Lewisite shock

Dermal or intravenous exposure to lewisite leads to local skin edema and pulmonary edema due to increased capillary permeability. The increased capillary permeability results in blood plasma loss and resultant physiological responses collectively referred to as lewisite shock . Lewisite shock may be likened to shock observed in severe bum cases. It has been hypothesized that functional changes in the lungs, kidneys, respiratory tract, cardiovascular, and lymphatic systems may be the result of a disturbance of osmotic equilibrium (Goldman and Dacre, 1989). 

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... 

Lmge exposures to Lewisite can cause Lewisite shock due to increased capillary membrane permeability and subsequent protein and plasma leakage across the capillary membranes. As a result, patients suffer intravascular fluid loss, hemoconcentration, hypovolemia, and hypotension (8,24). Cutaneous exposures can produce localized edema and pulmonary edema secondary to damage at the alveolm - capillary membrane (8). 

Cardiovascular Lewisite shock due to increased capillary permeability and subsequent intravascular volume loss, hypovolemia and organ congestion... 

Lewisite shock is seen after exposure to large amounts of Lewisite. This condition is the result of protein and plasma leakage from the capillaries and subsequent hemoconcentration and hypotension. 

Arsines are known to cause hemolytic anemia, but there is little mention of this in reports on Lewisite exposure. A true or hemolytic anemia was noted with Lewisite shock (Goldman and Dacre, 1989). 

Cardiovascular Lewisite shock or low blood pressure may occur... 

A condition named Lewisite Shock has also been described that is associated with loss of blood volume and an associated increase in RBC eount and haemoglobin concentration. This is accompanied by a decrease in plasma volume and plasma proteins, suggesting that movement of protein through damaged membranes may alter the hydrostatic pressure in the tissues and cause fluid to move into the tissues. The movement of fluid is consistent with the observation of copious jelly-like oedema at the site of application. The condition developed within 24 hours of dermal application of L to animals and persisted for up to 4 days. The authors point out the marked similarity between this condition and traumatic shock. Certainly, the effects of fluid loss from the circulation by blood loss and the pathology described above would be expected to be very similar, if not identical. 

G. R. Cameron and F. C. Courtice, Lewisite Shock, Porton Report 2150, Cdee, Porton down, (Gb), 1940, UK National Archie Number WO 198/2090. 

Severe exposure may cause encephalopathy and lewisite shock. ... 

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