Lewisite pulmonary effects

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... 

Lewisite (also known as Agent L), is no longer considered a state-of-the-art CW agent. Lewisite is a significant threat to unprotected personnel and causes prompt incapacitation from eye injuries and respiratory irritation, coupled with long-term incapacitation from skin bums, pulmonary injury, and systemic illness. Its decomposition products are toxic, making decontamination difficult. Munitions containing lewisite may contain toxic stabilizers. Lewisite is effective as vapor, aerosol, or liquid (Sidell et al., 1997). 

A chelator should be given if there is dyspnea, pulmonary edema, or skin bums larger than pahn size (Goldfrank et al, 2002). BAL is the traditional arsenic chelator, but it has numerous side effects. The deep intramuscular injections are very painful and BAL can cause hypertension, tachycardia, and vomiting. 2,3-Dimercaptosuccinic acid (DMSA, Succimer ) can also be used to chelate arsenic (Graziano et al, 1978). 2,3-Dimercapto-l-propanesulfonic acid (DMPS) is used in Europe and has been effective in protecting rabbits from the lethal effects of lewisite (Aposhian et al, 1982). 

Lewisite effects on the airway are similar to sulfm and nitrogen mustard, except that Lewisite is extremely irritating to the mucus membranes. The immediate, profound irritation of the mucus membranes may drive victims away from the dispersal site, thus helping to limit exposme (8). Exposme to high concentrations of Lewisite results in pulmonary edema (8). 

A small amount of Lewisite on the skin will cause local edema because of the effects of this agent on local capillaries. With a large amount of Lewisite, the pulmonary capillaries are also affected there is edema at the site of exposure and pulmonary edema. With even larger amounts of Lewisite, all capillaries are affected, and proteins and plasma leak from the circulation into the periphery. Even after small amounts of Lewisite, the fluid loss can be sufficient to cause diminution of renal function and hypotension (Goldman and Dacre, 1989). 

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