Antidotes for lewisite

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). 

Similar to the mustard agents, exposure prevention is the first line of defense against lewisite. Rapid decontamination is especially relevant to lewisite exposure due to the rapid development of pain (1-2 min) associated with lewisite exposure. Unlike other vesicants, an effective antidote for lewisite toxicity exists in the form of British anti-lewisite (BAL 2,3-dimercaptopropanol) which binds with arsenicals, thereby countering the lewisite-induced damage. Such chelation therapy is associated with notable side effects (e.g. renal effects) and requires carefiil medical management. More effective analogs of BAL have been developed with less significant side effects. 

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. 

F. Treatment of Lewisite Lesions. The treatment of lewisite lesions is detailed in Chapter 3 of FM 8-9 (Part III). An antidote for lewisite is dimercaprol, BAL (British Anti Lewisite). However, the toxicity of dimercaprol itself must be considered. It sometimes provokes local irritation. 

Antidotes British Anti-Lewisite (BAL) can be given by intramuscular injection as an antidote for systemic effects but has no effect on the local lesions of the skin, eyes, or airways. Treatment consists primarily of supportive care. 

Treatment for these poisons is the administration of sulfhydryl reagents with adjacent sulfhydryl groups to compete with the dihydrolipoyl residues for binding with the metal ion, which is then excreted in the urine. Indeed, 2,3-dimercaptopropanol (see Figure 17.20) was developed after World War I as an antidote to lewisite, an arsenic-based chemical weapon. This compound was initially called BAL, for British anti-lewisite. 

The clinical effects of lewisite are similar to those of mustard. However, unlike mustard, lewisite liquid or vapor produces irritation and pain upon contact. As with mustard, immediate decontamination will limit lewisite s damage to skin or eyes. A specific antidote for the systemic effects of the agent exists in the form of British Anti-Lewisite (BAL). BAL must be used under medical supervision owing to its own toxic properties. There is no need to have this antidote far forward, and it can be kept in modest quantities because of the minimum threat from lewisite. 

The second exception is that while an antidote is available for systemic effects of Lewisite exposure, there are no antidotes for nitrogen mustard or sulfur mustard toxicity, with one minor caveat if given within minutes after exposure, intravenous sodium thiosulfate may prevent death due to sulfur mustard exposure (25). Otherwise, the medical management for skin, ocular, and respiratory exposure is only supportive. One guideline physicians can follow is to keep skin, eye, and airway lesions free from infection. 

Obviously, sometimes, goal-oriented research can be and has been effective. This happens when both the information necessary to identify the problem and the techniques necessary for its solution not only are available but are known to the proper people. When this happens, the goal often is achieved reasonably expeditiously as was the case in the synthesis of BAL as an antidote to lewisite (10) or the development of PAM as an antidote for the organophosphorous compounds (11). However, the success of attempts to solve limited and clearly defined problems does not argue that similar success can be anticipated when large, poorly understood, and often illdefined problems are set as goals. 

Explain the way in which British Anti-Lewisite acts as an antidote for mercury poisoning. 

An antidote is available for lewisite exposure. BAL (British-Anti-Lewisite dimercaprol) was developed by the British during World War II. The antidote is produced in oil diluent for intramuscular administration to counter the systemic effects of lewisite. There is no effect, however, on the skin lesions (eyes, skin, and respiratory system) from the antidote. Mustard agents (H), (HD), (HS), and (HT), like nerve agents, would be classihed as Class 6.1 poisons by the DOT and would have NFPA 704 designations of health 4, flammability 1, reactivity 1, and special... 

Uses Chelating agent antidote to arsenic, gold, and mercury poisoning antidote to Lewisite detoxicant for heavy metal poisoning... 

Sternlieb I (1990) Perspectives on Wilson s disease. Hepatology 12 1234-1238 Stewart JR, Diamond G (1987) Renal tubular secretion of the alkanesulfonate 2,3-dimer capto-1-propane sulfonate. Am J Physiol 252 F800-F810 Stocken LA, Thompson RHS (1946) British anti-lewisite. II. Dithiol compounds as antidotes for arsenic. Biochem J 40 535-548 Sunderman FW Sr (1990) Use of sodium diethyldithiocarbamate in the treatment of nickel carbonyl poisoning. Ann Clin Lab Sci 20 12-21 Tell I, Somervaille LJ, Nilsson U, Bensryd I, Schiitz A, Chettle DR, Scott MC, Skerfving S (1992) Chelated lead and bone lead. Scand J Work Environ Health 18 113-119... 

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 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. 

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