Sulfur mustards respiratory toxicity

The interplay between the chemical and biological properties of the threat agent, on the one hand, and the specific attack scenario, on the other, can influence the lethality of the attack. Table 2-2 shows the relative respiratory toxicities (expressed as the lethal concentration of toxin at which 50 percent of test animals are killed, or LCT50, in milligrams per minute per cubic meter) of a variety of toxic gases compared with chlorine gas, which was used as a chemical weapon in World War I. According to Table 2-2, the nerve agent sarin (GB) has a respiratory toxicity approximately 100 times that of chlorine, while sulfur mustard (HD) is about 7 times more toxic. However, the lethality of an attack... 

Sulfur mustard is a known human carcinogen, and some of its degradation products may also be carcinogenic (IOM, 1993). Sulfur mustard acts as a vesicant or blister agent and shows acute systemic toxicity in addition to its effects on skin, eyes, and the respiratory tract. 

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. 

Acute lethality data in animals are summarized in Table 8.7. Based upon the animal data, interspecies variability in the lethal response to sulfur mustard vapor is less than an order of magnitude. For nonlethal effects, the animal data suggest that test species exhibit signs of toxicity that are qualitatively similar to humans when acutely exposed to sulfur mustard vapor. Ocular and respiratory tract irritations are clearly evident in studies using dogs, rats, mice, rabbits, and guinea pigs. 

Studies of occupational exposures to sulfur mustard indicate an elevated risk of respiratory tract and skin tumors following long-term exposure to acutely toxic concentrations. Overall, several factors are important regarding the assessment of the carcinogenicity of sulfur mustard. Increased cancer incidence in humans appears to be associated only with exposures that caused severe acute effects, and occupational exposures tended to involve repeated exposures and repeated injury of the same tissues. Because the therapeutic use of the sulfur mustard analog nitrogen mustard is associated with an increased incidence of CML, the reports of CML in HD-exposed individuals appear to be relevant to the eareinogenicity of sulfur mustard. 

The second exception is that while an antidote is available for systemic effects of Lewisite exposure, there are no antidotes for nitrogen mustard or sulfur mustard toxicity, with one minor caveat if given within minutes after exposure, intravenous sodium thiosulfate may prevent death due to sulfur mustard exposure (25). Otherwise, the medical management for skin, ocular, and respiratory exposure is only supportive. One guideline physicians can follow is to keep skin, eye, and airway lesions free from infection. 

Chevillard, M., Lainee, P., Robineau, P., and Puchelle, E. (1992). Toxic effects of sulfur mustards on respiratory epithelial cells in culture. Cell Biol Toxicol 8, 171-81. 

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... 

M. Balali-Mood, H. Kahrom, R. Afshari, D. Attaran, R. Zojaji and M. Kam-rani. Delayed toxic effects of sulfur mustard on upper and lower respiratory tracts in Iranian veterans, Toxicol Lett., 2010,196, S81. 

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