The methenamine misunderstanding in the therapy of phosgene poisoning

@article{Diller2004TheMM,
  title={The methenamine misunderstanding in the therapy of phosgene poisoning},
  author={Werner F. Diller},
  journal={Archives of Toxicology},
  year={2004},
  volume={46},
  pages={199-206}
}
  • W. Diller
  • Published 1 December 1980
  • Medicine, Chemistry
  • Archives of Toxicology
A thorough analysis of the pertinent literature leads to the conclusion that there is no justification for the use of methenamine (hexamethylene tetramin, Urotropin) for the therapy of phosgene poisoning. 
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The Prophylactic and Therapeutic Effects of Cholinolytics on Perfluoroisobutylene Inhalation Induced Acute Lung Injury
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The results suggest that cholinolytics might have prophylactic and therapeutic roles in PFIB inhalation induced ALI.
Phosgene-induced acute lung injury (ALI): differences from chlorine-induced ALI and attempts to translate toxicology to clinical medicine
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Hematology revealed hemoconcentration to be an early marker of pulmonary edema and fibrin as a discriminating endpoint that was positive for the airway irritant chlorine and negative for the alveolar irritant phosgene to be a harbinger of progressively developing lung edema.
Inhaled nitric oxide aggravates phosgene model of acute lung injury
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It is demonstrated that accidental exposures can be modeled best in rats by exposure durations of at least 20–30 min, and whether edema formation can be modulated by inhaled nitric oxide (iNO).

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All aspects of phosgene poisoning are discussed: epidemiology, toxicity, pathology, clinical course, complications, mortality, therapy, late effects, chronic intoxication, and acquired resistance.
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TLDR
The increase in mortality with decrease in HMT dose is suggestive of a quantitative relationship between the effective prophylactic dose of HMT and the concentration and dose of phosgene to which the animal is exposed, and the reduction in mortality in the treated animals is highly significant.
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Chemistry of phosgene
Schädliche Gase: Dämpfe, Nebel, Rauch- und Staubarten
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