Chemical pneumonitis: Difference between revisions
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[[Image:Streptococcus Chemical pneumonitise.jpg|right|200px]] | |||
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{{Infobox Disease | | |||
Name = Chemical pneumonitis | | |||
Image = | | |||
Caption = | | |||
DiseasesDB = 10166 | | |||
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}} | | |||
ICD9 = {{ICD9|480}}-{{ICD9|486}}, {{ICD9|770.0}} | | |||
ICDO = | | |||
OMIM = | | |||
MedlinePlus = | | |||
MeshName = Chemical pneumonitis | | |||
MeshNumber = C08.381.677 | | |||
}} | |||
{{Chemical pneumonitis}} | |||
'''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | |||
'''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] | |||
==[[Chemical pneumonitis overview|Overview]]== | |||
==[[Chemical pneumonitis historical perspective|Historical Perspective]]== | |||
==[[Chemical pneumonitis pathophysiology|Pathophysiology]]== | |||
==[[Chemical pneumonitis causes|Causes]]== | |||
:'''Specific causes:''' [[bacterial Chemical pneumonitis|Bacterial]] | [[fungal Chemical pneumonitis|Fungal]] | [[parasitic Chemical pneumonitis|Parasitic]] | [[viral Chemical pneumonitis|Viral]] | |||
:'''Classification scheme:''' [[Community-acquired Chemical pneumonitis]] | [[Hospital-acquired Chemical pneumonitis|Health-care associated Chemical pneumonitis]] | |||
:'''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]]) | |||
==[[Chemical pneumonitis differential diagnosis|Differentiating Chemical pneumonitis from other Diseases]]== | |||
==[[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]]== | |||
'''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]] | |||
==Diagnosis== | |||
[[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]] | |||
==Treatment== | |||
[[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]] | |||
[[Category:Diseaase]] | |||
[[Category:Pulmonology]] | |||
[[Category:Infectious disease]] | |||
[[Category:Chemical pneumonitis|Chemical pneumonitis]] | |||
[[Category:Emergency medicine]] | |||
{{WH}} | |||
{{WS}} | |||
{{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] | '''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== | ==Overview== | ||
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 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]]. | ||
==Historical perspective== | ==Historical perspective== | ||
* [[Mendelson's syndrome]] is a type of chemical | * [[Mendelson's syndrome]] is a type of chemical Chemical pneumonitis 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>. | * 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== | ==Natural History, Complications and Prognosis== | ||
| Line 62: | Line 120: | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category: | [[Category:Chemical pneumonitis|Chemical pneumonitis]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 17:18, 8 September 2012
| Chemical pneumonitis | ||
| ICD-10 | J12, J13, J14, J15, J16, J17, J18, P23 | |
|---|---|---|
| ICD-9 | 480-486, 770.0 | |
| DiseasesDB | 10166 | |
| MeSH | pneumonitis&field=entry#TreeC08.381.677 C08.381.677 | |
|
Chemical pneumonitis Microchapters |
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Diagnosis |
|---|
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Treatment |
|
Case Studies |
|
Chemical pneumonitis On the Web |
|
American Roentgen Ray Society Images of Chemical pneumonitis |
For patient information click here
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]; Philip Marcus, M.D., M.P.H.[3]
Overview
Historical Perspective
Pathophysiology
Causes
- Specific causes: Bacterial | Fungal | Parasitic | Viral
- Classification scheme: Community-acquired Chemical pneumonitis | Health-care associated Chemical pneumonitis
- 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)
Differentiating Chemical pneumonitis from other Diseases
Epidemiology and Demographics
Risk factors
Natural History, Complications and Prognosis
Prognosis predictor scores: CURB-65 | Chemical pneumonitis severity index | Criteria for severe community acquired Chemical pneumonitis
Diagnosis
Diagnostic criteria | History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray
Treatment
Site of care decision | Medical Therapy | Other treatments consideration | Prevention | Management of non-responding Chemical pneumonitis
|
Chemical pneumonitis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Chemical pneumonitis On the Web |
|
American Roentgen Ray Society Images of Chemical pneumonitis |
Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [4] Phone:617-632-7753; Philip Marcus, M.D., M.P.H.[5]
Overview
Chemical pneumonitis is inflammation of the lung caused by irritation from aspirated vomitus or barium used in gastro-intestinal imaging, ingested gasoline or other petroleum distillates, ingested or skin absorbed pesticides, 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.
Historical perspective
- Mendelson's syndrome is a type of chemical Chemical pneumonitis 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 [1].
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
Physical examination
Vitals
- Tachypnea
- Tachycardia
- Fever
- Hypoxemia on pulse oximetry
General
Lung
Auscultation
Diagnosis
- 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
- 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