Toxic Exposures

It s recommended that victims breathe fresh air or receive oxygen supplements by face mask, as well as have their eyes thoroughly rinsed in the decontamination and support zones at the incident site. In addition, give ED symptomatic victims oxygen supplementation and bronchodilators. Patients report relief with these therapeutic interventions.

Several uncontrolled case series report the efficacious use of nebulized sodium bicarbonate therapy in 3.75% to 5% concentrations. Some authors advocate its use on the basis of purported neutralization of hydrochloric acid formed when chlorine reacts with water in the airways. Give a single treatment of 3.75% sodium bicarbonate solution per hand-held nebulizer. Prepare the solution by diluting 2 mL of the standard pediatric IV sodium bicarbonate solution (8.4%) with 2.25 mL of normal saline. Low concentrations of sodium bicarbonate (3.75 to 4%) do not produce the exothermic reaction expected to occur when high concentrations are used. In one controlled animal study, sodium bicarbonate improved gas exchange but there was no difference in lung histology or mortality at 24 hours.