Severe lung injury following inhalation of nitric acid fumes

The Public Willingness to Pay for Reducing the Incidence of Hazardous Chemical Spill Accidents by Half in South Korea

Hazardous chemical spill (HCS) accidents, which occur due to careless workers, transport accidents, etc., can be harmful to humans. Recently, an average of 96 cases of HCS accidents have taken place in South Korea annually. As a result, the government is trying to reduce the incidence of HCS accidents by 50%. Government officials are seeking information about the value that the enforcement of the reduction plan will bring for the public. This knowledge will help government officials decide whether to implement the reduction plan. This article seeks to acquire information about the public willingness to pay (WTP) for the reduction plan, employing the contingent valuation (CV) technique. For this purpose, a total of 1000 households living in South Korea participated in the CV survey in 2017. The data on the WTP were gathered using a dichotomous choice question and analyzed using the spike model. Forty-five percent of the respondents were willing to accept an increase in income taxes to carry out the reduction plan. The mean household WTP estimate was obtained as KRW 3830 (USD 3.41) per annum. The national value expanded from the sample to the population is worth KRW 74.8 billion (USD 66.6 million) per year. This value implies the public value of the reduction plan and can be applied in policy analysis and decision-making concerning the reduction of the incidence of HCS accidents.

Combined acute inhalation of hydrofluoric acid and nitric acid: a case report and literature review

We describe a nonlethal, delayed onset case of combined acute inhalation of hydrofluoric acid (HFA) and nitric acid (NA) together with a review of the literature. Our patient was exposed to fumes of a 12% HFA and 22% NA solution in a closed environment and suffered during several months after the incident from exertional dyspnoea but recovered completely. Since HFA and NA are dangerous and widely used substances, preparedness for exposure is mandatory. After inhalational exposure, the principles of decontamination with attention to treatment of the skin for HFA burns together with general medical incident management should be applied. The severity of combined NA and HFA intoxication depends on the concentration, the nature of the contact and the duration of exposure but other factors may also be involved. Therapy resistant hypoxia and death have been reported in the literature. Inhalation injury from HFA alone is rare but systemic toxicity should be anticipated. Calcium is advocated as the cornerstone of local and systemic therapy. NA inhalation alone is very rare and causes heavy pulmonary irritation. Massive pulmonary secretions seem a sign of very severe intoxication and treatment appears to be mainly supportive.

Fatal pulmonary edema after acute occupational exposure to nitric acid

BACKGROUND

Nitric acid (HNO(3)) is a solution of nitrogen dioxide (NO(2)) in water commonly used as an industrial chemical and cleaner. Oxides of nitrogen liberated as nitric acid interact with the environment to cause inhalation injuries. The coexistence of HNO(3) with varying oxides of nitrogen likely results in the large continuum of symptoms related to HNO(3) exposure and varying times of onset--acute, subacute, and delayed. Furthermore, dyspnea and evidence of acute lung injury may not occur for several hours after exposure and can lead to rapidly progressive acute respiratory distress syndrome (ARDS).

OBJECTIVES

This case illustrates to physicians and occupational health personnel that HNO(3) inhalation may initially appear benign and that onset of severe effects may be delayed.

CASE REPORT

A 66-year-old man developed delayed-onset pulmonary edema, ARDS, and fatal circulatory collapse 53 h after occupational exposure to HNO(3).

CONCLUSION

This case serves to increase awareness among emergency physicians, as well as occupational health personnel, that patients exposed to HNO(3) may initially be asymptomatic. Patients should be evaluated and observed regardless of the severity or benign nature of symptoms, which occur immediately after exposure, as the most severe symptoms are often delayed in onset and rapidly progressive.