Abstract
Background
Nitrogen dioxide (NO2) is a pulmonary irritant produced as a byproduct of bacterial anaerobic metabolism
of organic materials, and is also produced as a byproduct of explosive detonations.
Significant NO2 exposure results in free-radical–induced pulmonary injury that may be delayed up
to 3–30 h after exposure and can progress to acute respiratory distress syndrome (ARDS)
and death. Here we present a case series of 3 patients with dose-dependent pulmonary
injury consistent with NO2 inhalation following exposure to fumes from detonation of an ammonium nitrate/nitromethane
(ANNM) explosive device.
Case Reports
Three individuals presented to the emergency department over the course of 16 h, beginning
approximately 16 h after exposure to fumes from an ANNM explosive device. Patient
1, with the most significant exposure, developed ARDS necessitating intubation and
mechanical ventilation. Patient 2 exhibited hypoxia and findings concerning for diffuse
airway inflammation, but ultimately required only supplemental oxygen. Patient 3,
with the least exposure, had imaging abnormalities but required no intervention.
Why Should an Emergency Physician Be Aware of This?
Respiratory distress is a common presenting complaint to the emergency department.
Because of the delayed presentation and the potential for progressive worsening of
symptoms associated with NO2 exposure, it is important that emergency physicians be aware of the multiple potential
means of exposure and consider this diagnosis in the proper clinical context. Patients
with suspicion of NO2-related lung injury should undergo more extended observation than their initial clinical
presentation may suggest.
Keywords
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Article info
Publication history
Published online: May 03, 2019
Accepted:
March 16,
2019
Received in revised form:
March 6,
2019
Received:
December 31,
2018
Footnotes
This case was presented as an abstract in poster form and as a lightning oral presentation at the North American Congress of Clinical Toxicology conference in October 2018 in Chicago, IL.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
