Chemical pneumonitis

File:Streptococcus Chemical pneumonitise.jpg

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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Patient Information
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
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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]; Philip Marcus, M.D., M.P.H.[3]

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

Physical examination

Vitals

• Tachypnea
• Tachycardia
• Fever
• Hypoxemia on pulse oximetry

General

• Cyanosis

Lung

Auscultation

• Diffuse crackles

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