Critical Care >Toxic Pulmonary Inhalation

John M. Oropello, Stephen M. Pastores, Vladimir Kvetan+

Table 57B–1Potential toxins in inhalational injury.

Category Substance Source Mechanism of Injury Specific Treatment Considerations

Competes for hemoglobin binding

Motor vehicle exhaust fumes, heaters,
Asphyxiants Carbon monoxide (CO) sites, impairs oxygen delivery and 100% oxygen, hyperbaric oxygen
smoke, gas
usage

Hydroxycobalamin, thiosulfate; amyl

Paint, nylon, silk, wool combustion,
Cyanide (CN) Inhibits cytochrome oxidase nitrite, sodium nitrite —>
smoke
methemoglobinemia

Amyl nitrite, sodium nitrite —>

Sewer, farm manure, natural hot
Hydrogen sulfide Inhibits cytochrome oxidase methemoglobinemia (not as clearly
springs
effective as in CN poisoning)

Irritants Ammonia Nylon, refrigerant, plastic, fertilizer Upper airway damage

Chlorine Bleach, germicide Lower airway damage

Wall paper, lacquered wood, dye,

Nitrogen oxides Lower airway damage Methylene blue
diesel combustion

Sulfur dioxide Coal, oil, cooking fuel combustion Upper airway damage

CNS depression, bronchospasm,

Systemic toxins Hydrocarbons Glue, paint remover, solvents
coma

Organophosphates Insecticides, nerve agents Blocks acetylcholinesterase Atropine ± pralidoxime

Flu-like symptoms, throat irritation,

Metal fumes Welding
chest tightness

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