British Anti 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). 

If HL (C03-A010) is involved, a BAL (British-anti-Lewisite, dimercaprol) solution or ophthalmic ointment may be beneficial if administered promptly. It may also decrease the severity of skin and eye lesions if applied topically within minutes after decontamination is complete (i.e., within 2-5 minutes postexposure). 

Dimercaprol (British Anti-Lewisite or BAL) is a colorless, viscous oily compound with an offensive odor used in treating arsenic, mercury, and gold poisoning. It displaces the arsenic bound to enzymes. The enzymes are reactivated and can resume their normal biological activity. When given by injection, BAL can lead to alarming reactions that seem to pass in a few hours. 

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. 

BAL British Anti-Lewisite. Dimercaprol, a treatment for toxic inhalations. 

ALARA As low as reasonably achievable BAL British Anti-Lewisite CIA Central Intelligence Organization CK Cyanogen chloride (blood agent)... 

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... 

British Anti-Lewisite dimercaprol alleviates some effects (Ellison 2000)... 

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. 

Figure 1.2 The structures of Lewisite and dimercaprol or British anti-Lewisite.

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. 

Dimercaptopropanol-1, British anti-Lewisite or dimercaprol Dithiocarbamate... 

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... 

Arsenic Toxicosis. Urine arsenic is the best indicator of current or recent exposure. Atomic absorption spectrophotometry is preferred as the detection method. Hair or fingernail sampling may also be helpful. Use of blood is useful if analyzed soon after exposure or in cases of continuous chronic exposure. After acute exposure, chelation therapy is instituted utilizing either (1) Dimercaprol BAL (British Anti-Lewisite) and analogues ... 

Another compound used to treat lead poisoning is British anti-Lewisite (BAL), originally developed to treat arsenic-containing poison gas Lewisite. As shown in Figure 10.6, BAL chelates lead through its sulfhydryl groups, and the chelate is excreted through the kidney and bile. 

The origins of chelation therapy can be traced back to the treatment of First World War soldiers who had suffered from gas attacks that used the arsenic-based toxin, Lewisite. A dithiol, British anti-Lewisite (BAL), was developed to remove the toxic metal. 

Peters R, Stocken L, Thompson R (1945) British Anti-Lewisite (BAL). Nature 156 616-619... 

A special derivatization reaction is required for lewisite 1, which is so reactive that it cannot be determined by GC/MS in low quantities (e.g. below 10 ng per injection). It has been known for a long time that lewisite 1 reacts with compounds having an a, P-dithiol structure, such as 2,3-dimercaptopropanol-l (British-Anti-Lewisite (BAL) also used for medical treatment). The derivatization reaction can be performed at an analytical level and several examples have been described (29). The reaction product of lewisite 1 with 3,4-dimercaptotoluene, 2-(2-chlorovinyl)-5-methyl-l,3,2-benzodithiarsole (see (1)), is a useful derivative for GC/MS analysis. Its mass spectrum is simple with molecular ion peaks at m/z 290/292 and the base peak at m/z 229 due to the loss of the 2-chlorovinyl group (30). 

Trivalent arsenic forms strong bonds with sulfur, and thiols are therefore used for derivatizing both lewisite and CVAA, forming the same derivative (19). Lewisite reacts with mono and dithiols the reaction with dithiols occurring rapidly at ambient temperature. In a competitive environment, lewisite reacts almost exclusively with dithiols rather than monothiols (35). Three dithiols, 1,2-ethanedithiol, 1,3-propanedithiol and 2,3-dimercaptopropan-l-ol (British Anti-Lewisite, BAL) have been used for biomedical sample analysis of CVAA to form cyclic derivatives (14a, b) and (15). Unlike derivatiza-tion of TDG, CVAA can be derivatized direcdy in an aqueous solution. 2,3-Dimercaptotoluene, which has been used extensively for environmental analysis (19), does not appear to have been used. 

Figure 7. Chemical structures of 2-chlorovinyldichloroarsine (lewisite LI), 2-chlorovinylarsonous acid (CVAA), British Anti-Lewisite (BAL) and the CVAA-BAL complex...

Figure 8. Chemical structures of 2-chlorovinyldichloroarsine (Lewisite LI), 2-chlorovinylarsonous acid (CVAA), British Anti-Lewisite (BAL) and the CVAA-BAL complex. (Reprinted from Toxicology and Applied Pharmacology, Vol. 184, D. Noort,H.P. BenschopandR.M. Black, Biomonitoring of Exposure to Chemical Warfare Agents A Review, pages 116-126 (2002), with permission from Elsevier Science.)...

Atomic Absorption Spectrometry Acetylcholinesterase British Anti-Lewisite Carboxylesterase Central Nervous System Chemical Warfare Agent 2-chlorovinylarsonous Acid Enzyme-linked Immunosorbent Assay Environmental Protection Agency... 

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