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ACUTE EXPOSURE INFORMATION

  1. USES: Anhydrous hydrogen chloride is used in the production of pharmaceutical hydrochlorides and chlorine, rubber, as a gaseous flux for babbiting operations. It is also used in the leather tanning, electroplating, and food processing industries. Hydrogen chloride in aqueous solution (hydrochloric acid) has many commercial and industrial uses.
  1. TOXICOLOGY: Acids cause coagulation necrosis. Hydrogen ions desiccate epithelial cells, causing edema, erythema, tissue sloughing and necrosis, with formation of ulcers and eschars.
  1. EPIDEMIOLOGY: Exposure is rare. Hydrogen chloride is typically available for industrial purposes.
  1. WITH POISONING/EXPOSURE
    1. Hydrogen chloride exposure is unusual; limited data regarding specific human toxicity following hydrogen chloride exposure is available. The following effects could be expected to occur, based on exposure data of other acids.
    1. MILD TO MODERATE ORAL TOXICITY: Patients with mild ingestions may only develop irritation or grade I (superficial hyperemia and edema) burns of the oropharynx, esophagus or stomach; acute or chronic complications are unlikely. Patients with moderate toxicity may develop grade II burns (superficial blisters, erosions and ulcerations) are at risk for subsequent stricture formation, particularly gastric outlet and esophageal. Some patients (particularly young children) may develop upper airway edema.
    1. SEVERE ORAL TOXICITY: May develop deep burns and necrosis of the gastrointestinal mucosa. Complications often include perforation (esophageal, gastric, rarely duodenal), fistula formation (tracheoesophageal, aortoesophageal), and gastrointestinal bleeding. Upper airway edema is common and often life threatening. Hypotension, tachycardia, tachypnea and, rarely, fever may develop. Other rare complications include metabolic acidosis, hemolysis, renal failure, disseminated intravascular coagulation, elevated liver enzymes, and cardiovascular collapse. Stricture formation (primarily gastric outlet and esophageal, less often oral) is likely to develop long term. Esophageal carcinoma is another long term complication.
      1. PREDICTIVE: The grade of mucosal injury at endoscopy is the strongest predictive factor for the occurrence of systemic and GI complications and mortality. Initial signs and symptoms may not reliably predict the extent of GI burns.
    1. INHALATION EXPOSURE: Mild exposure may cause dyspnea, pleuritic chest pain, cough and bronchospasm. Severe inhalation may cause upper airway edema and burns, hypoxia, stridor, pneumonitis, tracheobronchitis, and rarely acute lung injury or persistent pulmonary function abnormalities. The current NIOSH IMMEDIATELY DANGEROUS TO LIFE OR HEALTH (IDLH) air concentration for hydrogen chloride is 50 ppm. No significant effects have been seen with chronic exposure to low levels of gaseous hydrogen chloride.
    1. OCULAR EXPOSURE: Ocular exposure can produce severe conjunctival irritation and chemosis, corneal epithelial defects, limbal ischemia, permanent vision loss and in severe cases perforation.
    1. DERMAL EXPOSURE: A minor exposure can cause irritation and partial thickness burns. More prolonged or a high concentration exposure can cause full thickness burns. Complications may include cellulitis, sepsis, contractures, osteomyelitis and systemic toxicity.
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