질산(Nitric Acid) 증기 흡입에 의한 급성호흡곤란증후군 1예
A Case of Acute Respiratory Distress Syndrome Caused by Nitric Acid Inhalation
송정섭 (가톨릭대학교)
박성학 (가톨릭대학교)
김치홍 (가톨릭대학교)
문화식 (가톨릭대학교)
윤혜은 (가톨릭대학교)
이승재 (가톨릭대학교)
김용현 (가톨릭대학교)
송소향 (가톨릭대학교)
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초록
질산은 금속의 순화, 세척, 전기도금에 사용되는 산화제로서 공기나 금속과 반응하여 발생하는 증기를 흡입하는 경우 화학성 폐렴을 유발할 수 있다. 44세 남자가 보호 장구 없이 질산을 이용하여 기계 얼룩 제거 작업을 4시간가량 한 후, 기침과 호흡곤란이 발생하여 내원하였다. 내원 당시 혈압 80/50 mmHg, 맥박수 분당 140회, 호흡수 분당 26회, 체온은 36.5℃ 이었다. 내원 직후 Ambu bagging을 하면서 실시한 동맥혈 검사에서 pH 7.26, PaCO2 49.2 mmHg, PaO2 31.1 mmHg, HCO3 21.3 mmHg, SaO2 54.2%로 호흡성 산증과 저산소증이 나타났으며, 흉부 방사선 검사에서 양측 폐야의 폐포성 경화와 미만성 폐침윤이 관찰되어 임상적으로 급성호흡곤란증후군으로 진단되었다. 환자는 호기말 양압을 이용한 기계 환기 및 항생제, 기관지 확장제, 전신적인 스테로이드 치료 후 완전히 회복하였으며 추적 흉부 방사선 검사와 고해상 전산화단층촬영 및 폐기능 검사에서도 합병증 없이 모두 호전되었기에 이를 보고하는 바이다.
- keywords
- Nitric acid, Chemical pneumonitis, Acute respiratory distress syndrome, Mechanical ventilation, Nitric acid, Chemical pneumonitis, Acute respiratory distress syndrome, Mechanical ventilation
Abstract
Nitric acid is an oxidizing agent used in metal refining and cleaning, electroplating, and other industrial applications. Its accidental spillage generates oxides of nitrogen, including nitric oxide (NO) and nitrogen dioxide (NO2), which cause chemical pneumonitis when inhaled. The clinical presentation of a nitric acid inhalation injury depends on the duration and intensity of exposure. In mild cases, there may be no symptoms during the first few hours after exposure, or the typical symptoms of pulmonary edema can appear within 3-24 hours. However, in cases of prolonged exposure, progressive pulmonary edema develops instantaneously and patients may not survive for more than 24 hours. We report a case of a 44-year-old male who was presented with acute respiratory distress syndrome after nitric acid inhalation. He complained of cough and dyspnea of a sudden onset after inhaling nitric acid fumes at his workplace over a four-hour period. He required endotracheal intubation and mechanical ventilation due to fulminant respiratory failure. He was managed successfully with mechanical ventilation using positive end expiratory pressure and systemic corticosteroids, and recovered fully without any deterioration in his pulmonary function. (Tuberc Respir Dis 2005; 59: 690-695)
- keywords
- Nitric acid, Chemical pneumonitis, Acute respiratory distress syndrome, Mechanical ventilation, Nitric acid, Chemical pneumonitis, Acute respiratory distress syndrome, Mechanical ventilation
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