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      Phosgene exposure: mechanisms of injury and treatment strategies.

      Journal of Occupational and Environmental Medicine
      Adult, Environmental Exposure, Humans, Phosgene, poisoning, Poisoning, therapy, Pulmonary Edema, chemically induced, physiopathology, Respiratory Distress Syndrome, Adult, Triage

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          Abstract

          Phosgene (carbonyl chloride, CAS 75-44-5) is a highly reactive gas of historical interest and current industrial importance. Phosgene has also proved to be a useful model for the study of those biochemical mechanisms that lead to permeability-type pulmonary edema (adult respiratory distress syndrome). In turn, the study of phosgene-induced adult respiratory distress syndrome has provided insights leading to revised treatment strategies for exposure victims. We summarized recent findings on the mechanisms of phosgene-induced pulmonary edema and their implications for victim management. In light of that research, we also provide a comprehensive approach to the management and treatment of phosgene exposure victims.

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          Most cited references44

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          Reactive Airways Dysfunction Syndrome (RADS)

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            Review of the Toxicity of Long-Term Phosgene Exposure

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              Pharmacokinetics and absolute bioavailability of ibuprofen after oral administration of ibuprofen lysine in man.

              The lysine salt of d,l-2-(4-isobutylphenyl)-propionic acid (ibuprofen lysine) was administered as a single oral dose of 500 mg by means of commercially available coated tablets (Imbun).* To assess the absolute bioavailability of ibuprofen after its oral application as a lysine salt, intravenous injections of ibuprofen solutions containing 200 mg and 400 mg of the drug served as reference application. In a partially randomized cross-over design, 8 healthy male volunteers received three different single dose administrations which were separated by wash-out periods of 4 days each. Ibuprofen plasma concentrations were determined by HPLC using direct injection, pre-column enrichment and column switching techniques. From the results of intravenous injections one can deduce linear ibuprofen pharmacokinetics within the considered dosage range, with corresponding AUC0-infinity values of 3786 micrograms * min ml-1 and 7260 micrograms * min ml-1 for the 200 mg and 400 mg doses, respectively. The values of plasma clearances as well as those of different volumes of distribution showed remarkable constancy after evaluation from both intravenous injections. The absorption of orally administered ibuprofen lysine proved to be rapid, resulting in a mean peak plasma level (Cmax) of 31 micrograms ml-1 ibuprofen and in a mean time to peak (tmax) of 45 min. The absolute bioavailability of ibuprofen amounts to 102.7 per cent, indicating a complete absorption of ibuprofen when administered as its lysine salt. Drug tolerability was excellent for the oral administration of ibuprofen lysine as well as for the intravenous treatments with ibuprofen free acid. Only mild and transient adverse drug reactions such as mild burning or dragging sensation during injection or mild redness at the site of injection were reported.
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                Author and article information

                Journal
                11227628
                10.1097/00043764-200102000-00008

                Chemistry
                Adult,Environmental Exposure,Humans,Phosgene,poisoning,Poisoning,therapy,Pulmonary Edema,chemically induced,physiopathology,Respiratory Distress Syndrome, Adult,Triage

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