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INHALATIONAL AIRWAY INJURY DURING ILLICIT METHAMPHETAMINE PRODUCTION
Kamaljit Dhaliwal, MD, Resident & Akshay Sood, MD, MPH, Assistant Professor of Medicine
Case Presentation
Photograph of Skin Burns
Chest X-ray Portable Anteroposterior View
Questions
References
A 35 year old white male with no significant past
medical history was transferred from a small rural town in Illinois
to the Regional Burns Unit at the University hospital. The patient
was a farmer’s son and a 20 pack-year smoker. He was involved
in the illicit manufacture of methamphetamine in the basement of his
home. Subsequent explosion resulted in 16 % TBSA burn involving face,
neck and hands, difficulty with breathing and vision.
Before transfer to the Burns Unit, the patient was intubated in the field by the paramedics, his eyes were irrigated with water, and a nasogastric tube and an indwelling urinary catheter was placed. His examination in the Burns Unit showed conjunctival erythema; lacrimation, thick nasal discharge, wheezing, throat and second degree skin burns (see Figure 1). His Laboratory reports were within normal limits. His arterial blood gases drawn on Assist Control mode of ventilation with a tidal volume of 8 cc/kg. body weight, respiratory rate of 12/minute, peep of 5 and FiO2 of 40% showed a pH of 7.48 and a PaCO2 of 32 mms. of Hg. and PaO2 of 70 mms. of Hg. His chest X-ray portable anteroposterior view is shown in Figure 2.
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Figure 1: Photograph of skin burns
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Figure
2: Chest X-ray portable anteroposterior view
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Which ONE of the following is a possible cause of chemical inhalational lung injury during production of illicit methamphetamine?
Question 2:
Which ONE of the following BEST describes the pathophysiology of the tissue injury caused by this chemical?
Question 3:
Which ONE of the following is not seen during the bronchoscopic examination of this patient’s airways?
Question 4:
Which ONE of the following statements is false?
Question 5:
Which ONE of the following may NOT be useful in the management of this patient?
Question 6:
Which ONE of the following is LEAST likely to be a late sequela of this exposure?
References:
1. Wibbenmeyer, L.A., et al., Our chemical burn experience: exposing
the dangers of anhydrous ammonia. J Burn Care Rehabil, 1999. 20(3):
p. 226-31.
2. Millea, T.P., J.O. Kucan, and E.C. Smoot, 3rd, Anhydrous ammonia
injuries. J Burn Care Rehabil, 1989. 10(5): p. 448-53.
3. Montague, T.J. and A.R. Macneil, Mass ammonia inhalation. Chest,
1980. 77(4): p. 496-8.
4. Summer, W. and E. Haponik, Inhalation of irritant gases. Clin Chest
Med, 1981. 2(2): p. 273-87.
5. Close, L.G., F.I. Catlin, and A.M. Cohn, Acute and chronic effects
of ammonia burns on the respiratory tract. Arch Otolaryngol, 1980.
106(3): p. 151-8.
6. O'Kane, G.J., Inhalation of ammonia vapour. A report on the management
of eight patients during the acute stages. Anaesthesia, 1983. 38(12):
p. 1208-13.
7. Arwood, R., J. Hammond, and G.G. Ward, Ammonia inhalation. J Trauma,
1985. 25(5): p. 444-7.
8. Birken, G.A., P.J. Fabri, and L.C. Carey, Acute ammonia intoxication
complicating multiple trauma. J Trauma, 1981. 21(9): p. 820-2.
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