Nitrogen mustard symptoms

Physiological Effects. The sulfur and nitrogen mustards act first as cell irritants and finally as a cell poison on all tissue surfaces contacted. The first symptoms usually appear in 4—6 h (4). The higher the concentration, the shorter the interval of time between the exposure to the agent and the first symptoms. Local action of the mustards results in conjunctivitis (inflammation of the eyes) erythema (redness of the skin), which may be followed by blistering or ulceration and an inflammatory reaction of the nose, throat, trachea, bronchi, and lung tissue. Injuries produced by mustard heal much more slowly and are much more Fable to infection than bums of similar intensity produced by physical means or by other chemicals. 

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. 

After exposure, sulfur and nitrogen mustards have a delayed onset of symptoms, resulting in delays of detection with concomitant increased morbidity (15). 

Table 3.5 (25,26) summarizes the clinical presentation of exposure to sulfur and nitrogen mustards. Sulfur and nitrogen mustards affect primarily the eyes, skin and respiratory tract. Most exposed patients will not have immediate symptoms, and will not... 

The earliest systemic symptoms of sulfur or nitrogen mustard exposures are nausea and vomiting, which typically begin within 2 h of exposure. These early gastrointestinal symptoms are self-limited and probably due to the cholinergic... 

Patients exposed to sulfur or nitrogen mustard arriving at the hospital within 30-60min of exposure will seldom have symptoms. After decontamination, patients with respiratory symptoms require placement in a critical care unit, whereas those without symptoms require observation only for at least 6h. The sooner after exposure symptoms develop, the more likely they are to progress (25,26). 

HN-3, a liquid with no odor in its pure form, is the most common nitrogen mustard and its blistering power is similar to that of HD. It is used as a delayed-action casualty agent — most symptoms may be delayed for 4 to 6 hr. The body does not detoxify HN-3 therefore, it accumulates in the body. Unlike HN-2, HN-3 is stable in storage. 

The eye-irritating effect and blistering effect are likely caused by HCl. This reaction is not very fast unlike that of phosgene, and hence there is usually a delay of a few days before its poisonous symptoms show up. The nastiness of mustard gas is due to its small size and relative chemical stabUity, and hence it can go into almost any place in your body and its effect lasts relatively long. Nitrogen mustard is supposed to work similarly. 

Management of Lewisite or Mustard-Lewisite exposure is similar to that of nitrogen and sulfur mustard exposures with two exceptions. First, patients exposed to Lewisite or the mixture will have an abrupt onset of symptoms and will likely present to emergency rooms immediately after exposure. On the other hand, because of the delayed effects, most patients with severe exposures to nitrogen or sulfur mustards will go home or elsewhere after their exposure and may only present later at emergency rooms or physicians offices when they begin developing symptoms. 

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