Comprehensive Report on Cough and Lachrymal Toxicology and Treatment

This report provides a comprehensive overview of cough and lachrymal toxicology, focusing on the effects of chlorine gas and tear gas exposure. It details the clinical manifestations, mechanisms of action, and treatment strategies for each type of poisoning. The report discusses the respiratory and ocular irritations caused by these substances, including symptoms such as coughing, difficulty breathing, lacrimation, and chemical burns. It also explores the pathophysiology of these poisons, including how chlorine gas oxidizes molecules and how tear gas irritates mucous membranes. The report covers various treatment options, from supportive intensive care to specific interventions like bronchodilators, nebulizers, and irrigation techniques. Additionally, it includes references to relevant research and guidelines, offering a valuable resource for understanding the complexities of cough and lachrymal toxicology. This assignment is contributed by a student to be published on the website Desklib, a platform which provides all the necessary AI based study tools for students.

Running head: COUGH AND LACHRYMAL TOXICOLOGY
Cough and Lachrymal Toxicology
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Author Note

1COUGH AND LACHRYMAL TOXICOLOGY
Cough Poison- Chlorine gas
Chlorine in gaseous form is a known respiratory aggravator, which can moderately
dissolve in water and cause acute patho-physiological condition. This condition irritates both
upper as well as lower pulmonary tract. People who are occupationally bound to be exposed to
chlorine gas are at the most risk of exposure and poisoning. The clinical manifestations of
chlorine gas poisoning include, respiratory deficiency, difficulty in breathing and vigorous
coughing. The lungs examinations reveal crackles and wheezing sounds (Massa et al. 2014).
Chlorine gas is known to irritate lungs, nose and throat which makes it difficult for the patient.
Severe doses of chlorine gas can also be absorbed into the skin and cause chemical burns, induce
eye infection, lacrimation and conjunctivitis. The affected person may also show symptoms
which induce nausea followed by vomiting and headache. Depending on the severity of the gas
exposure the patient may also be susceptible to convulsive wheezing episodes, phlegm induced
coughing and asthmatic symptoms.
Inhalation of the chlorine gas is followed by diffusion into epithelial lining fluid (ELF)
of the epithelial tissues of the respiratory tract. Chlorine has the ability to oxidise small
molecules like proteins, lipids and amino acids and cause permanent damage (White and Martin
2010). Hydrolysis reaction of these molecules can give rise to formation of hypochlorous and
hydrochloric acid causes’ cellular necrosis by generating reactive oxygen species. These
compounds can be generated from the ionic products of chlorine and destroys tissues or even
organs.

2COUGH AND LACHRYMAL TOXICOLOGY
Fig 1: Airway injury due to chlorine inhalation
Source: (White and Martin 2010)
The treatment of chlorine gas poisoning is to provide a supportive intensive care by
commencing oxygen supplement in a concentrated humid condition according to the severity of
the situation. Reducing the risk of oedema in the pulmonary tract can be done by commencing
restriction of fluid and diuretics. PEEP or positive end-expiratory pressure is maintained by
restricting the airway passage pressure above atmospheric pressure, is administered to patients
who do not have inflammation induced pulmonary tract. Bronchodilators as well as β-2 blockers
can dilate the cardiac vessels and inhibit the spasming of the bronchial muscles (Agency for
Toxic Substances & Disease Registry| CDC, 2014). Lidocaine nebulizer needs to be commenced
to reduce the analgesic condition and minimize the coughing. This will clear the air passageway.

3COUGH AND LACHRYMAL TOXICOLOGY
Sodium bicarbonate can be administered through the nebulizer to neutralise the anionic condition
of the internal systems. Corticosteroids can be induced either by inhalation or by nebulisation
(Jonasson et al. 2013). Irrigation with saline water is very important to effected area like skin,
eyes as well as digestive tract to wash away the chlorine. Metabolic acidosis can be neutralised
by administering mild basic agents as well as ionic salt solution.
Lachrymal poison- Tear Gas
A very common form of lachrymal poison is tear gas, used as a chemical weapon to
control mobs or riots. This kind of chemical gas was used in world war to cause mass homicide
(Jones 2014). This kind of lachrymator causes severe irritation in the eyes and induces tearing
vigorously (Schep Slaughter and McBride 2015). Along with this, respiratory as well skin
irritation is also observed in tear gas poisoning. Prolonged exposure to this gas or concentrated
exposure can even induce blindness, severe chemical burn and respiratory trouble. The common
lachrymators are nonivamide spray, pepper spray, phenyl chloride gas , mace, CS , CR and CN
et cetera.
The mechanism of action of tear gas is to irritate by the mucous membrane of the eyes
and induce the lachrymal glands to secrete copious amounts of tear. The mucous membranes of
mouth, nose and lungs are also induced after prolonged exposure, which causes difficulty in
breathing, talking and sneezing sensation. This leaves the person in distress and confusion, which
is why these tear gases are used to control riots (Schep Slaughter and McBride 2015).
Tear gases can induce the distress within 20-30 seconds post exposure, but quickly
resolves after the person has been removed from the source into an open air after thirty minutes.
Some kinds of tear gases like “oleoresin capsicum”, the symptoms include loss of motor skills

