Toxic Fumes Exposure–More than Just an Airway Concern

Introduction: Exposure to toxic fumes from an industrial chemical fire may not only lead airway burns and inhalational injury but also exposure via the transdermal route. Method: A 45-year-old gentleman presented with dyspnea two hours after a ten-minute while fighting without personal protective equipment. He reported voice hoarseness chest tightness. Nasoendoscopy demonstrated paranasal sinus soot significant upper edema. Awake fiber-optic intubation was performed for prophylactic protection in Burns ICU bronchoscopy did reveal any burns. However, patient developed worsening lactic acidosis (serum lactate 2.8mmol/L 8.1mmol/L pH 7.28) within 12 post-exposure. Carboxyhemoglobin 0.9%. Toxicology consulted suspicions of HAZMAT contamination, particular cyanide given profound acidosis. The doses hydroxocobalamin brought Hospital Decontamination Unit de-gowning thorough wash-down. scan meter showed high levels (352IU) unknown on his skin pre-decontamination, which could be detected post-decontamination. Lactate improved 5.0mmol/L post-decontamination resolved at eight extubated discharged sequelae. Results: To our knowledge, no other human cases poisoning have been reported. Cyanide interferes mitochondrial oxidative phosphorylation pathways cause toxicity death if untreated. its effects are often delayed compared more conventional routes. This makes recognition difficult compounds challenge long turnaround time blood tests. Increased absorption is possible through intact moistened by sweat. Conclusion: potential underrecognized. It crucial maintain vigilance challenges diagnosing importance initiating treatment early.