Sulfur mustard complications

Acute exposures to sulfur mustard can result in skin and eye damage, gastrointestinal irritation, and depressed myelopoiesis (resulting in leukopenia and anemia) (Vogt et al., 1984). Damage to the respiratory tract, which is the principal cause of mortality in the first few days to weeks after exposure to sulfur mustard, involves acute edema, inflammation, and destruction of the airway epithelial lining (Institute of Medicine, 1993). Infection of the respiratory tract resulting in bronchopneumonia is a common complication of exposure to sulfur mustard. 

Mahmoudi, M., Hefazi, M., Rastin, M., Balali-Mood, M. (2005). Long-term hematological and immunological complications of sulfur mustard poisoning in Iranian veterans. Int. Immuno-pharmacol. 5 1479-85. 

High doses of sulfur mustards can cause hyperexcitability, convulsions, and insomnia. Systemic absorption of sulfur mustard may induce bone marrow suppression and an increased risk for fatal complicating infections, hemorrhage, and anemia. 

Table 3.6 lists the long-term mustard complications affecting the respiratory tract, the eyes, the skin, the central nervous system and the bone marrow (8,25,26). As alkylating agents, sulfur and nitrogen mustards are carcinogens. 

Although incapacitating airway injury occurs at vapor exposures significantly lower than those that cause severe skin blistering, inhaled sulfur mustard injures respiratory epithelium from the nasopharynx to the bronchioles. Since WWI, the majority of deaths occurring in sulfur mustard casualties have resulted from respiratory complications (Vedder, 1925 Warthin et al., 1918 Willems, 1989). Mild cases are treated to allow maximum comfort, whereas severe cases must attain ade-... 

The reported proportion of casualties who fully recover from sulfur mustard respiratory injury varies from over 90% (Vedder, 1925) to only 20% (Balali-Mood, 1986). Much of this variation can be explained by differences among patients and by attribution of chronic bronchitic symptoms to previous mustard gas exposure in the presence of ongoing causes such as heavy smoking. Major chronic problems such as bronchiectasis and recurrent pneumonia appear confined to casualties who had severe pulmonary infections complicating the acute injury (Urbanetti, 1988). Ocular and skin injuries generally heal completely but with the need for corneal transplantation or for skin grafting to deal with uncommon complications. 

Balali M. The evaluation of late toxic effects of sulfur mustard poisoning in 1428 Iranian veterans. In Proceedings of Seminar on Late Complications of Chemical Warfare Agents in Iranian Veterans. Tehran, Iran, Veteran Foundation, Tehran Tehran University Press, 1992, pp. 15-37. 

Balali-Mood M, Hefazi M, Mahmoudi M, Jalali I, Attaran D, Maleki M, Etezad-Razavi M, Zare GH, Jafaari MR, Tabatabaee A. Long term complications of sulfur mustard poisoning in severely intoxicated Iranian veterans. Fundam. Clin. Pharmacol. 2005 19 713-721. 

Aslani, J., 2000. Late respiratory complications of sulfur mustard. In Cheraghali, A.M. (Ed.)/ Rrevention and Treatment of Complications of Chemical Warfare Agents Chemical Warfare Research Center, Tehran, Iran, pp. 76-79. 

Hefazi, M., Maleki, M., Mahmoudi, M., et al., 2006. Delayed complications of sulfur mustard poisoning in the skin and the immune system of Iranian veterans 16-20 years after exposure. Int. J. Dermatol. 45 (9), 1025-1031. 

Emadi, S.N., Aslani, J., Poursaleh, Z., et al., 2012. Comparison late cutaneous complications between exposure to sulfur mustard and nerve agents. Cutan Ocul. Toxicol. 31 (3), 214 9. 

Another interesting development is comprehensive GC-MS. Comprehensive GC offers great selectivity and resolution and is ideal for complex samples such as biomedical samples. Its combination with time-of-flight mass spectrometry offers the possibility to analyze in full-scan mode, not target-directed, with the availability of a full mass spectrum that will meet the forensic standards. The utility has been demonstrated for the detection of CWAs in complicated matrices such as fuel (Reichenbach et al., 2003). The method has also been used for the analysis of regenerated sarin in inhibited plasma (van der Meer et al., 2010). Finally, it may be expected that the sample preparation will be more or less automated. Recently, a promising result was published by Carol-Visser et al. (2008), who described the digestion and analysis of sulfur mustard adducts in albumin and the sarin adduct to BuChE. 

M. Shohrati, M. Peyman, A. Peyman, M. Davoudi and M. Ghanei, Cutaneous and ocular late complications of sulfur mustard in Iranian veterans. Cutaneous Ocul Toxicol, 2007,26,73. 

NIKOLSKY S SIGN. The condition in which a person s outer layer of skin is easily rubbed off by slight injury or contact. In many cases, the condition leads to complications, such as infection of the exposed area. In the context of chemical warfare (CW), a peculiar complication is the prospect of forming secondary blisters resulting from the transfer of a vesicant, such as sulfur mustard or nitrogen mustard, from skin that is rubbed off onto unaffected surfaces, such as nearby skin. 

Sulfur Mustard stability in nonpolar solvents has been determined by GC and GC-MS methods. The situation is more complex for Lewisite because GC methods generally involve derivatization with thiols, and are also complicated by the fact that Lewisite and its hydrolysis products give the same compound after derivatization. The solution to this problem can be found by measuring Lewisite without derivatization. In a study reported by Down in 2005 [63], toluene was selected as the extraction solvent because Lewisite slowly decomposed in other organic solvents, such as acetone and hexane. Thermal oligomerization in the injection port was prevented by on-column injection and a deactivated guard column was used to prevent the well-known problems of memory effects and column deterioration that occur with Lewisite. The extracts were analysed by GC-AED and GC-MS with both electron and chemical ionization [63]. More GC-MS techniques will be described in Chapter 4 with respect to the numerous degradation products of Sulfur Mustard. 

---