Mustard clinical effects

Field First Aid Decontaminate At Once for All Exposed Victims Although sulfur mustards cause cellular changes within minutes of contact, the onset of pain and other clinical effects are delayed for one to twenty-four hours. Sulfur mustards are alkylating agents that may cause bone marrow suppression and neurologic and gastrointestinal toxicity. However, the biochemical mechanisms of action are not clearly understood by anyone. The death rate from exposure to sulfur mustard during World War I was 2-3 percent,... 

Both liquid and vaporized mustard have rapid skin penetration. The higher the dose, temperature and humidity, the quicker the absorption (NATO, 1973). Mustard is dermaUy absorbed through hair follicles and sweat glands within minutes. Cellular reactions begin within 1 to 2 min of contact of mustard to skin or mucous membranes, but clinical effects are delayed between 2 and 24 h (Grant and Sehuman, 1993 Sidell et al, 1997). 

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. 

After sulfur and nitrogen mustards are absorbed and interact with body tissues, they are no longer intact molecules. Therefore, unlike nerve gas victims, the body fluids of decontaminated mustard-exposed patients pose no risk to health care providers or other responders (2). In contrast to the other vesicants, Lewisite does not require a cyclization reaction, so its effects are immediate. Through direct inhibition of thiol-containing enzymes. Lewisite disrupts energy pathways, causing ATP depletion, cell death, and clinical effects (15). 

Mustard 2,2"-dicholorethylsulfide (BCES, H, HD) Hours later Immediate onset of clinical effects is hours later Fluid filled... 

Initial Clinical Effects from Mustard Exposure... 

Lewisite (b-chlorovinyldichloroarsine) is an arsenical vesicant but of secondary importance in the vesicant group of agents. It was synthesized in the early twentieth century and has seen little or no battlefield use (Balali-Mood et al., 2005). Lewisite is similar to mustard in that it damages the skin, eyes, and airways however, it differs from mustard because its clinical effects appear within seconds of exposure. An antidote, British anti-Lewisite (BAL), can ameliorate the effects of Lewisite if used soon after exposure. Lewisite has some advantages over mustard but also some disadvantages. 

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). 

Sidell and Hurst have described the long-term effects produced from acute symptomatic clinical dose exposure to mustard, but less is known about the clinical effects from chronic, sometimes symptomatic, low-dose exposure. Acute is defined here as an exposure lasting less than 24 h. The term chronic refers to an exposure lasting for days, weeks, months, and even years. Clinical means producing a recognizable illness directly related to mustard exposure. Symptomatic means having either the acute or chronic clinical illness produced by sulfur mustard. Asymptomatic, of course, is without symptoms at all. 

INITIAL CLINICAL EFFECTS FROM MUSTARD EXPOSURE... 

The onset of clinical effects following exposure to mustard occurs hours after the exposure.6 The delay usually ranges from 2 to 24 hours and is inversely proportional to the amount of mustard and other factors. 

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 produces immediate clinical effects (unlike mustard gas, which is delayed). Stinging pain is often felt within 10-20 seconds. Skin damage can occur within 5 minutes and blister formation is complete within 12-18 hours. Warm, moist areas of the body are the most vulnerable and it easily penetrates ordinary clothing as well as wood, leather and rubber. Absorption is increased by heat and moisture. Exposure to the liquid agent is more severe than to its vapour. 

Lewisite may be mixed with other agents, such as mustard gas (HL), which may delay its clinical effects. Caustic agents also cause bums with tissue oedema and fluid loss but the formation of blisters is unusual. 

Effects of orally administered sulfur mustard in rats were studied by Sasser et al. (1996a). Repeated gavage administration of sulfur mustard in sesame oil produced epithelial hyperplasia of the forestomach at the highest dose tested but no deaths and no other treatment-related pathological lesions or changes in clinical chemistry or hematological parameters. 

Shohrati, M., Aslani, J., Eshraghi, M., Alaedini, F., Ghanei, M. (2008). Therapeutics effect of N-acetyl cysteine on mustard gas exposed patients evaluating clinical aspect in patients with impaired pulmonary function test. Respir. Med. 102 443-8. 

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