Clinical Practice and Cases in Emergency Medicine

Introduction: Chlorine and chloramine gases are pulmonary irritants that can cause pulmonary edema and acute respiratory distress syndrome (ARDS). We present two cases that show effective treatment with noninvasive positive pressure ventilation (NIPPV).

Case Reports: Case 1. A 9-year-old male developed chloramine pneumonitis and ARDS with hypoxia to 78% on room air after urinating in a bucket of sodium hypochlorite. He was placed on
NIPPV with improvement in symptoms and discharged on day four. Case 2. A 58-year-old male developed chlorine gas pneumonitis with hypoxia to 85% on room air. Point-of-care ultrasound of this patient demonstrated greater than three B-lines in bilateral lower lung fields, which resolved after initiating NIPPV. He ultimately left against medical advice.

Conclusion: Noninvasive positive pressure ventilation can be an effective treatment modality for severe lung injury secondary to chlorine or chloramine exposure.