Chlorine poisoning

Poisonous Ingredient

• Chlorine, which reacts with water in and out of the body to form hydrochloric acid and hypochlorous acid. Both are extremely poisonous.

Where Found

• Gas released when mixing bleach with some of the powdered cleansing products and ammonia (chloramine gas)
• Gas released when opening a partially filled industrial container of chlorine tablets that have been sitting for several months (for example, the first opening of a container after a pool has been closed all winter)
• Mild cleaners
• Some bleach products
• Swimming pool water (and tablets used in swimming pool water)

Note: This list may not include all uses of chlorine.

Symptoms

• Airways and lungs
  • Breathing difficulty (from breathing in the chlorine)
  • Throat swelling (may also cause breathing difficulty)
  • Water filling the lungs (pulmonary edema)
• Blood
  • Severe change in acid levels of the blood (pH balance), which leads to damage in all of the body organs
• Eyes, ears, nose, and throat
  • Loss of vision
  • Severe pain in the throat
  • Severe pain or burning in the nose, eyes, ears, lips, or tongue
• Gastrointestinal
  • Blood in the stool
  • Burns of the food pipe (esophagus)
  • Severe abdominal pain
  • Vomiting
  • Vomiting blood
• Heart and blood vessels
  • Collapse
  • Low blood pressure that develops rapidly
• Skin
  • Burns
  • Holes (necrosis) in the skin or tissues underneath
  • Irritation

Home Care

Seek immediate medical help. Do NOT make a person throw up unless told to do so by poison control or a health care professional.

If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes.

If the chemical was swallowed, immediately give the person water or milk, unless instructed otherwise by a health care provider. Do NOT give water or milk if the patient is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow.

If the person breathed in the poison, immediately move him or her to fresh air.

Before Calling Emergency

Determine the following information:

• Patient's age, weight, and condition
• Name of the product (ingredients and strengths, if known)
• Time it was swallowed
• Amount swallowed

Poison Control

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The patient may receive:

• Activated charcoal
• Breathing tube
• Bronchoscopy -- camera down the throat to see burns in the airways and lungs
• Endoscopy -- camera down the throat to see burns in the esophagus and the stomach
• Fluids through a vein (by IV)
• Medicine (antidote) to reverse the effect of the poison
• Oxygen
• Surgical removal of burned skin (skin debridement)
• Tube through the mouth into the stomach to empty the stomach (gastric lavage)
• Washing of the skin (irrigation) -- perhaps every few hours for several days

Outlook (Prognosis)

How well you do depends on the amount of poison swallowed and how quickly treatment is received. The faster you get medical help, the better the chance for recovery.

Swallowing such poisons can have severe effects on many parts of the body.

References

Perez A, McKay C. Halogens (bromine, iodine, and chlorine compounds). In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 96.

Sioris LJ, Schuller HK. Soaps, detergents, and bleaches. In: Shannon MW, Borron SW, Burns MJ, eds. Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 102.

Update Date: 1/30/2012

Reviewed by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.