Irritant and asphyxiant gases

Abstract

Both irritant and asphyxiant gases are hazardous substances that, when inhaled, can cause a spectrum of respiratory complications, ranging from mild irritation to life-threatening respiratory failure. These gases are classified into three main categories based on their mechanisms of toxicity: pulmonary irritants, simple asphyxiants, and chemical asphyxiants. Pulmonary irritants, such as chlorine, phosgene, and ammonia, cause direct injury to the respiratory mucosa, leading to inflammation, bronchospasm, and pulmonary edema. Simple asphyxiants, including nitrogen, methane, and carbon dioxide, displace oxygen in the environment, resulting in hypoxia and potentially fatal respiratory depression. Chemical asphyxiants, such as carbon monoxide, hydrogen cyanide, and hydrogen sulfide, interfere with oxygen transport or cellular respiration, causing systemic hypoxia at the mitochondrial level.

Diagnosis of the gas exposure relies on a detailed history of exposure, clinical symptoms, and laboratory investigations, including arterial blood gas analysis, pulse oximetry, and carboxyhemoglobin or methemoglobin levels. Management involves immediate removal from the toxic environment, decontamination, oxygen supplementation, and supportive treatment. Specific antidotes, such as hydroxocobalamin for cyanide poisoning and methylene blue for methemoglobinemia, may be required in severe cases. Given the potential for rapid deterioration, early recognition and prompt intervention are essential in preventing morbidity and mortality. This review provides an in-depth analysis of the toxicology, pathophysiology, and management strategies associated with asphyxiant gas exposure.