Accidental Nitric acid Gas Exposure and Respiratory Effect

Introduction: Nitric acid also known as aqua fortis is a highly strong corrosive mineral acid. Accidental exposure to nitric acid inhalation can be fatal. In this case report, we will share our experience on successful management of a patient developing respiratory insufficiency subsequent to nitric acid inhalation. Case: A 46 years old non smoker male patient was admitted to the emergency department (ED) with the complaint of difficulty in breathing and cough. Two days prior to being admitted to the ED an accident occurring in his workplace caused dispersion of nitric acid in the closed working environment for approximately 10 minutes. Afterwards mild symptoms of dyspnea and coughing started that progressed causing him to apply to the hospital. Upon admittance to the ED he had severe stridor and signs of bronchospasm with a SpO2 level of 85% and respiratory rate of 38/min. Immediate treatment was initiated with intra venous Methyl-prednisolone 120 mg, N-acetyl cysteine (NAC) 1200 mg enteral and bronchodilators. Noninvasive mechanical ventilation (NIV) was initiated. Within four hours the respiratory rate normalized and he hospitalized at ward for one week. End of the treatment he did not require any further oxygen supportive treatment. Conclusion: Nitric acid exposure may be life-threatening and fatal, early administration (initial 24 hours) to hospital is essential. N-acetyl cysteine, corticosteroids, and bronchodilators may be helpful as medical treatment. Noninvasive mechanical ventilation can be use as a supportive therapy for the respiratory symptoms.