Toxicity symptoms, mustard agents

There is no antidote for nitrogen mustard toxicity, and decontamination of potentially exposed persons must be done within minutes to avoid tissue damage. Victims should be moved out of the hot zone, administered oxygen and/or assisted ventilation, and seek medical attention at once. The nitrogen mustards are delayed chemical agents, and may delay for up to twenty-four hours to show symptoms. They are poisons, and contact with vapor or liquids can be fatal. Do not eat, drink, or smoke during response to a nitrogen mustard incident or criminal event. 

Lewisite is the most important of the organo-arseni-cal CW agents. Exposure to lewisite is quite painful, and onset of symptoms occurs rapidly (seconds to minutes) (31) in contrast to sulfur mustard for which a latency period occurs of several hours between exposure and symptoms (32). Although it is not known to have been used as a CW agent, lewisite is still considered a potential threat due to the relative ease of production and its rapid onset of action. Moreover, substantial stockpiles of lewisite are present in the United States, Russia, and in China abandoned by the Japanese Imperial Army. This may constitute a potential hazard for public health (33). The toxicity of lewisite is inter alia caused by the high affinity for the vicinal di-thiol system present in dihydrolipoic acid, a component of the pyruvate dehydrogenase complex, as is the case for other arsenicals (34). This prevents the formation of acetyl coenzyme A from pyruvate. 

It is important that the agent be washed from the skin with soap and water as soon after exposure as possible. The eyes should be thoroughly flushed. The onset of symptoms typically is delayed and an absence of immediate effect does not rule out toxicity. Although ingestion is unlikely, due to the sources of mustard gas, an emetic should not be administered because of the extreme caustic nature of the chemical. If the patient is not comatose, dilution of stomach contents with milk or water, prior to gastric lavage, may be attempted. Application of a solution of sodium thiosulfate to the skin and inhalation of a nebulizing mist of sodium thiosulfate may speed inactivation of mustard gas. Animal studies have shown that administration of corticosteroids (e.g., dexamethasone) and antihistamines (e.g., promethazine) may prove beneficial. 

L Signs and Symptoms of Toxicity. Mustard vesicants (agents HD and HN2) are acutely toxic by direct contact, the skin, eyes, and upper respiratory tract... 

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