Tuberc Respir Dis.  2005 Dec;59(6):690-695.

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

• Kim DS
• Yoon HE
• Lee SJ
• Kim YH
• Song SH
• Kim CH
• Moon HS
• Song JS
• Park SH

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.

Keyword

Nitric acid; Chemical pneumonitis; Acute respiratory distress syndrome; Mechanical ventilation

MeSH Terms

Adrenal Cortex Hormones
Adult
Cough
Dyspnea
Electroplating
Humans
Inhalation*
Intubation, Intratracheal
Male
Nitric Acid*
Nitric Oxide
Nitrogen
Nitrogen Dioxide
Oxides
Pneumonia
Positive-Pressure Respiration
Pulmonary Edema
Respiration, Artificial
Respiratory Distress Syndrome, Adult*
Respiratory Insufficiency
Adrenal Cortex Hormones
Nitric Acid
Nitric Oxide
Nitrogen
Nitrogen Dioxide
Oxides