Objective: We present a rare case of survival following inhalation of nitric acid fumes and its decomposition products, which resulted in severe pulmonary edema and Acute Respiratory Distress Syndrome (ARDS). Successful outcome followed ventilatory support and use of steroids. Design: Case report. Setting: Tertiary-level medical intensive care unit. Patient: A single case of inhalation of nitric oxide fumes. Intervention: Ventilatory support and addition of steroids. Measurement and main results: Improvement and discharge. Conclusion: Inhalation of nitric acid fumes and its decomposition gases such as nitrogen dioxide results in delayed onset of severe pulmonary edema deteriorating into ARDS. Intensive respiratory management, ventilatory support, and steroids can help in survival.
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