Medicine of the Future in America

Respiratory Failure and Death Following Acute Inhalation (2)

Results of routine laboratory testing were also unremarkable with the exception of room air arterial blood gases that revealed a Po2 of 64 mm Hg, a PcOj of 31 mm Hg, and a pH of 7.46. His initial chest roentgenogram was normal (Fig 1); however, on transfer, it revealed bilateral difiiise pulmonary infiltrates (Fig 2). His arterial blood gases, now obtained on a 50 percent oxygen concentration, revealed a Po2 of 69 mm Hg, a Pco2 of 39 mm Hg, and a pH of 7.43. The patient claimed to have been exposed to freon fumes while cleaning an old refrigerator, but Public Health officials evaluating the reported unexplained inhalation informed the physician staff of evidence found in the home implicating mercury vapor. proventil inhaler

When notified of such, serum and urine mercury levels were obtained and dimercap-rol (BAL) therapy was started at 5 mg/kg intramuscularly every 4 h. The initial serum mercury concentration was 16.1 jjLg/dl with a urinary concentration 423 |ig/L. Despite chelation therapy achieving increases in urinary excretion of mercury, serum levels remained elevated throughout the hospitalization.
Because of progressive hypoxemia and tachypnea, endotracheal intubation was performed and mechanical ventilation was instituted.

Figure-1

Figure 1. Chest roentgenogram on presentation shows no evidence of parenchymal disease.

Figure-2

Figure 2. Chest roentgenogram four days after presentation demonstrates diffuse bilateral infiltrates.

This entry was posted in Pulmonary function and tagged adult respiratory distress syndrome, arterial blood gases, chelation therapy, chest roentgenograms, lung injury.
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