Lewisite systemic effects

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—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... 

Lewisite is an arsenical compound that acts locally as a vesicant, but also causes systemic effects (HSDB, 2008 Sidell et al, 1997). Lewisite directly affects enzyme... 

Exposure to lewisite is very painful. Both the vapor and liquid lewisite can penetrate skin. Reddening of the skin is followed by tissue destruction (EPA, 1985a Goldman and Dacre, 1989 Pohanish, 2002 Sidell et al, 1997). Amounts as small as 0.5 ml may cause severe systemic effects and 2 ml may be lethal. Severe edema develops secondary to increased capillary permeability. Dermal bums are deeper than those seen with mustard gas and are quicker to appear (Goldman and Dacre, 1989 Sidell et al, 1997). 

Lewisite, a vesicant with HD-Uke properties, causes a similar constellation of signs and symptoms involving the skin, eyes, and airways as well as systemic effects (e.g. increased capillary permeability) after absorption. However, it does not produce immunological suppression like mustard. Another difference is that the management of lewisite toxicity includes an antidote, British Anti-Lewisite (BAL) (Yue/u/.,2003). 

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... 

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. 

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. 

British Anti-Lewisite (BAL), also known as Dimercaprol, is a chelating agent than can reduce systemic effects from Lewisite. BAL works by binding the arsenic group in Lewisite and displacing it from tissue binding sites. If applied topically within minutes, after decontamination, BAL may prevent or reduce the severity of cutaneous and ocular toxicity (8). 

No antidote is available for treatment of the sulfur component of Sulfur/ Arsenical Vesicants. BAL (Brihsh-Anti-Lewisite, dimercaprol) will alleviate some effects of the arsenical component. BAL is available as a soluhon in oil for intramuscular administration to counteract systemic effects. BAL skin ointment and BAL ophthalmic ointment are not currently manufactured. 

Lewisite damages skin, eyes, and airways by direct contact and has systemic effects after absorption. Unlike mustard, it does not produce immunosuppression. Data on human exposure are few. Lewisite was applied to human skin in a few studies however, most information on its clinical effects is based on animal studies (Rovida and Lewisite 1929 Wardell, 1940 Dailey et al., 1941 Buscher and Conway, 1944). 

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... 

Lewisite damages skin, eyes, and airways by direct contact and has systemic effects after absorption. Unlike mustard, it does not produce immuno-... 

Medical personnel should follow the same principles for managing Lewisite skin, eye, and airway lesions that they follow for managing mustard lesions. A specific antidote, BAL (dimercaprol), will prevent or greatly decrease the severity of skin and eye lesions if applied topically within minutes after the exposure and decontamination (however, preparations of BAL for use in the eyes and on the skin are no longer available). Given intramuscularly, BAL will reduce the severity of systemic effects. BAL binds to the arsenic of... 

D. Lewisite bums to the eye. Create a 5% solution of BAL by diluting the 10% ampule 1 1 in vegetable oil, and immediately apply to the surface of the eye and conjunctivae. Parenteral treatment may also be necessary to treat systemic effects (see p 372). 

The Merck Index, an annual encyclopedia of chemicals and drugs, states for Lewisite Caution Extremely toxic Produces severe vesication, even through rubber. If left on skin, as little as 0.5 ml may give rise to sufficient absorption to produce severe systemic effects 2 ml may cause death. (Similar warnings do not accompany the other war gases.)... 

Lewisite (15-chlorovinyldichloroarsine) was synthesized in 1918 for use as a weapon, and its clinical effects are similar to those of mustard in many respects, although the cellular mechanisms are believed to differ. However, unlike mustard. Lewisite liquid or vapor produces irritation and pain seconds to minutes after contact. Immediate decontamination may limit damage to skin or eyes, and intramuscular injections of a specific antidote, dimercaprol, or British antiLewisite (BAL) will reduce the severity of systemic effects. BAL has toxic effects of its own, however, and must be used with care. 

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). 

Czerwinski et al., 2006). In the case of vesicant agents, such as sulfur mustard and lewisite, the skin is both a target organ, susceptible to severe local effects, and a pathway for absorption of the agent, leading to its distribution and subsequent systemic effects. The protective skin architecture is provided by a sophisticated and effective barrier built of two main components the outer epidermis and the underl3ung inner dermis. 

Antidote BAL-dimercaprol may decrease systemic effects of lewisite... 

Lewisite was first isolated in its pure form in 1918 as an alternative, less persistent agent than mustard gas. Like mustard gas, it inhibits DNA function, killing off rapidly dividing cells such as those of the skin, gastrointestinal mucosa and bone marrow, causing blistering of the skin and mucous membranes. However, lewisite is an arsenic compoimd and therefore can also cause systemic effects of arsenic poisoning which may be lethal (see p. 276). 

Dimercaprol chelates arsenic and other heavy metals. It may have some benefit for ocular, dermal or respiratory effects of lewisite, but is mainly used to attenuate the onset of systemic effects. 

Tissue damage occurs within minutes of exposure to vesicants, but clinical effects may not appear for up to 24 hours. Mixtures such as HL (C03-A010) contain lewisite (C04-A002) and will produce an immediate burning sensation on contact with the skin or eyes. Some agents are rapidly absorbed through the skin and extensive skin contamination may cause systemic damage. 

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