Mustard pulmonary effects

After skin is exposed to HN-2 an epidermal rash develops within approximately an hour. If initial exposure is very low, a rash may not develop. As with HN-1, HN-2 exposure is cumulative. If a person receives multiple low-level exposures, a rash will eventually appear. Blistering will begin about 12 hours after the onset of the skin rash. As with other blister agents, great irritation results when HN-2 vapor or liquid mixes with sweat and flows to tender skin areas (e.g., armpits, buttocks, crotch). Pulmonary effects from exposure to HN-2 are not as severe as for distilled mustard. Dry-land drowning syndrome can occur as the lungs flood with mucus, dead tissue, and blood. The victim dies from a combination of asphyxiation and heart failure. 

Immediately after exposure, there is eye irritation and coughing, sneezing, salivation and lachrymation rapidly follow. Contamination of the skin causes erythema at concentrations of 0.05-0.01 mg cm-2 (Inns et al., 1990) with vesication after a few hours. Pain in the skin and eyes is immediate, a major point of difference from sulphur mustard. The effects in the eye and skin reach their greatest at 4-8 h post-exposure. The patient is seriously incapacitated, breathing with difficulty and unable to see. In severe cases, pulmonary edema follows and the patient may die of respiratory failure. In cases where skin contamination is extensive, there may be liver necrosis and the absorption of arsenic may be sufficient to cause death. 

SM causes injury via four major routes (i) skin damage after absorption through the integument (ii) eye damage after exposure to mustard gas vapor (iii) broncho-pulmonary effects after inhalation and (iv) systemie toxicity after ingestion or absorption of high amounts of SM. ... 

Vesicant agents, such as mustard, require no special treatment once the bums have occurred. Copious washing is quite effective when used early for Hquid contamination of the eyes, and soap and water removes the Hquid agent from the skin. Bums resulting from mustard agent are treated like any other severe bum. The pulmonary injuries are treated symptomatically antibiotics are used only if indicated for the control of infection. 

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. 

A single low-dose exposure to mustard vapor with laryngeal and tracheobronchial mucosal effects may not lead to significant injury once healed. A cough may persist 1 month or longer. Hoarseness usually lasts only 1-2 weeks. However, repeated or chronic low-dose exposure can lead to progressive pulmonary fibrosis, chronic bronchitis, and bronchiectasis. 

Lewisite effects on the airway are similar to sulfm and nitrogen mustard, except that Lewisite is extremely irritating to the mucus membranes. The immediate, profound irritation of the mucus membranes may drive victims away from the dispersal site, thus helping to limit exposme (8). Exposme to high concentrations of Lewisite results in pulmonary edema (8). 

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