4COUGH AND LACHRYMAL TOXICOLOGY
and distress, which occurs after immediate exposure of the gas. The mechanism of action is not
properly known, but is hypothesized that it attacks the functional groups containing sulfhydryl as
a part of the active site of the enzymes. The TRPA1 ion channel is attacked by these gases which
triggers the sensory nerves of the nose, mouth, eyes, nose and lungs to secrete mucous which
causes loss of water and distress (Shapiro et al. 2013).
Fig 2: patho-physiology of poisonous gases.
Source: (Baker 2014)
The gas is known to cause inflammation in skin and the consequences are severe for
people who are already suffering from respiratory diseases, asthma, hypotension and other
associated breathing disorders. Critical cases of exposure require patients require ventilation

5COUGH AND LACHRYMAL TOXICOLOGY
support and critical care support. Severe exposure can cause skin inflammation and dermatitis.
Scarring of the cornea is also common in these cases. Frequent exposure may also induce chronic
respiratory diseases.
Gas masks with pore size smaller than 60 microns can be helpful in preventing exposure
of tear gas (Drew et al. 2013). Specific treatment for tear gas is not clearly known, but removing
the patient from the source area and getting rid of the exposed clothing helps fading of the effects
of the tear gas. Hydrolytic irrigation is the best way to get rid of the effects of poisonous
compound from eyes and skin. Although it is reported that sometimes the irrigation causes
aching sensation, for these cases saline water is the best option. Diphoterine solution is also
effective solution for treating ocular burns and mild chemical burns. Antihistamines and anti-
allergens are important to reduce the secretions from mouth and nasal cavity (Jones 2014).
Analgesics can be administered to minimize the pain sensations. Substances like vinegar,
petroleum, milk products and citrus juice can also absorb the poison from the exposed area.
Vegetable oils can also act as an absorbent for the poison.

6COUGH AND LACHRYMAL TOXICOLOGY
References:
Agency for Toxic Substnaces & Disease Registry|CDC. (2014). ATSDR-Medical Management
GUidelines (MMG):Chlorine. [online] Available at:
https://www.atsdr.cdc.gov/MMG/MMG.asp?id=198&tid=36 [Accessed 17 Apr. 2018].
Baker, D. (2014). The Pathophysiology of Toxic Trauma. Toxic Trauma, [online] pp.85-112.
Available at: https://link.springer.com/chapter/10.1007/978-1-4471-5598-0_6 [Accessed 17 Apr.
2018].
Drew, J.E., Virr, A. and Crumblin, G., ResMed Ltd, 2013. Respiratory mask having washout
vent and gas washout vent assembly for a respiratory mask. U.S. Patent 8,528,558.
Jonasson, S., Wigenstam, E., Koch, B. and Bucht, A., 2013. Early treatment of chlorine-induced
airway hyperresponsiveness and inflammation with corticosteroids. Toxicology and applied
pharmacology, 271(2), pp.168-174.
Jones, E., 2014. Terror weapons: the British experience of gas and its treatment in the first world
war. War in history, 21(3), pp.355-375.
Massa, C.B., Scott, P., Abramova, E., Gardner, C., Laskin, D.L. and Gow, A.J., 2014. Acute
chlorine gas exposure produces transient inflammation and a progressive alteration in surfactant
composition with accompanying mechanical dysfunction. Toxicology and applied
pharmacology, 278(1), pp.53-64.
Schep, L.J., Slaughter, R.J. and McBride, D.I., 2015. Riot control agents: the tear gases CN, CS
and OC—a medical review. Journal of the Royal Army Medical Corps, 161(2), pp.94-99.

7COUGH AND LACHRYMAL TOXICOLOGY
Shapiro, D., Deering-Rice, C.E., Romero, E.G., Hughen, R.W., Light, A.R., Veranth, J.M. and
Reilly, C.A., 2013. Activation of transient receptor potential ankyrin-1 (TRPA1) in lung cells by
wood smoke particulate material. Chemical research in toxicology, 26(5), pp.750-758.
White, C. and Martin, J. (2010). Chlorine Gas Inhalation: Human Clinical Evidence of Toxicity
and Experience in Animal Models. Proceedings of the American Thoracic Society, [online] 7(4),
pp.257-263. Available at:
https://www.researchgate.net/publication/45092737_Chlorine_Gas_Inhalation_Human_Clinical_
Evidence_of_Toxicity_and_Experience_in_Animal_Models.