.

References

1. Persinger RL, Poynter ME, Ckless K, Janssen-Heininger YM. Molecular mechanisms of nitrogen dioxide induced epithelial injury in the lung. Mol Cell Biochem 2002;234-235:71-80.Article PubMed
2. Hajela R, Janigan DT, Landrigan PL, Boudreau SF, Sebastian S. Fatal pulmonary edema due to nitric acid fume inhalation in three pulp-mill workers. Chest 1990;97:487-9.Article PubMed
3. Kao SL, Yap ES, Khoo SM, Lim TK, Mukhopadhyay A, Teo ST. Acute lung injury after inhalation of nitric acid. Eur J Emerg Med 2008;15:348-50.Article PubMed

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Acute lung injury following occupational exposure to nitric acid

Acute Crit Care. 2021;36(4):395-396. Published online November 26, 2021

DOI: https://doi.org/10.4266/acc.2021.01557

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