Lewisite respiratory tract effects

The main effect of lewisite on the upper respiratory tract is to produce necrosis of the epithelium, which is accompanied by the formation of a false diphtheria-type membrane which consists of sloughed epithelial cells, together with inflammatory cells and mucus. The membrane may become detached and cause bronchial obstruction. Widespread edema and congestion of the lungs occurs and they may acquire a greyish-red to purple hue. Areas of atelectasis and secondary emphysema are common. Secondary bronchopneumonia is common and a frequent cause of death (Vedder, 1926). 

Phenyldichlorarsine was used on a large scale during the World War I. It was used as a compound capable of penetrating the respirators then available and also capable of producing severe irritation of the respiratory tract. It was apparently a very effective chemical weapon. Treatment should probably be as for lewisite and phenyldichlorarsine forms an analogous adduct... 

Lewisite (chlorovinyldichloroarsine), a war gas, is a colorless, oily liquid at room temperature with a faint "geranium-like" odor. Lewisite dissolves slowly in water and hydrolyzes rapidly to hydrochloric acid and lewisite oxide (Daniels et al., 1990). Lewisite produces irritation and blistering of the skin and injmy to the eyes and limgs promptly after high exposme at lower levels the effects resemble exposure to tear gas, with irritation of skin, eyes, and respiratory tract. Chronic exposure may lead to development of chronic bronchitis and predispose to Bowen squamous cell intraepithelial cancer of the skin. 

Signs and symptoms of acute lewisite exposure include a rapid onset of irritation to the eyes and mucous membranes of the upper respiratory tract (lachrymation and rhinitis). In more serious cases of vapor intoxication, chest pain, nausea, vomiting, headache, weakness, convulsions, hypothermia, and hypotension occur (Sidell et al., 1997 Katos et al., 2007). Laboratory tests of the blood of persons exposed may show hemoconcentra-tion animal studies suggest elevated liver enzymes, including lactate dehydrogenase (LDH) (King et al., 1994 Sasser et al., 1999). The following sub-sections describe the effects on specific body sites. 

---