The toxicology of zinc chloride smoke producing bombs and screens

Figures & data

Table 1. Overview of ZnCl₂ intoxication cases.

Case	Year of exposure/publication	Origin	Subjects	Fatalities	Cases analysed	Remarks	Ref.
Sailor overcome by a smoke screen	1942/1945	United Kingdom	1	0	1		[5]
Explosion of smoke generators in adjacent room	1943/1945	United Kingdom	7	3	1	Incident occurred in Mediterranean during WWII	[6]
Smoke generators ignited next to air-raid shelter	1943/1945	United Kingdom	70	10		Incident occurred in Malta during WWII	[7]
Smoke bomb ignited at night in fraternity house	unknown/1952	United States	47	0			[8]
Exposure to smoke during military training	1952/1954	United Kingdom	1	0	1		[9]
Exposure to smoke during military training in bunker	1955/1956	Sweden	3	0	1		[10]
Exposure to smoke during military training in tunnel	1955/1956	Sweden	12	0	1		[10]
Exposure to smoke during military survival training	1959/1961	United States	3	0	3		[11]
Smoke bomb thrown into truck with soldiers	1961/1963	Netherlands	17	1	4		[12]
Smoke generator ignited in fire prevention exercise	unknown/1963	Canada	2	1	1		[13]
Exposure to smoke during military exercise	unknown/1964	United Kingdom	3	1	1		[14]
Soldier exposed to smoke at practice march	1967/1974	Germany	1	0	1		[15]
Smoke bomb thrown into house at military training	1969/1974	Germany	1	0	1		[15]
Smoke blown into tunnel at military training	1970/1974	Germany	1	0	1		[15]
Simulation of an airplane fire with smoke bombs	1979/1980	United States	135	0			[16]
Soldier ignited smoke bomb during bee attack	1983/1987	Singapore	1	0	1		[17]
Exposure to smoke grenade in closed civilian vehicle	unknown/1986	United States	1	0	1		[18]
Soldiers passing through smoke-filled pipeline	1985/1988, 1992	Denmark	5	2	2		[19,20]
Soldiers exposed to smoke in an enclosed room	unknown/1989	France	12	0			[21]
Soldiers exposed to smoke in an enclosed room	unknown/1992	United Kingdom	7	0	1		[22]
Exposure to smoke in sewer during military training	unknown/1996	Switzerland	1	0	1		[23]
Soldier lay on the ground next to smoke canister	unknown/1999	United States	1	0	1		[24]
Exposure to smoke during military exercise	unknown/1999	Denmark	13	0			[25]
Smoke bomb thrown into small cottage	unknown/2000	Finland	6	2	2		[26]
Exposure to smoke during military training	unknown/2000	Finland	1	0	1		[26]
Accidental smoke bomb ignition in combat exercise	2003/2005, 2006, 2008, 2010	Taiwan	20	0	3		[27–32]
Smoke bomb used in fire drill at school	unknown/2008	Spain	1	1	1		[33]
Civilians hit by smoke bomb capsules in Syrian war	unknown/2015	Turkey	3	2		Victims received treatment in a Turkish hospital	[34]

Table 2. Frequency of symptoms present after ZnCl₂ smoke exposure.

	Time after exposure
	0–6 h	6–24 h	>24 h	Number of different cases
General symptoms
Fever (>38 °C)	5	5	12	20
Malaise	2	2	0	4
Cyanosis	4	2	5	9
Tachycardia	0	2	5	6
Shock	1	0	3	4
Respiratory symptoms
Dyspnoea	12	5	11	20
Tachypnoea	4	3	10	14
Cough	17	1	10	20
Sore throat	10	1	1	11
Frothy sputum	4	1	0	4
Purulent sputum	0	0	2	2
ARDS	1	0	3	4
Gastrointestinal symptoms
Nausea	5	0	1	6
Vomiting	7	0	0	7
Abnormal taste	1	0	0	1
Other symptoms
Burning/tearing eyes	4	1	0	5
Chest pain/tightness	10	1	6	15
Abdominal pain	2	0	2	3
Subcutaneous crepitus	0	1	3	4
Pneumothorax	0	0	2	2
Generalised seizures	0	0	1	1
Limited exercise tolerance	1	0	4	4
Liver injury	n.d.	n.d.	13	13

Figure 1. Clinical outcomes classified as died, “permanent damage” or “complete recovery” of 31 patients with ZnCl₂ smoke poisoning. Patient numbers are indicated in bold font. Extent of permanent damage was established by imaging (chest radiograph) or functional (spirometry) techniques, or by a combination of both investigations.

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