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{{Chemical pneumonitis}}
{{Chemical pneumonitis}}
'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; [[Philip Marcus, M.D., M.P.H.]][mailto:pmarcus192@aol.com]


==Overview==
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
Chemical pneumonitis is inflammation of the lung caused by irritation from aspirated [[vomitus]] or barium used in gastro-intestinal imaging, ingested gasoline or other [[Fractional distillation|petroleum distillate]]s, ingested or skin absorbed [[pesticide]]s, gases from [[electroplating]], or other irritants. It is sometimes called a "chemical [[pneumonia]]", though it is not infectious. May also be caused by the use of [[inhalants]].When the toxic substance is an oil, the pneumonia may be called [[lipoid pneumonia]].
==Historical perspective==
* [[Mendelson's syndrome]] is a type of chemical pneumonia in which aspiration of gastric acid is present.
* It was first described in pregnant females who aspirated gastric content during anesthesia, with development of [[respiratory distress]], [[cyanosis]] and lung infiltrates on chest Xray <ref name="pmid20993766">{{cite journal |author=MENDELSON CL |title=The aspiration of stomach contents into the lungs during obstetric anesthesia |journal=[[American Journal of Obstetrics and Gynecology]] |volume=52 |issue= |pages=191–205 |year=1946 |month=August |pmid=20993766 |doi= |url= |accessdate=2012-09-08}}</ref>.
==Natural History, Complications and Prognosis==
===Prognosis===
* Approximately, 3 in 5 patients have clinical improvement with clearing of chest Xray.
* Approximately, 1 in every 3rd patient shows a rapid improvement followed with a new progressive infiltrate suggesting secondary superimposed bacterial infection or the development of ARDS.
* The least common course but with worst prognosis is the development of fulminant disease resulting in acute death.


==History & Symptoms==
'''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]
* Acute onset [[dyspnea]]
* [[Cyanosis]]
* Low grade [[fever]]
* Productive cough with pink frothy sputum


==Physical examination==
==[[Chemical pneumonitis overview|Overview]]==
===Vitals===
* [[Tachypnea]]
* [[Tachycardia]]
* [[Fever]]
* [[Hypoxemia]] on pulse oximetry
===General===
* [[Cyanosis]]


===Lung===
==[[Chemical pneumonitis historical perspective|Historical Perspective]]==
====Auscultation====
* [[Diffuse crackles]]


==Diagnosis==
==[[Chemical pneumonitis pathophysiology|Pathophysiology]]==
* Documented aspiration may be absent or present
* History, symptoms, physical examination
* CXR with infiltrates in dependent pulmonary lobe
* Bronchoscopy - Bronchial inflammation
===Chest XRay===
* Infiltrates on chest Xray
** Either unilateral or bilateral
** Commonly in the dependent pulmonary segment
** Dependent lobes in the upright position are the lower lobes
** Dependent lobes in recumbent position are superior segments of the lower lobes and the posterior segments of the upper lobes.
===Bronchoscopy===
* Erythema of the bronchi


==Medical therapy==
==[[Chemical pneumonitis causes|Causes]]==
* Tracheal suction (observed aspiration). However, the initial lung injury can't be prevented as it occurs rapidly
===Supportive Pulmonary therapy===
* Positive pressure ventilation
* Intravenous fluids (high molecular weight colloid)
* [[Sodium nitroprusside]] infusion in the pulmonary artery
* Mechanical ventilation (if respiratory failure)
* Antimicrobial agents prophylactically for superimposed bacterial infection
* Use of steroids is controversial


==References==
==[[Chemical pneumonitis differential diagnosis|Differentiating Chemical pneumonitis from other Diseases]]==
{{reflist|2}}


[[Category:Diseaase]]
==[[Chemical pneumonitis epidemiology and demographics|Epidemiology and Demographics]]==
 
==[[Chemical pneumonitis risk factors|Risk Factors]]==
 
==[[Chemical pneumonitis natural history, complications, and prognosis|Natural History, Complications and Prognosis]]==
 
==Diagnosis==
 
[[Chemical pneumonitis history and symptoms| History and Symptoms]] | [[Chemical pneumonitis physical examination | Physical Examination]] | [[Chemical pneumonitis laboratory findings|Laboratory Findings]] | [[Chemical pneumonitis chest x ray|Chest X Ray]] | [[Chemical pneumonitis CT|CT]] | [[Chemical pneumonitis MRI|MRI]] | [[Chemical pneumonitis other imaging findings|Other Imaging Findings]] | [[Chemical pneumonitis other diagnostic studies|Other Diagnostic Studies]]
 
==Treatment==
[[Chemical pneumonitis medical therapy|Medical Therapy]] | [[Chemical pneumonitis primary prevention|Primary Prevention]] | [[Chemical pneumonitis secondary prevention|Secondary Prevention]] | [[Chemical pneumonitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Chemical pneumonitis future or investigational therapies|Future or Investigational Therapies]]
 
==Case Studies==
[[Chemical pneumonitis case study one|Case #1]]
 
[[Category:Toxicology]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Infectious disease]]
[[Category:Disease]]
[[Category:Pneumonia|Pneumonia]]
 
[[Category:Pneumonia]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
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Latest revision as of 17:21, 18 September 2017

Chemical pneumonitis Microchapters

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Chemical pneumonitis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1 Template:WH Template:WS

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