Dung lung: a report of toxic exposure to liquid manure.

The use of liquid manure storage facilities poses several serious threats: toxic gas inhalation, asphyxiation, aspiration of liquid manure, and infection. Hydrogen sulfide poisoning in a manure storage pit resulted in three deaths. Two of the persons who died had massive aspiration of liquid manure; the third had severe pulmonary edema but had not aspirated manure. The clinical course of the patient who survived was complicated by hemodynamic instability, adult respiratory distress syndrome, and infection. These accidents can be prevented by the use of a self-contained breathing apparatus and a safety line, as well as the presence of a second person for rescue if necessary. Recommendations for treatment are mainly supportive, including cardiopulmonary resuscitation, mechanical ventilation, oxygen, and positive end-expiratory pressure. Nitrites may speed recovery but in excess can cause other complications.