Chlorine 

### Chlorine (Cl ) 2 

### CAS 7782-50-5; UN 1017 Synonyms include molecular chlorine.

• Persons exposed only to chlorine gas pose little risk of secondary contamination to others. However, clothing or skin soaked with industrial-strength chlorine bleach or similar solutions may be corrosive to rescuers and may release harmful chlorine gas.

• Chlorine is a yellow-green, noncombustible gas with a pungent, irritating odor. It is a strong oxidizing agent and can react explosively or form explosive compounds with many common substances. Chlorine is heavier than air and may collect in low-lying areas.

• Chlorine gas is highly corrosive when it contacts moist tissues such as the eyes, skin, and upper respiratory tract. Significant dermal absorption or ingestion is unlikely.



### Description At room temperature, chlorine is a yellow-green gas with a pungent irritating odor. Under increased pressure or a t temperatures below -30 E F, i t is a clear, amber-colored liquid. It is gene rally shipped in steel cylinders as a compressed liquid

. Chlorine is only slightly soluble in water, but on contact wit h mois ture it forms hypochlorous acid (HClO) and hydrochlori c aci d (HCl); the unstable HClO readily decomposes, formin g oxyg en free radicals. Because of these reactions, wate r substantially enhances chlorine ’s oxidizing and corrosive effects. 

### Routes of Exposure
Inhalation Most exposures to chlorine occur by inhalation. Chlorine’s odor or irritant properties are discernible by most individuals a t 0.32 ppm which is less than the OSHA permissible exposur e lim it (PEL) of 1 ppm. Chlorine’s odor or irritant propertie s generally provide adequate warning of hazardous concentrations. However, prolonged, low-level exposures, such as those tha t occur i n the workplace, can lead to olfactory fatigue an d tolerance of chlorine’s irritant effects. Chlo rine is heavier than air and may cause asphyxiation in poorly ventilated, enclosed, o r low-lying areas. Childrenare at increased risk for exposure to inhaled toxicants because they ha ve a greater lung surface area:body weight ratio and an increased minute volume:weight ratio. Children may b e more vulnerable to corrosive agents than adults because of the smaller diameter of their airways. Children also may be a t

ATSDR • General Information 1Chlorine

Skin/Eye Contact
Ingestion



### Sources/Uses

Standards and Guidelines

Physical Properties incre ased risk because of their short stature, when highe r concentrations of the chemical are found at low-lying areas. Direct contact with liquid c hlorine or concentrated vapor causes severe chemical burns, leading to cell death and ulceration. Ingestion is unlikely to occur because chlorine is a gas at room tempe rature. Solutions that are able to generate chlorine (e.g. , sodium hypochlorite solutions) may cause corrosive injury i f ingested.
Chlorine is produced commercially by electrolysis of sodiu m chlo ride brine. It is among the ten highest volume chemical s manufactured in the United States, with 1998 production i n excess of 14 million tons. Chlorine’ s most important use is as a bleach in the manufacture of

paper and cloth. Chlorine is also used widely as a chemica l reagent in the synthesis and manufacture of metallic chlorides , chlorinated solvents, pesticides, po lymers, synthetic rubbers, and refrigerants. Sodium hypochlorite, which is a component of commercia l bleaches, cleaning solutions, a nd disinfectants for drinking water and w aste water purification systems and swimming pools , releases chlorine gas when it comes in contact with acids. OSHA ceiling = 1 ppm NIO SH IDLH (immediately dangerous to life or health) = 10 ppm AIHA ERPG- 2 (maximum airborne concentration below which it

is believed that nearly all persons could be exposed for up to 1 hour without experiencing or developing irreversible or other ser ious health effects or symptoms that could impair thei r abilities to take protective action) = 3 ppm. Description : Yellow-green gas at room temperature
Warnin g properties : odor and irritation are generally adequate, but olfactory fatigue can occur; p ungent odor at about 0.31 ppm Molecular weight : 70.9 daltons Boiling point : (760 mm Hg) = -29 E F (-34 E C)

2 General Information • ATSDRChlorine Freezing point : -150 E F (-101 E C) Specific gravity : 1.56 at boiling point (water = 1) Vapor pressure : 5,168 mm Hg at 68 E F (20 C) Gas density : 2.5 (air = 1) Water solubility : (0.7% at 68 E F) (20 E C) Flamm ability : Not flammable, but reacts explosively or form s explosive compounds with many common substances 

### Incompatibilities Chlorine reac ts explosively or forms explosive compounds with man y common substances such as acetylene, ether, turpentine , ammonia, fuel gas, hydrogen, and finely divided metals.

