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Fatal chlorine poisoning: report of two cases with clinicopathologic correlation.

Two healthy adults died 25 and 76 hours, respectively, after being exposed to gaseous chlorine. Clinically, each had severe hypoxemia and metabolic acidosis. At autopsy, both patients had severe pulmonary edema with superimposed pneumonia, prominent hyaline membrane formation, multiple recent pulmonary thromboses, and ulcerative tracheobronchitis. The kidneys of the longer-surviving victim were the seat of glomerular capillary thromboses, and the white matter of her brain was studded with focal and confluent destructive hemorrhages. The pulmonary and airway damage in chlorine poisoning are produced by the strong oxidizing action created by the interaction of the toxic gas with water, which results in the liberation of nascent oxygen, a potent protoplasmic poison. Because lungs traumatized by the irritant effect of chlorine may be abnormally vulnerable to the toxic effect of oxygen, it is probable that at least some of the pulmonary damage observed in both victims was created by the deleterious effects of high pressure therapy with this gas.