Antidotes dimercaprol

Tolerance to heavy metals, specifically mercury and cadmium, has been associated with the induction of kidney metallothionein, a protein rich in sulfhydryl groups which protects by chelation (102). The synthetic antidote dimercaprol, introduced after World War I for arsenic-containing gases, works by a similar mechanism (103). 

Lewisite (15-chlorovinyldichloroarsine) was synthesized in 1918 for use as a weapon, and its clinical effects are similar to those of mustard in many respects, although the cellular mechanisms are believed to differ. However, unlike mustard. Lewisite liquid or vapor produces irritation and pain seconds to minutes after contact. Immediate decontamination may limit damage to skin or eyes, and intramuscular injections of a specific antidote, dimercaprol, or British antiLewisite (BAL) will reduce the severity of systemic effects. BAL has toxic effects of its own, however, and must be used with care. 

Inhalation and dermal absorption mustards no antidote. For lewisite and ewisite/ mustard lmixtures British Anti-Lewisite (BAL or Dimercaprol) IM (rarely available). Thermal burn therapy supportive care (respiratory support and eye care). 

Treatment—Patients should be decontaminated immediately prior to treatment using the decontamination method presented in Section 7.3.2. British Anti-Lewisite (BAL) dimercaprol antidote will alleviate some effects. It is available as a solution in oil for intramuscular administration to counteract systemic effects. It is not manufactured currently in the forms of skin and eye ointments.2... 

Dimercaprol (BAL, British Anti-Lewisite) was developed in World War 11 as an antidote against vesicant organic arsenicals (B). It is able to chelate various metal ions. Dimercaprol forms a liquid, rapidly decomposing substance that is given intramuscularly in an oily vehicle. A related compound, both in terms of structure and activity, is di-mercaptopropanesulfonic acid, whose sodium salt is suitable for oral administration. Shivering, fever, and skin reactions are potential adverse effects. 

For the treatment of poisoning, a selective antidote (which antagonises the action) may be given e.g., nalorphine and naloxone in case of morphine poisoning, atropine in case of anticholinergic drugs, dimercaprol in mercury and penicillamine in lead poisoning, etc. 

For example, the elucidation of the mechanism of action of the war gas Lewisite (Fig. 1.2), which involves interaction with cellular sulfhydryl groups, allowed the antidote, British anti-Lewisite or dimercaprol (Fig. 1.2), to be devised. Without the basic studies performed by Sir Rudolph Peters and his colleagues, an antidote would almost certainly not have been available for the victims of chemical warfare. 

The first chelating agent developed as an antidote to a heavy metal poison was 2,3-dimereaptopropanol (dimercaprol, British Anti-Lewisite, BAL). Originally intended for use on victims of the arsenical vesicant poison gas Lewisite52, it has since proved efficacious in the treatment of antimony, gold and mercury poisoning as well as... 

Lewisite, dichloro(2-dichlorovinyl)arsine is a chemical that contains arsenic, which though a liquid is sufficiently volatile to be dispersed among enemy troops. The arsenic atom in the lewisite reacts with proteins and causes terrible blisters on the skin and damage to the eyes and lungs if inhaled. Fortunately, an antidote was devised as a result of the work of the British biochemist Rudolf Peters. The antidote was appropriately named British anti-lewisite (dimercaprol), and abbreviated to BAL. 

Lewisite Shock Pulmonary injury Blisters Decontamination soap, water, no bleach Antidote BAL-dimercaprol may decrease systemic effects of lewisite Pulmonary management BAL 3-5 mg/kg deep IM q4 h X 4 doses (dose depends on severity of exposure and symptoms) Skin management BAL ointment Eye management BAL ophthalmic ointment... 

Dimercaprol is a synthetic therapeutic substance developed during World War II as an antidote against the vesicant arsenic war gases (lewisite). The first experiments were based on the fact that arsenic products react with SH radicals. Among all the compounds originally tested, BAL was the most effective and the least toxic. In 1951, BAL was used by a... 

British antilewisite (BAL) or dimercaprol was developed as an antidote for lewisite. It is used in medicine as a chelating agent for heavy metals. Although BAL can cause toxicity itself, evidence suggests that BAL in oil administered intramuscularly will reduce the systemic effects of lewisite. BAL skin and ophthalmic ointment decrease the severity of skin and eye lesions when applied immediately after early decontamination, but neither of these ointments is currently manufactured. 

A4.1 The answers are shown in Figure 11.5. Incidentally, dimercaprol is also known as British Anti Lewisite (or BAL) and was originally developed as an antidote to the chemical warfare agent Lewisite, an arsenic derivative. 

No antidote is available for treatment of the sulfur component of Sulfur/ Arsenical Vesicants. BAL (Brihsh-Anti-Lewisite, dimercaprol) will alleviate some effects of the arsenical component. BAL is available as a soluhon in oil for intramuscular administration to counteract systemic effects. BAL skin ointment and BAL ophthalmic ointment are not currently manufactured. 

Two water-soluble analogs of dimercaprol have been studied as lewisite antidotes, namely meio-2,3-dimercaptosuccinic acid (DMSA) and 2,3-dimercapto- 1-propane sulfonic acid (DMPS) (see review by Aposhian, 1993). Their structures are as follows ... 

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