A Case of Acute Respiratory Distress Syndrome Caused by Nitric Acid Inhalation.

Kim, Dae Sung; Yoon, Hye Eun; Lee, Seung Jae; Kim, Yong Hyun; Song, So Hyang; Kim, Chi Hong; Moon, Hwa Sik; Song, Jeong Sup; Park, Sung Hak

doi:2005.59.6.690

Tuberc Respir Dis > Volume 59(6); 2005 > Article

Case Report

Tuberculosis and Respiratory Diseases 2005;59(6):690-695.
DOI: https://doi.org/10.4046/trd.2005.59.6.690 Published online December 1, 2005.

A Case of Acute Respiratory Distress Syndrome Caused by Nitric Acid Inhalation.

Dae Sung Kim, Hye Eun Yoon, Seung Jae Lee, Yong Hyun Kim, So Hyang Song, Chi Hong Kim, Hwa Sik Moon, Jeong Sup Song, Sung Hak Park

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. chihongk@yahoo.co.kr

Abstract

Nitric acid is an oxidizing agent used in metal refining and cleaning, electroplating, and other industrial applications. Its accidental spillage generates oxides of nitrogen, including nitric oxide (NO) and nitrogen dioxide (NO2), which cause chemical pneumonitis when inhaled. The clinical presentation of a nitric acid inhalation injury depends on the duration and intensity of exposure. In mild cases, there may be no symptoms during the first few hours after exposure, or the typical symptoms of pulmonary edema can appear within 3-24 hours. However, in cases of prolonged exposure, progressive pulmonary edema develops instantaneously and patients may not survive for more than 24 hours. We report a case of a 44-year-old male who was presented with acute respiratory distress syndrome after nitric acid inhalation. He complained of cough and dyspnea of a sudden onset after inhaling nitric acid fumes at his workplace over a four-hour period. He required endotracheal intubation and mechanical ventilation due to fulminant respiratory failure. He was managed successfully with mechanical ventilation using positive end expiratory pressure and systemic corticosteroids, and recovered fully without any deterioration in his pulmonary function.

Key Words: Nitric acid, Chemical pneumonitis, Acute respiratory distress syndrome, Mechanical ventilation