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This case report presents an acute and chronic inflammation process at the same time and resulted in death following exposure to chlorine gas. A 65-years-old woman died shortly after cleaning her bathroom with a mixture of various chemicals including bleach and an acid containing product. She was declared dead when she arrives to hospital. She is a non-smoker and has no significant medical history other than asthma. Toxicological analysis showed that paracetamol, methylprednisolone, venlafaxine and its metabolite O-desmethylvenlafaxine were detected in blood. Histological examinations showed edema, fresh intra alveolar bleeding and emphysematous changes in both lungs. Asthma and acute inhalation injury have a relatively lower mortality rates. However, the coincidence of both clinical presentations may be the cause of death. with a mixture of various chemicals including bleach and an acid containing product (hydrochloric acid). According to witnesses, her symptoms include cough, shortness of breath along with red tearing eyes. She is a non-smoker and has no significant medical history other than asthma. She was declared dead when she arrives to hospital. The decedent was 155 cm tall and weighed 67 kg. The external findings were unremarkable. Internally the left and right lungs weighed 303 g and 421 g, respectively, and showed marked pulmonary edema, congestion and hyperemia. The heart weighed 270 g and the brain weighed 1056 g both organs were congested. The coronary artery showed no abnormal findings. Histological examinations showed edema, fresh intra alveolar bleeding and emphysematous changes in both lungs, perivascular interstitial fibrosis in heart, and that brain, kidney and liver were congested. Toxicological analysis showed that paracetamol (2300 ng/mL), methylprednisolone (274 ng/mL), venlafaxine and its metabolite O-desmethylvenlafaxine (133 ng/mL) were detected in blood. These drugs and their levels can be explained by the drugs she received for her asthma and depression. Inhalated gas or particulates may cause respiratory tract diseases. Exposure to a toxic agent in this way generally appears during industrial or domestic accidents. One of the most common used toxic irritant gases is chlorine gas. Mixing sodium hypochlorite with any acid containing product generates chlorine gas. The respiratory damage of toxic gases is related to several factors. The most important factors are the concentration of gas and the degree of water solubility. Highly water soluble gas accumulates in the upper airways and can lead to more acute conjunctival, nasal and laryngeal symptoms. The less water soluble gas can reach the distal airways and alveoli. As chlorine gas water solubility at the medium level, it can cause acute injury to both upper and lower airways.

A Case Report: What is the Real Cause of Death from Acute Chlorine Exposure in an Asthmatic Patient?