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| [[Image:Streptococcus Chemical pneumonitise.jpg|right|200px]]
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| __NOTOC__ | | __NOTOC__ |
| {{Infobox Disease |
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| Name = Chemical pneumonitis |
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| Image = |
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| Caption = |
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| DiseasesDB = 10166 |
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| ICD10 = {{ICD10|J|12||j|09}}, {{ICD10|J|13||j|09}}, {{ICD10|J|14||j|09}}, {{ICD10|J|15||j|09}}, {{ICD10|J|16||j|09}}, {{ICD10|J|17||j|09}}, {{ICD10|J|18||j|09}}, {{ICD10|P|23||p|20}} |
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| ICD9 = {{ICD9|480}}-{{ICD9|486}}, {{ICD9|770.0}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| MeshName = Chemical pneumonitis |
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| MeshNumber = C08.381.677 |
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| }}
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| {{Chemical pneumonitis}} | | {{Chemical pneumonitis}} |
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh@perfuse.org]; [[Philip Marcus, M.D., M.P.H.]][mailto:pmarcus192@aol.com] | | '''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] |
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| ==[[Chemical pneumonitis overview|Overview]]== | | ==[[Chemical pneumonitis overview|Overview]]== |
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| ==[[Chemical pneumonitis causes|Causes]]== | | ==[[Chemical pneumonitis causes|Causes]]== |
| :'''Specific causes:''' [[bacterial Chemical pneumonitis|Bacterial]] | [[fungal Chemical pneumonitis|Fungal]] | [[parasitic Chemical pneumonitis|Parasitic]] | [[viral Chemical pneumonitis|Viral]]
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| :'''Classification scheme:''' [[Community-acquired Chemical pneumonitis]] | [[Hospital-acquired Chemical pneumonitis|Health-care associated Chemical pneumonitis]]
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| :'''Other types:''' [[Severe acute respiratory syndrome]] | [[Bronchiolitis obliterans organizing Chemical pneumonitis]] | [[Eosinophilic Chemical pneumonitis]] | [[Aspiration Chemical pneumonitis]] ([[Chemical pneumonitis]] | [[Aspiration Chemical pneumonitis bacterial infection]] | [[Airway obstruction]])
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| ==[[Chemical pneumonitis differential diagnosis|Differentiating Chemical pneumonitis from other Diseases]]== | | ==[[Chemical pneumonitis differential diagnosis|Differentiating Chemical pneumonitis from other Diseases]]== |
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| ==[[Chemical pneumonitis epidemiology and demographics|Epidemiology and Demographics]]== | | ==[[Chemical pneumonitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==[[Chemical pneumonitis risk factors|Risk factors]]== | | ==[[Chemical pneumonitis risk factors|Risk Factors]]== |
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| ==[[Chemical pneumonitis natural history, complications, and prognosis|Natural History, Complications and Prognosis]]== | | ==[[Chemical pneumonitis natural history, complications, and prognosis|Natural History, Complications and Prognosis]]== |
| '''Prognosis predictor scores:''' [[CURB-65]] | [[Chemical pneumonitis severity index]] | [[Chemical pneumonitis medical therapy#Criteria for severe community acquired Chemical pneumonitis|Criteria for severe community acquired Chemical pneumonitis]]
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| ==Diagnosis== | | ==Diagnosis== |
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| [[Chemical pneumonitis diagnostic criteria | Diagnostic criteria]] | [[Chemical pneumonitis history and symptoms| History and Symptoms]] | [[Chemical pneumonitis physical examination | Physical Examination]] | [[Chemical pneumonitis laboratory studies |Laboratory Findings]] | [[Chemical pneumonitis chest x ray|Chest X Ray]]
| | [[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]] |
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| ==Treatment== | | ==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]] |
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| [[Chemical pneumonitis medical therapy#Chemical pneumonitis site of care decision|Site of care decision]] | [[Chemical pneumonitis medical therapy|Medical Therapy]] | [[Chemical pneumonitis medical therapy#Other treatments consideration|Other treatments consideration]] | [[Chemical pneumonitis prevention|Prevention]] | [[Chemical pneumonitis medical therapy#Management of non-responding Chemical pneumonitis|Management of non-responding Chemical pneumonitis]] | | ==Case Studies== |
| [[Category:Diseaase]] | | [[Chemical pneumonitis case study one|Case #1]] |
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| | [[Category:Toxicology]] |
| [[Category:Pulmonology]] | | [[Category:Pulmonology]] |
| [[Category:Infectious disease]] | | [[Category:Disease]] |
| [[Category:Chemical pneumonitis|Chemical pneumonitis]]
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| [[Category:Emergency medicine]]
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| {{WH}}
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| {{WS}}
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| {{Chemical pneumonitis}}
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| '''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]
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| ==Overview==
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| 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 [[Chemical pneumonitis]]", though it is not infectious. May also be caused by the use of [[inhalants]].When the toxic substance is an oil, the Chemical pneumonitis may be called [[lipoid Chemical pneumonitis]].
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| ==Historical perspective==
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| * [[Mendelson's syndrome]] is a type of chemical Chemical pneumonitis in which aspiration of gastric acid is present.
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| * 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>.
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| ==Natural History, Complications and Prognosis==
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| ===Prognosis===
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| * Approximately, 3 in 5 patients have clinical improvement with clearing of chest Xray.
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| * 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.
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| * The least common course but with worst prognosis is the development of fulminant disease resulting in acute death.
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| ==History & Symptoms==
| | [[Category:Pneumonia]] |
| * Acute onset [[dyspnea]]
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| * [[Cyanosis]]
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| * Low grade [[fever]]
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| * Productive cough with pink frothy sputum
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| ==Physical examination==
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| ===Vitals===
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| * [[Tachypnea]]
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| * [[Tachycardia]]
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| * [[Fever]]
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| * [[Hypoxemia]] on pulse oximetry
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| ===General===
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| * [[Cyanosis]]
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| ===Lung===
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| ====Auscultation====
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| * [[Diffuse crackles]]
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| ==Diagnosis==
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| * Documented aspiration may be absent or present
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| * History, symptoms, physical examination
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| * CXR with infiltrates in dependent pulmonary lobe
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| * Bronchoscopy - Bronchial inflammation
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| ===Chest XRay===
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| * Infiltrates on chest Xray
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| ** Either unilateral or bilateral
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| ** Commonly in the dependent pulmonary segment
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| ** Dependent lobes in the upright position are the lower lobes
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| ** Dependent lobes in recumbent position are superior segments of the lower lobes and the posterior segments of the upper lobes.
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| ===Bronchoscopy===
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| * Erythema of the bronchi
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| ==Medical therapy==
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| * Tracheal suction (observed aspiration). However, the initial lung injury can't be prevented as it occurs rapidly
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| ===Supportive Pulmonary therapy===
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| * Positive pressure ventilation
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| * Intravenous fluids (high molecular weight colloid)
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| * [[Sodium nitroprusside]] infusion in the pulmonary artery
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| * Mechanical ventilation (if respiratory failure)
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| * Antimicrobial agents prophylactically for superimposed bacterial infection
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| * Use of steroids is controversial
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| ==References==
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| {{reflist|2}}
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| [[Category:Diseaase]]
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| [[Category:Pulmonology]]
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| [[Category:Infectious disease]]
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| [[Category:Chemical pneumonitis|Chemical pneumonitis]] | |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |