Subject poisoning, clinical effects

The neuromuscular effects of nerve agents have been the subject of hundreds of studies since nerve agents were first synthesized in 1936. Much of our information on the mechanism of action of nerve agents and potential therapeutic measures has come from these studies. Because this chapter is primarily concerned with clinical effects of nerve agent poisoning, a comprehensive review of these studies is not presented here. 

This may call for maintenance of fluid intake, and if a marked increase in temperature occurs, cooling is indicated. If there is continued mental aberration then the antidote physostigmine can be given as 2-3 mg IM for alleviation, followed by repeat injections at 15-60 min intervals to prevent relapse, and if required a slow i.v. infusion. The dose should be determined by the clinical condition of the subject. Another antidote is 7-methoxytocrine (7-MEOTA). For mild intoxication an oral dose of 100 mg can be given. For more severe poisoning, IM dosing (50 mg) is more effective. 

Effect. Perhaps the earliest and most frequent symptoms of selenosis in humans are dry and brittle hair that breaks off, and brittle nails with white spots or streaks. Although these effects may not be specific to selenium, determination of selenium status may be useful if they are observed in a subject. Additional, biomarkers of negative effects that could be detected before clinical signs of selenium toxicity could be helpful in preventing selenium poisoning. 

In a recent evaluation of pediatric poisoning from trimedoxime and atropine-containing autoinjectors in Israel, no serious side effects were associated with exposure to the oxime. Twenty two children who inadvertently injected more than the recommended, age-adjusted dose (1 mg atropine and 40 mg trimedoxime for children 3-8 years or double that dose for persons > 8 years) did not develop severe adverse reactions, nor did they require medical intervention (Kozer et al, 2005). HI 6 dichloride was tested in a double-blind, placebo controlled, ascending dose-tolerance study (HI 6 + 2 mg atropine sulfate) in 24 healthy male volunteers (Clement and Erhardt, 1994). Doses from 62.5 up to 500 mg were well tolerated by the subjects without serious complaints. There were no clinically significant changes in heart rate or ECG, respiration or blood pressure or visual and mental acuity... 

While the significance of these effects is subject to debate, it is OSHA s position that these enzyme disturbances are early stages of a disease process which may eventually result in the clinical symptoms of lead poisoning. Whether or not the effects do progress to the later stages of clinical disease, disruption of these enzyme pro-... 

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