ATSDR • General Information 3Chlorine

4 General Information • ATSDRChlorine 

### Health Effects

• Chlorine gas is irritating and corrosive to the eyes, skin, and respiratory tract.

• Exposure to chlorine may cause burning of the eyes, nose, and throat; cough as well as constriction and edema of the airway and lungs can occur.



### Acute Exposure The tox ic effects of chlorine are primarily due to its corrosiv e properties. The action of chlorine is due to its strong oxidizing capability, in which chlori ne splits hydrogen from water in moist tissue, causing the release of nascent oxygen and hydroge n chloride which produce major tissue damage. Alternatively , chlorine may be converted to hypochlorous acid which ca n penetrat e cells and react with cytoplasmic proteins to form N

chloro derivatives that destroy cell structure. Symptoms may be apparent immediately or delayed for a few hours. Respiratory Chlorine is water soluble and therefore, primar ily removed by the upper airways. Exposure to low concentrations of chlorine (1 to 10 ppm) may cause eye and nasal irritation, sore throat, an d coug hing. Inhalation of higher concentrations of chlorine ga s (>1 5 ppm) can rapidly lead to respiratory distress with airwa y cons triction and accumulation of fluid in the lungs (pulmonar y edema). Patients may have immediate onset of rapid breathing, blue discoloration of the skin, wheezing, rales or hemoptysis. In symp tomatic patients, pulmonary injury may progress ove r severa l hours. Lung collapse may occur. The lowest letha l conce ntration for a 30-minute exposure has been estimated a s 430 ppm. Exposure to chlorine can lead to reactive airway s dysfunction syndrome (RADS), a chemical irritant-induced type of asthma. Children may be more vulnerable to corrosive agents than adults be cause of the smaller diameter of their airways. Children ma y also be more vulnerable to gas exposure because of increase d minut e ventilation per kg and failure to evacuate an are a promptly when exposed. Cardiovascular Tachycardia and initial hypertension followed by hypotensio n may o ccur. After severe exposure, cardiovascular collapse may occur from lack of oxygen.

ATSDR • Health Effects 5Chlorine Metabolic Acidosis may result from insufficient oxygenation of tissues. An unusual complicatio n of massive chlorine inhalation is an excess of chloride ions in the blood, causing an acid-base imbalance.
Be cause of their higher metabolic rates, children may be mor e vulnerable to toxicants interfering with basic metabolism. Dermal Chlorin e irritates the skin and can cause burning pain , infl ammation, and blisters. Exposure to liquefied chlorine ca n result in frostbite injury. Ocular Low concentrations in air can cause burning discomfort , spasmodic blinking or involuntary closing of the eyelids, redness, conjun ctivitis, and tearing. Corneal burns may occur at hig h concentrations. Potential Sequelae After acute exposure, pulmonary function usually returns toward baselin e within 7 to 14 days. Although complete recover y ge nerally occurs, symptoms and prolonged pulmonar y imp airment may persist. Exposure to chlorine can lead t o rea ctive airways dysfunction syndrome (RADS), a chemica l irritant-induced type of asthma. Chronic Exposure Chron ic exposure to chlorine, usually in the workplace, ma y cause corrosion of the teeth. Multiple exp osures to chlorine have produced flu-like symptoms and a high risk of developin g reactive airways dysfunction syndrome (RADS). Carcinogenicity
Reproductive and Developmental Effects Chlor ine has not been classified for carcinogenic effects

. Howe ver, the association of cigarette smoking and chlorin e fumes may increase the risk of cancer.
No information is available regarding reproductive o r develo pmental effects of chlorine in experimental animals o r humans. Chlorine gas has been used as a c hemical warfare agent, but no retrospective reprodu ctive studies of survivors have been pub lished. Chlorine is not included in Reproductive an d Developmental Toxicants , a 1991 report published by the U.S. General Accounting Office (GAO) that lists 30 chemicals o f co ncern because of widely acknowledged reproductive an d developmental consequences.

6 Health Effects • ATSDRChlorine 

### Prehospital Management

• Rescue personnel are at low risk of secondary contamination from victims who havebeen exposed only to chlorine gas. However, clothing or skin soaked with industrialstrength bleach or similar solutions may be corrosive to rescuers and may release harmful chlorine gas.

