Reaction of Nitric Acid with Metal, Delayed Type Lung Edema
Background: A 69-year old female had stored a bottle of nitric acid in her bathroom. When the bottle broke, its contents spread over the floor and came into contact with a metal shelf. Thereaction between metal and nitric acid resulted in a formation of nitrogen oxides. The patient was found sitting in her living room with severe dyspnoea. Later, she had to be administeredartificial respiration and transferred into hospital. Case Report: Manifestations/course: Findings made by the emergency physician included cyanosis, a rattling respiration and an oxygensaturation level of 78%. In addition, hypertension up to 220 mmHg was found. Initial treatment included administration of glycerol trinitrate and furosemide. On the next morning, i.e. 18 hours after the accident had happened, the patient required artificial respiration due to lung oedema of delayed type. In the further course, placing of a central venous catheter into her right jugular vein was followed by pneumothorax requiring intercostal drainage. Case Discussion: Due to her severe pulmonary problems, the patient was transferred to a specialized hospital with drained pneumothorax and in a reduced general condition. The respiratory situation rapidly improved under administration of high doses of corticosteroids. In the further course, the patient developed peak blood pressure values of more than 300 mmHg followed by rapid falls in blood pressure. This was followed by signs of hemiparesis on the left side of her body. After nine days the patient got a total atelectasis of the left lung due to a mucous plug. Conclusion: After a total of 12 days of intensive therapy with different complications, the patient could be transferred to her regional hospital and could be discharged two weeks later. From the therapeutic aspect, the early oxygen supply is the most important measure. A central role has also been attributed to the early administration of corticosteroids.