At the present time, the following parameters can be recommended for "early diagnosis" of phosgene overexposure: (a) Phosgene indicator paper badges, to be worn by all persons involved in handling phosgene (these badges permit immediate estimation of the exposure dose in each individual case); (b) Observation of the initial irritative symptoms of the eye and the upper respiratory tract after phosgene inhalation can provide a rough indication of the inhalation concentration and dose; (c) X-ray photographs of the lungs make it possible to detect incipient toxic pulmonary edema at an early stage, during the clinical latent period. A number of additional parameters require further critical investigation.
Get full access to this article
View all access options for this article.
References
1.
Diller, W.F. , Lungenreizstoffvergiftungen. Die Berufsgenossenschaft, 2: 94, 1982.
2.
Diller, W.F. and Zante, R., Dosis-Wirkungs-Beziehungen bei Phosgen-Einwirkung auf Mensch and Tier, Zbl. Arbeitsmed. 32: 360, 1982.
3.
Bruner, H.D. and Coman, D., The Pathologic Anatomy of Phosgene Poisoning in Relation to the Pathologic Physiology, in Fasciculus on Chemical Warfare medicine, Vol. II, Respiratory Tract, p. 234, National Research Council, Committee on Treatment of Gas Casualties , Washington, D.C., 1945.
4.
Mayer, H., DerAbbau des Blutfarbstoffes durch Phosgen, Dtsch. Med. Wschr., 54: 1557, 1928 .
5.
Diller, W.F., Radiologische Untersuchungen zur verbesserten Frühdiagnose von industriellen Inhalationsvergiftungen mit verzögertem Wirkungseintritt, Vlg.f.Medizin Dr. EwaldFischerHeidelberg, 1976.
6.
Muntsch, O., Die Blutveranderungen bei Kampfgaserkrankungen als diagnostisches Hilfsmittel , Klin. Wschr., 13: 482, 1934.
7.
Gerard, R.W., Recent Research on Respiratory Irritants, Chapter XXXVII, in Science In World War II, Vol. II., Advances in Military Medicine , edited by E. C. Andrus, p. 565, Little, Brown & Co., Boston, 1948.
8.
Swift, M. and Postel, S., Body Fluid Distribution in Phosgene Poisoning, in Fasciculus on Chemical Warfare Medicine, Vol. II, Respiratory Tract, p. 440, National Research Council, Committee on Treatment of Gas Casualties, Washington, D.C., 1945.
9.
Ordway, N.K., The Pathological Physiology of Phosgene Poisoning, in Fasciculus on Chemical Warfare Medicine, Vol. II, Respiratory Tract, p. 494, National Research Council, Committee on Treatment of Gas Casualties, Washington, D.C., 1945.
10.
Kimmerie, G. and Diller, W.F., Röntgenologische and hämatologische Untersuchungen zur frühzeitigen Erkennbarkeit des Lungenödems nach Phosgeninhalation , Zbl. Arbeitsmed., 21: 3, 1971.
11.
DILLER, W.F., Unpublished Observations.
12.
Diller, W.F. , MedicalPhosgene Problems and Their Possible Solution, J. Occ. Med. , 20: 189, 1978.
13.
Diller, W.F. , Drope, E. and Reichold, E., Eine Phosgen-Indikator-Plakette für den ärztlichen Notfall. 6. Internat. Kolloquium f.d. Verhütung v. Arbeitsunfällen u. Berufskrankheiten in der chemischen Industrie , Frankfurt J Main1979.
14.
Matherne, R.N. , Lubs, P.L. and Kerfoot, E.J., The Development of a Passive Dosimeter for Immediate Assessment of Phosgene Exposures, Amer. Ind. Hyg. Assoc. J., 42: 631, 1981.
15.
Paskal, St S. , An Evaluation of an Emergency Phosgene Dosimeter , Univer. Pittsburgh (1979).
16.
Frosolono, M.F. , Basic Mechanisms , Diagnostic Procedures, and TherapeuticCountermeasures for Phosgene Poisoning in Lungs, Report toChemical Manufacturers Association, March 30, 1976,
17.
BASF-Wyandotte Report to Chemical Manufacturers Association , March 13, 1978.
18.
Scarpelli, E. , Research Report to Chemical Manufacturers Association , March 24, 1982.
19.
Korte, W., Zur Bedeutung des Phasenwinkels bei der oszillatorischen Widerstandsmessung , Prax. Pneumol., 33: 825, 1979.
20.
Long, J.E. and Hatch, T.F., A Method of Assessing the Physiological Impairment Produced by Low-Level Exposure to Pulmonary Irritants, Amer. Ind. Hyg. Ass. J., 22: 6, 1961.
21.
Henschler, D. , Hahn, E., Heymann , H. and Wunder, H., Mechanismus einer Toleranzsteigerung bei wiederholter Einatmung von Lungenödem erzeugenden Gasen, Naunyn-Schmiedebergs , Arch. Exp. Path., 249: 343, 1964.
22.
Glass, W.I. , Harris, E.A. and Whitlock, R.M.L., Phosgene Poisoning : Case Report, N.Z. Med J., 74: 386, 1971.
23.
Pommerantz, M.Baumgartner, R., Lauridson , J. and Eiseman, B., Transthoracic Electrical Impedance for the Early Detection of Pulmonary Edema, Surgery, 66: 260, 1969.
24.
Tempel, G., Jelen, S., Forster, B., Gullotte, U. and Daum, S., Entstehung undVerlauf einer scheeren respiratorischen Insuffizienz nach Ertrinkungsfall , Anaesthesist, 26: 428, 1977.
Da Luz, P.L. , Shubin, H., Weir , M.H., Jacobson, E. and Stein L., Pulmonary Edema Related to Changes in Colloid Osmotic and Pulmonary Artery Wedge Pressure in Patients after Acute Myocardial Infarction, Circulation , 51: 350, 1975.
27.
Morissette, M., Weir, M.H. and Shubin, H., Reduction in Colloid Osmotic Pressure Associated with Fatal Progression of Cardiopulmonary Failure, Crit. Care Med., 3: 115, 1975.
28.
Skillman, J. , The Role of Albumin and Oncotically Active Fluids in Shock, Crit. Care Med., 4: 55, 1976.
29.
Cameron, G.R. and Courtice, F.C., The Production andRemoval of Edema Fluid in the Lung after Exposure to Carbonyl ChlorideJ. Physiol., 105: 175, 1946.