• Acute exposure to chlorine gas initially causes coughing, eye and nose irritation, lacrimation, and a burning sensation in the chest. Airway constriction and noncardiogenic pulmonary edema may occur. Chlorine irritates the skin and can cause burning pain, inflammation, and blisters. Exposure to liquefied chlorine can result in frostbite.

• There is no specific antidote for chlorine poisoning. Treatment is supportive.



### Hot Zone Res cuers should be trained and appropriately attired befor e entering the Hot Zone. If the proper equipment is not available, or if rescuers have not been trained in its use, assistance should be obtained from a local or regional HAZMAT team or othe r properly equipped response organization.
Rescuer Protection Chlorine is a severe respiratory-tract and skin irritant.
Re spiratory Protection : Positive-pressure, self-containe d breat hing apparatus (SCBA) is recommended in respons e situations that involve exposure to potentially unsafe levels o f chlorine. Skin Protection : Chemical-protective clothing should be wor n becaus e chlorine gas can condense on the skin and caus e irritation and burns. ABC Reminders Quickl y access for a patent airway, ensure adequate respiration and pulse. If trauma is suspected, maintain cervica l im mobilization manually and apply a cervical collar and a backboard when feasible. Victim Removal If v ictims can walk, lead them out of the Hot Zone to th e Decontamination Zon e. Victims who are unable to walk may be removed on backboards or gurneys; if these are not available , carefully carry or drag victims to safety. Cons ider appropriate management of chemically contaminate d children, such as measures to redu ce separation anxiety if a child is separated from a parent or other adult.

ATSDR • Prehospital Management 7Chlorine 

### Decontamination Zone

Rescuer Protection

ABC Reminders

Basic Decontamination

Transfer to Support Zone Victim s exposed only to chlorine gas who have no skin or ey e irritation do not need d econtamination. They may be transferred immed iately to the Support Zone. All others requir e decontamination as described below. If

exp osure levels are determined to be safe, decontaminatio n may be conducted by personnel wearing a lower level o f protection than that worn in the Hot Zone (described above). Quickl y access for a patent airway, ensure adequate respiration and pulse. Stabilize the cervical spine with a collar and a backboard if trauma is suspected. Administer supplementa l oxygen as required. Assist ventilation with a bag-valve-mas k device if necessary. Victims who are able and cooperative may assist with their own decontamination. Remove and double-bag conta minated clothing and personal belongings. Handle frostbitten skin and eyes with caution. Place frostbitten skin in warm water, abo ut 108 E F (42 E C). If warm water is not availab le wrap the affected part gently in blankets. Let th e circu lation reestablish itself naturally. Encourage the victim t o exercise the affected part while it is being warmed. Flush exposed ski n and hair with plain water for 3 to 5 minutes, then wash twice with mild soap. Rinse thoroughly with water.
Do not irrigate eyes that have sustained frostbite injury

. Otherwise, irrig ate exposed or irritated eyes with plain water or saline for 15 minutes. Eye irrigation may be carried ou t simu ltaneously with other basic care and transport. Remov e contact lenses if it can be done without additional trauma to the eye. If a corrosive material is suspected or if pain or injury i s evid ent, continue irrigation while transferring the victim to th e support zone. Cons ider appropriate management of chemically contaminate d children, such as measures to redu ce separation anxiety if a child is separated from a parent or other adult. If possible, see k assistance from a child separation expert. As soo n as basic decontamination is complete, move the victim to the Support Zone.

