Nitrogen tetroxide toxicity

Background

• N₂O₄ (NTO) is used as a propellant.
• In 1975 three astronauts on the Apollo-Soyuz Test Project were exposed to NTO during reetry and treated for pulmonary edema and chemical pneumonitis

Clinical Features

• Eye burning and tearing
• Cutaneous pruritis
• Shortness of breath
• Cough
• Pulmonary edema

Differential Diagnosis

Space medicine

• Anemia of spaceflight
• Contact dermatitis of spaceflight
• General physics of spaceflight
• HEENT
  • Acoustics and noise
  • Barotrauma
  • Ear infections (Otitis Media)
  • Dental barotrauma
  • Inner ear dysfunction
  • Ocular foreign body (microgravity)
  • Sinus infection
  • Taste reduction
• Immunology in spaceflight
  • Cytokines and immune function
  • Infectious disease
  • Hypersensitivity and allergic reactions
  • Viral reactivation
• Interpersonal conflicts in spaceflight
• Musculoskeletal effects of spaceflight
  • Bone loss
  • Muscle loss
  • Spinal decompression
  • Trauma
• Pulmonary disorders of spaceflight
  • Ebullism syndrome
  • Hyperoxia
  • Hypercarbia
  • Hypoxia
  • Particulate exposure
  • Toxic exposure
    • Airborne carcinogens
    • Ammonia
    • Carbon dioxide
    • Carbon monoxide
    • Formaldehyde
    • Freons
    • Hypergolic propellant
      • Hydrazine toxicity
      • Nitrogen tetroxide toxicity
    • Sulfurous compounds
• Radiation exposure
• Sinus congestion (Rhinitis) in spaceflight
• Sinus infection (Acute rhinosinusitis) in spaceflight
• Sleep disorders of spaceflight
• Space adaptation syndrome
• Space dentistry
• Space motion sickness
• Spaceflight headache
• Spaceflight genitourinary
  • Kidney stones (Nephrolithiasis)
  • Testicular torsion
  • Urinary retention/incontinence
  • Urinary tract infection

Inhalation injury

Unintentional

• Smoke inhalation injury
  • Cyanide
  • Carbon monoxide
• Chloramine
• Hydrocarbons
• Sewer gas
  • Hydrogen Sulfide
  • Ammonia toxicity
  • Methane
  • Carbon monoxide
• Hydrazine toxicity
• Nitrogen tetroxide
• Metal fume fever

Terrorism

• Pulmonary chemical agents
  • Ammonia
  • Methyl isocyanate
  • methyl bromide
  • Hydrochloric acid
  • Chlorine
  • Phosgene
• Bioterrorism
  • Anthrax
  • Smallpox
  • Plague
  • Tularemia
  • Botulinum toxin
  • Viral hemorrhagic fever
  • Ricin

Evaluation

• Xray (if available)

Management

• Supportive care after removal from the contaminated environment.