Lewisite treatment

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. 

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... 

Other organoarsenicals, most notably lewisite (dichloro[2-chlorovinyl]arsine), were developed in the early twentieth century as chemical warfare agents. Arsenic trioxide was reintroduced into the United States Pharmacopeia in 2000 as an orphan drug for the treatment of relapsed acute promyelocytic leukemia and is finding expanded use in experimental cancer treatment protocols (see Chapter 54). Melarsoprol, another trivalent arsenical, is used in the treatment of advanced African trypanosomiasis (see Chapter 52). 

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... 

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. 

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). 

Residues from demilitarization, treatment, and testing of nerve, military, and chemical agents CX, GA, GB, GD, H, HD, HL, HN-1, HN-2, HN-3, HT, lewisite, T, and VX (Hazardous Waste Code F999). 

Snider, T.H., M.G. Wientjes, R.L. Joiner and G.L. Fisher. 1990. Arsenic distribution in rabbits after lewisite administration and treatment with British anti-lewisite (BAL). Fundam. Appl. Toxicol. 14 262—272. 

Treatment of arsenic poisoning relies on removing the chemical from the body with a chelating agent. The one commonly used is dimercaprol or British anti-lewisite (see pp. 236-7). 

A recently developed treatment foi acute mercury poisoning is the injection of a H sulfur compound BAL (British anti-lewisite). This compound, pro-... 

Treatment for these poisons is the administration of sulfhydryl reagents with adjacent sulfhydryl groups to compete with the dihydrolipoyl residues for binding with the metal ion, which is then excreted in the urine. Indeed, 2,3-dimercaptopropanol (see Figure 17.20) was developed after World War I as an antidote to lewisite, an arsenic-based chemical weapon. This compound was initially called BAL, for British anti-lewisite. 

The method of making lewisite was suggested by the analogous method of mustard-gas manufacture used by the Allies. Thus, mustard is formed by the action of ethylene on sulfur monochloride, while lewisite is produced by action of acetylene on araeme trichloride in the pieaenct of aluminum trichloride acting as a catalyst. The dark brown viscid liquid a hich results from this latter reaction is decomposed by treatment with hydrochloric acid at O C. (32 F.), and an oil is obtained which < an be fractionated by distillation in vacuo into three chlor inyl derivatives of arsenic trichloride. These derivatives, which differ from each other only by the successive addition to the arsenic trichloride of one, two, or three molecules of acetylene, are as follows (see Chart Xlll) ... 

Organoarsenicals were used as poison gases in World War I. The most notorious of these was Lewisite (140). During the years before World War II, researchers looked for antidotes and found the compound 2,3-dimercaptopropanol, now commonly known as British Anti-Lewisite or BAL (190). This compound has proven extremely effective in the treatment of lead and mercury poisoning. 

In acute exposure prompt medical attention is critical. The victim should be immediately removed to fresh air and away from the source of exposure. Oxygen should be provided if there is a respiratory distress. Initial therapy should be directed at stopping the ongoing hemolysis by performing exchange transfusion. Currently there is no other treatment to decrease arsine hemolysis however, studies in vitro have shown that some dithiol chelators (meso-2,3-dimercaptosuccinic acid, DMSA 2,3-dimercapto-l-propanesulfonic acid, DMPS and 2,3-butanedithiol) are effective (see Further Reading). This should be followed by aims to restore renal function or compensate for lost renal function (hemodialysis). This process does not remove any formed arsenic from the exposed body. Administration of dimercaprol (British Anti-Lewisite, BAL) has no effect on arsine hemolysis, but it lowers blood arsenic levels resulting from arsine exposure. The use of chelators must be... 

Research on anesthetic gases during the nineteenth century facilitated the development and use of poisonous war gases in the twentieth. This led to attempts to counteract the effects of chemical warfare agents and other toxic compounds, particularly arsenicals, introduced by Paul Ehrlich (1854-1915) for the treatment of syphilis. This resulted in the synthesis of the first specific chemical antidote, British anti-Lewisite (BAL), in 1945 by R.A. Peters, L.A. Stocken, and R.H.S. Thompson in Oxford. Studies on the mechanistic bases for toxicity were applied to the synthesis of effective insecticides. For example, during the 1940s, the Swiss chemist Paul Muller discovered a compound, now known as DDT, that poisons insects on contact. 

Treatment of inorganic arsenic poisoning involves decontamination procedures and use of the antidote BAL (British anti-lewisite compound 2,3-dime-rcaptopropanol). Use of demulcent to coat the gastrointestinal tract and the use of antibiotics is also recommended. Organic arsenic poisoning treatment involves only withdrawal of the feed involved, with recovery occurring in 3-5 days. Severely affected pigs should be culled. 

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