8 Prehospital Management • ATSDRChlorine 

### Support Zone

ABC Reminders

Additional Decontamination Advanced Treatment Be certai n that victims have been decontaminated properly (see Decontamination Zone above). Victims who have undergon e decontamination or have been expo sed only to chlorine gas pose no serious risks of seco ndary contamination to rescuers. In such cases, Support Zone pe rsonnel require no specialized protective gear. Quickly access for a patent airway. If trauma is suspected , mai ntain cervical immobilization manually and apply a cervica l collar and a backboard when feasible. Ensure adequat e resp iration and pulse. Administer supplemental oxygen a s requir ed and establish intravenous access if necessary. Place on a c ardiac monitor. Watch for signs of airway swelling an d obstruction such as prog ressive hoarseness, stridor, or cyanosis. Continue irrigating exposed skin and eyes, as appropriate. In cases of respiratory compromise secure ai rway and respiration via endotracheal intu bation. Avoid blind nasotracheal intubation or use o f an esophageal obturator. Use direct visualization t o in tubate. When the patient’s condition precludes endotrachea l intuba tion, perform cricothyroidectomy if equipped and trained to do so.
Treat patients who have bronchospasm with aerosolize d bro nchodilators. The use of bronchial sensitizing agents i n situa tions of multiple chemical exposures may pose additiona l ri sks. Consider the health of the myocardium before choosin g wh ich type of bronchodilator should be administered. Cardia c sensiti zing agents may be appropriate; however, the use o f cardia c sensitizing agents after exposure to certain chemical s may pose enhanced risk o f cardiac arrhythmias (especially in the elderly). Chlorine poisoning i s not known to pose additional risk during the use of bronchial or cardiac sensitizing agents. Consider racemic epinephrine aerosol for children who develop strido r. Dose 0.25–0.7 5 m of 2.25% racemic epinephrin e so lution in 2.5 cc water, repeat every 20 minutes as neede d cautioning for myocardial variability.
Pat ients who are comatose, hypotensive, or having seizures o r who ha ve cardiac arrhythmias should be treated according t o advanced life support (ALS) protocols. If

f

rostbite is present, treat by rewarming in a water bath at a temperature of 102 to 108 E F (40 to 42 E C) for 20 to 30 minutes and continue until a flush has returned to the affected area.

ATSDR • Prehospital Management 9Chlorine Transport to Medical Facility On ly decontaminated patients or those not requirin g decon tamination should be transported to a medical facility

. “Body bags” are not recommended. Rep ort to the base station and the receiving medical facility the cond ition of the patient, treatment given, and estimated time of arrival at the medical facility. Multi-Casualty Triage Consult with the base station physician or the regional poiso n control center for advice regarding triage of multiple victims. Patie nts with evidence of significant exposure (e.g., severe o r per sistent cough, dyspnea or chemical burns) should b e transported to a medical facility for evaluation. Patients wh o have mino r or transient irritation of the eyes or throat may b e dischar ged from the scene after their names, addresses, an d telephone numbers are recorded. They should be advised to seek medical care promptly if symptoms develop or recur (see Patient Information Sheet below).

10 Prehospital Management • ATSDRChlorine 

### Emergency Department Management

• Hospital personnel are at minimal risk of secondary contamination from patients who have been exposed only to chlorine gas. However, clothing or skin soaked with industrial-strength bleach or similar solutions may be corrosive to personnel and may release harmful chlorine gas.

• Acute exposure to chlorine gas initially causes coughing, eye and nose irritation, lacrimation, and a burning sensation in the chest. Airway constriction, noncardiogenic pulmonary edema, hemoptysis, and bronchopneumonia may occur. • Chlorine irritates the skin and can cause burning pain, inflammation, and blisters. Exposure to liquefied chlorine can result in frostbite.

• There is no specific antidote for chlorine poisoning. Treatment requires supportive care.



### Decontamination Area Previously decontaminated patients and patients exposed only to ch lorine gas who have no skin or eye irritation may b e transfe rred immediately to the Critical Care Area. All other s require decontamination as described below. ABC Reminders Evaluate and support airway, breathing, and cir culation. Children may be more vulner able to corrosive agents than adults because of

the smaller diameter of their airways. In cases of respiratory compromise secure airway and respiration via endotrachea l intubation. If not possible, surgically secure an airway.
Treat patients who have bronchospasm with aerosolize d bro nchodilators. The use of bronchial sensitizing agents i n si tuations of multiple chemical exposures may pose additiona l ri sks. Consider the health of the myocardium before choosin g wh ich type of bronchodilator should be administered. Cardia c sensiti zing agents may be appropriate; however, the use o f cardia c sensitizing agents after exposure to certain chemical s may pose enhanced risk o f cardiac arrhythmias (especially in the elderly). Chlorine poisoning i s not known to pose additional risk during the use of bronchial or cardiac sensitizing agents. Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25–0.75 mL of 2.25% racemic epinephrin e so lution in 2.5 cc water, repeat every 20 minutes as neede d cautioning for myocardial variability.

