For physicians: Chlorine toxicity… “after the strike”



Chlorine gas is a respiratory irritant. Chlorine is only slightly soluble in water. It causes upper and lower respiratory tract irritation.

Occupational exposure is a higher risk of serious poisoning caused by the high concentration of Chlorine, which is somewhat resemble the war exposure because of the use of chlorine by Al-Assad’s militias.

Mixing chlorine bleach (sodium hypochlorite) with ammonia or acidic cleansing agent; which is a common source of exposure to family.

The dose determines the toxicity: exposure to low concentrations of chlorine for long periods may has the same toxic effect such as a short-term acute exposure to high concentrations.


The symptoms may vary depending on the degree of exposure. The likelihood of exposure are:

⦁ Low acute levels.

⦁High acute levels.

⦁ Low chronic levels.

The most affected by the Chlorine gas attacks are those people in the place of the explosion and spread of the Chlorine gas, the paramedics, and the civil defense who come to the area, according to the concentration in the breathed air and the accompanying symptoms.


Acute exposure to low levels (ppm15-1, 5-3%)

– Most poisonings fall into this category and it is a result of exposure to domestic low concentration cleaning products. The symptoms are as follows:

– Tearing

– Sneezing

– Drooling

– Irritability and anxiety


Acute exposure to high levels (ppm <30, % 20)

In addition to the previously mentioned symptoms (exposure to low levels), exposure to high levels may lead to the following:

– Labored breathing (dyspnea): swelling and occlusion of the upper respiratory tract.

– Severe cough

– Nausea and vomiting (with the smell of chlorine in the vomit)

– Vertigo

– Headaches

– Chest pain or a burning sensation behind the cage

– Muscle weakness

– Abdominal discomfort

– Inflammation of the skin (exposure to the liquid): cornea burns and cornea ulcer that may happen because of exposure to high concentration of chlorine.

– Perforation of the esophagus


Chronic exposure:

– Acne (chloracne)

– Chest pain

– Cough

– Sore throat

– Hemoptysis


By initial examination, we may encounter the following:

– Tachypnoea.

– Cyanosis.

– Tachycardia.

– Whiz (wheeze).

– Spasm intercostal.

– Lack of (weak) breath sounds.

– Pulmonary edema.

– Nose exposure (nostrils trembling).

– Aphonia, squeaking, laryngeal edema.

– Respiratory tract ulcer, respiratory tract bleeding.

– Runny nose.

– Eyelids spasm.

– Chloracne or teeth enamel excoriation (by chronic exposure).

– Redness of the skin, erythema, chemical burns in the skin of the assigned to the exposure dosage of the liquid.



Studies about patients with severe exposure to Chlorine gas may include the following:

– Measuring pulse oximeter.

– Electrolytes’ serum, BUN, and creatinine.

– Arterial blood gases.

– Chest X-ray.

– Electrocardiogram (ECG).

– Chest CT scan.

– Ischemia.

– Lung function tests.

– Laryngoscopy or bronchoscopy.


By chest’s radiographs, we encounter with the following:

– Often it is normal at first, but it may exclude the other reasons for the lack of hypoxia in the differential diagnosis.

– The abnormalities may not be nonspecific.

– Pulmonary edema, pneumonia, and ARSD may be examined in some cases.



It includes:

⦁Hypoxia (due to bronchospasm or pulmonary edema).

⦁Metabolic acidosis, which may be hyperchloremic metabolic acidosis (anion gap).

⦁Chest’s radiographs is usually normal at first, but later it may show nonspecific abnormalities.

⦁Pulmonary edema, pneumonia, air at the mediastinum, or signs of ARSD (acute respiratory syndrome distress).



The most important aspect in addressing the patients exposed to chlorine gas is to provide supportive care as follows:

– Supplemental oxygen (wet if possible) as necessary.

– Prescribe fluids and diuretics for the imminent pulmonary edema.

– PEEP in the patients with pulmonary edema that isn’t of a cardiac origin.

– BETA2 (salbutamol) tensor and other bronchodilators as necessary for bronchospasm.

– Nebulized lidocaine for soothing and relieving cough.

– Nebulized bicarbonate.

– Nebulized steroid.

– Frequently wash the exposed skin and eyes with saline.

– Accept and control the patients exposed to high concentrations in closed place, even if initially symptoms don’t appear on them because they are in serious danger of respiratory failure.

– Patients with respiratory and dente cardiovascular.

– Children.


Differential Diagnosis:


Nontoxic lesions:

– Asthma

– Respiratory distress syndrome

– Viral pneumonia

– Pulmonary embolism



Or being poisoned by one of the following elements:

– Carbon Monoxide

– Ammonia

– Hydrogen sulfide