Sulfur mustards delayed

Delayed-acting chemical Sulfur mustard Blistering, redness, swelling 2 to 24 hours... 

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,... 

Sulfur mustards (designated H [mustard], HD [distilled mustard], and HT [HD and T mixture]) do not present acute lethal hazards. Their principal effect is severe blistering of the skin and mucous membranes. Epidemiological evidence indicates a causal relationship between exposure to mustard agent at high concentrations and the development of chronic nonreversible respiratory disorders, such as chronic bronchitis and asthma, and ocular diseases, such as delayed recurrent keratitis and prolonged, intractable conjunctivitis (IOM, 1993). Sulfur mustard has been classified as a known human carcinogen based on evidence of in-... 

The mechanism of action of sulfur mustard is multifaceted and complex, and has been reviewed in some detail by Papirmeister et al. (1991), Hurst and Smith (2008), and Smith et al. (2008). Efforts to understand the mechanisms of sulfur mustard toxicity are ongoing. Basically, sulfur mustard disrupts the interface of the epidermis and basement membrane causing blistering between the epidermis and dermis. Both immediate (immediate cell membrane damage) and delayed phases (secondary effects resulting from inflammatory responses, DNA damage, vascular leakage) have been described for sulfur mustard-induced dermal effects (Somani and Babu, 1989). Many of the toxic effects of sulfur mustard can be attributed to oxidative stress. 

In addition to the acute toxic effects on the eyes, skin, and respiratory tract, both acute and longer-term neuropsychiatric effects (e.g. depression, anxiety, neurasthenia, insomnia, post-traumatic stress syndrome) have been documented for individuals exposed to sulfur mustard (Romano et al, 2008). Many of these effects have been documented for individuals exposed during noncombat (e.g. munitions plant workers) activities and are not always the result of high-level exposure that result in serious overt effects. Longer-term effects such as chronic bronchitis have been associated with occupational exposures that included episodes of acute toxicity, and delayed or recurrent keratitis may occur 8-40 years after a severe vapor exposure. Sulfur mustard-induced immunosuppression resulting in greater susceptibility to infections has also been reported. 

Casillas and Babin, unpublished). Finally, inflammatory cell infiltration, which may occur about a day after exposure, may also play a role in delaying SM wound healing (Maumenee and Schloz, 1948). The sheer number of potential target areas in a multilayered, multicell organ that may be affected by sulfur mustard make the task of determining SM s exact mechanism of action quite difficult. 

Kadar, T., Turetz, J., Fishbine, E., Sahar, R., Chapman, S., Amir A. (2001). Characterization of acute and delayed ocular lesions induced by sulfur mustard in rabbits. Curr. Eye Res. 22 42-53. 

Hefazi, M., Maleki, M., Mahmoudi, M., Tabatabaee, A., Balali-Mood, M. (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 1025-31. 

Exposure of the respiratory tract to nitrogen mustard produces the same effects as sulfur mustard. These include the delay in onset, irritation of the nose and throat, hoarseness progressing to aphonia, and persistent cough, fever, dyspnea, and moist rales. After 24 h, chemical pneumonitis may appear. 

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. 

Balali-Mood, M. (1996). Delayed toxic effects of sulfur mustard in 1428 patients. In Proceedings of the Chemical Biological Medical Treatment Symposium An exploration ofpresent capabilities and future requirements (pp. 125—133). Spiez, Switzerland. 

M. and Rabatabaee, A. (2005), Evaluation of delayed toxic effects of sulfur mustard poisoning in... 

Like many other organosulfur compounds, such as mustard gas, dimethyl sulfate manifests delayed effects too. The toxicity is lower than the sulfur mustards with latent period somewhat longer. It can damage eye, respiratory tract, skin, liver, and kidney. The effects appear 2-12 hours after contact, progressively worsening over several days or even weeks. 

Delayed Toxicity. Acute exposures to sulfur mustard can also result in longterm respiratory damage manifested as asthma-like conditions, emphysematous... 

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