ATSDR • Emergency Department Management 11Chlorine

Basic Decontamination



### Critical Care Area

ABC Reminders

Inhalation Exposure Pat ients who are comatose, hypotensive, or having seizures o r car diac arrhythmias should be treated in the conventiona l manner. Patients who are able an d cooperative may assist with their own decontamination. Remove and double bag c ontaminated clothing and personal belongings. Handle frostbitten skin and eyes with caution. Place frostbitten skin in warm water, abo ut 108 E F (42 E C). If warm water is not ava ilable, wrap the affected part gently in blankets. Let th e circu lation reestablish itself naturally. Encourage the victim t o exercise the affected part while it is being warmed. Flus h exposed skin and hair with plain water for 2 to 3 minutes (pref erably under a shower), then wash twice with mild soap

. Rinse thoroughly w ith water. Use caution to avoid hypothermia when decontaminating children or the elderly. Use blankets o r warmers when appropriate.
Do not irrigate frostbitten eyes. Otherwise, begin irrigation o f exposed eyes. Remove contact lenses if it can be done without ad ditional trauma to the eye. Continue irrigation whil e transporting the patient to the Critical Care Area. Be certain that appropriate decontaminat ion has been carried out (see Decontamination Area above). Evalu ate and support airway, breathing, and circulation as i n ABC Reminders above. Establish int ravenous access in seriously ill patients if this has not been done previously. Continuousl y monitor cardiac rhythm.
Pat ients who are comatose, hypotensive, or having seizures o r car diac arrhythmias should be treated in the conventiona l manner. Admi nister supplemental oxygen by mask to patients who have re spiratory symptoms. Treat patients who have bronchospas m wi th aerosolized bronchodilators. The use of bronchia l se nsitizing agents in situations of multiple chemical exposure s may pos e additional risks. Consider the health of th e myo cardium before choosing which type of bronchodilato r should be administered. Cardiac sensitizing agents may b e appropriate; howev er, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (espec ially in the elderly). Chlorine poisoning is not

12 Emergency Department Management • ATSDRChlorine known t o pose additional risk during the use of bronchial o r cardiac sensitizing agents. Children may be more vulnerable to corrosive agents than adults because of their smaller airways. Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25–0.75 mL of 2.25% racemic epinephrin e so lution in 2.5 cc water, repeat every 20 minutes as neede d cautioning for myocardial variability. Skin Exposure If concentrated chlorine gas or chlorine-generating solution s cont act the skin, chemical burns may occur; treat as therma l burns. If the liquefied compressed gas is released and contact s the skin, frostbite may result. If a victim has frostbite, treat b y rewarming affected areas in a water bat h at a temperature of 102 to 108 E F (40 to 42 E C) for 20 to 30 minutes and continue until a flush has returned to the affected area.
Because of their larger surface area:body weight ratio childre n are more vulnerable to toxicants absorbed through the skin. Eye Exposure

Antidotes and Chlorine-exposed eyes should be irrigated for at leas t 15 min utes. Test visual acuity and examine the eyes for corneal damag e and treat appropriately. Immediately consult a n ophthalmologist for patients who have corneal injuries. Other Treatments There is no specific antidote for chlorine. Treatment i s supportive. Laboratory Tests



### Disposition and Follow-up Th e diagnosis of acute chlorine toxicity is primarily clinical , based on respiratory difficulties and irritation. However , laboratory testing is useful for monitoring the patient an d eva luating complications. Routine laboratory studies for al l exp osed patients include CBC, glucose, and electrolyt e dete rminations. Patients who have respiratory complaints ma y re quire pulse oximetry (or ABG measurements) and ches t ra diography. Massive inhalation may be complicated b y hype rchloremic metabolic acidosis; in addition to electrolytes , monitor blood pH. Consider hospitalizing p atients who have a suspected significant exposure or have eye burns or serious skin burns. Delayed Effects Sympt omatic patients complaining of persistent shortness o f breath, severe cough, or chest tightness should be admitted t o

ATSDR • Emergency Department Management 13Chlorine the hospital an d observed until symptom-free. Pulmonary injury may progress for several hours. Patient Release Asym ptomatic patients and those who experienced only mino r se nsations of burning of the nose, throat, eyes, and respirator y tract (w ith perhaps a slight cough) may be released. In mos t cases, these patients will be free of symptoms in an hour or less. They should be advised to seek medical care promptly i f sy mptoms develop or recur (see the Chlorine—Patien t Information Sheet below). Follow-up Obtain the name of the patient’s primary care physician so that th e hospital can send a copy of the ED visit to the patient’ s doctor. Follow u p is recommended for all hospitalized patients because long-term respiratory problems can result. Respirator y mo nitoring is recommended until the patient is symptom-free

. Chlorine-induced reactive airways dysfunction syndrom e (RADS) has been reported to persist from 2 to 12 years. Patients who have skin or corneal injury should be re-examined within 24 hours. 

