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Rose L. Tse, MD, PhD; Albert A. Bockman, MD

JAMA. 1970;212(8):1341-1344.

Abstract
Four firemen with acute toxic reactions to nitrogen dioxide were observed over a period of 18 months. A wide spectrum of responses was noted. All had initial symptoms of acute toxic conditions. One subsequently developed chronic pulmonary insufficiency; the other three eventually became asymptomatic. Since initial symptoms of acute toxic conditions are often minimal and delayed onset of respiratory distress and superimposed bacterial infection are distinct possibilities, patients with significant exposure should be hospitalized and observed for at least 48 hours. After discharge from the hospital, these patients should be closely observed for at least an additional six weeks, since the second acute phase of the illness, which may be fatal, usually occurs during this period. Certain studies on chronic exposure of animals to low concentrations of nitrogen dioxide, an important air pollutant, are reviewed.

Author Affiliations
From the Department of Medicine, Philadelphia General Hospital, Philadelphia.

Footnotes
Read in part before the 28th annual Eastern Pennsylvania regional meeting of the American College of Physicians, Hershey, Pa, Nov 15,1968.

Reprint requests to Philadelphia General Hospital, 34th St and Civic Center Blvd, Philadelphia 19104 (Dr. Tse).

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