### Reporting If a w ork-related incident has occurred, you may be legall y requi red to file a report; contact your state or local healt h department. Other per sons may still be at risk in the setting where thi s incide ntoccurred. If the incident occurred in the workplace , discus sing it with company personnel may prevent futur e incidents. I f a public health risk exists, notify your state or local health department or other responsible public agency. Whe n appropriate, inform pa tients that they may request an evaluation of their workplace from OSHA or NIOSH. See Appendices III and IV for a list of agencies that may be of assistance.

14 Emergency Department Management • ATSDRChlorine 

### Chlorine Patient Information Sheet This handout provides information and follow-up instructions for persons who have been exposed to chlorine. What is chlorine? Chlorine is a yellowish-green gas with a sharp, burning odor. It is used widely in chemica l manu facturing, bleaching, drinking-water and swimming-pool disinfecting, and in cleaning agents

. Ho usehold chlorine bleach contains only a small amount of chlorine but it can release chlorine gas i f mixed with other cleaning agents. What immediate health effects can be caused by exposure to chlorine? Even small exposures to the gas may cause immediate burning of the eyes, nose, and throat, an d shortness of breath, as well as coughing, wheezing, shortness of breath, and tearing of the eyes

. However, once exposure is stopped, symptoms usually clear up quickly. Breathing large amounts o f chlorine may cause the lining of the throat an d lungs to swell, making breathing difficult. Generally, the more serious the exposure, the more severe the symptoms. Can chlorine poisoning be treated? The re is no antidote for chlorine, but its effects can be treated and most exposed persons get well

. Persons who have experienced serious symptoms may need to be hospitalized. Are any future health effects likely to occur? A

single small exposure from which a person recovers quickly is not likely to cause delayed or longterm effects. After a serious exposure, symptoms may worsen for several hours. What tests can be done if a person has been exposed to chlorine? Specifi c tests for the presence of chlorine in blood or urine generally are not useful to the doctor. If a severe exposure has occurred, blood and urine analyses and other tests may show whether the lungs, heart, or brain has been injured. Testing is not needed in every case. Where can more information about chlorine be found? More information about chlorine c an be obtained from your regional poison control center, your state, county, or local he alth department; the Agency for Toxic Substances and Disease Registry (ATSDR); your d octor; or a clinic in your area that specializes in occupational and environmental health. If th e exp osure happened at work, you may wish to discuss it with your employer, the Occupational Safety and Health Administration (OSHA), or the National Institute for Occupational Safety and Healt h (NIOSH). Ask the person who gave you this form for help in locating these telephone numbers.

ATSDR • Patient Information Sheet 15Chlorine 

### Follow-up Instructions Keep this page and take it with you to your next appointment. Follow only the instructions checked below. [ ] Call y our doctor or the Emergency Department if you develop any unusual signs or symptoms within the next 24 hours, especially:

• coughing or wheezing

• difficulty breathing, shortness of breath, or chest pain

• increased pain or a discharge from injured eyes

• increased redness or pain or a pus-like discharge in the area of a skin burn [ ] No follow-up appointment is necessary unless you develop any of the symptoms listed above. [ ] Call for an appointment with Dr. in the practice of

. When you call for your appointment, please say that you were treated in the Emergency Department at Hospital by and were advised to be seen again in days. [ ] Return to the Emergency Department/ Clinic on (date) at AM/PM for a follow-up examination. [ ] Do not perform vigorous physical activities for 1 to 2 days. [ ] You may resume everyday activities including driving and operating machinery. [ ] Do not return to work for days. [ ] You may return to work on a limited basis. See instructions below. [ ] Avoid exposure to cigarette smoke for 72 hours; smoke may worsen the condition of your lungs. [ ] Avoid drinking alcoholic beverages for at least 24 hours; alcohol may worsen injury to your stomach or have other effects. [ ] Avoid taking the following medications: [ ] You may continue taking the following medication(s) that your doctor(s) prescribed for you:

[ ] Other instructions:

• Provide the Emerg ency Department with the name and the number of your primary care physician so that the ED can send him or her a record of your emergency department visit.

• You or your physician can get more information on the chemical by contacting: or , or by checking out the following Internet Web sites: ; . Signature of patient Date Signature of physician Date

16 Patient Information Sheet • ATSDR