Sulfur mustard toxicity: Difference between revisions
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==Background== | ==Background<ref> Walls, R., & Rosen, P. (2018). Rosen's emergency medicine: Concepts and clinical practice (9th ed.). Philadelphia, PA: Elsevier/Saunders. </ref>== | ||
*Abbreviation: H | *Abbreviation: H | ||
*2,2,-dichlordiethyl sulfide | *2,2,-dichlordiethyl sulfide | ||
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*Damage begins at 1-2 minutes post-exposure with irreversible damage within 20 minutes | *Damage begins at 1-2 minutes post-exposure with irreversible damage within 20 minutes | ||
*Symptoms are visible by 4-8 hours | *Symptoms are visible by 4-8 hours | ||
==Clinical Features== | ==Clinical Features<ref> Walls, R., & Rosen, P. (2018). Rosen's emergency medicine: Concepts and clinical practice (9th ed.). Philadelphia, PA: Elsevier/Saunders. </ref>== | ||
*Odor of garlic, onion, or horseradish | *Odor of garlic, onion, or horseradish | ||
*Physical symptoms do not occur until approximately 20 minutes but may take up to 4 hours | *Physical symptoms do not occur until approximately 20 minutes but may take up to 4 hours | ||
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**Systemic | **Systemic | ||
***Bone marrow suppression leading to neutropenia within 3-5 days → development of secondary infections | ***Bone marrow suppression leading to neutropenia within 3-5 days → development of secondary infections | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 13:02, 14 March 2018
Background[1]
- Abbreviation: H
- 2,2,-dichlordiethyl sulfide
- A blister chemical agent (vesicant) type of chemical weapon
- Mustard vapor exposure greater medical concern than liquid form
- Damage begins at 1-2 minutes post-exposure with irreversible damage within 20 minutes
- Symptoms are visible by 4-8 hours
Clinical Features[2]
- Odor of garlic, onion, or horseradish
- Physical symptoms do not occur until approximately 20 minutes but may take up to 4 hours
- Penetrates skin, rubber gloves, clothing
- Causes both local and systemic toxicity
- Local
- Eye
- Only 1% have permanent eye damage; the majority heal within 2 weeks to 2 months without sequelae
- Conjunctivitis
- Blepharospasm
- Skin
- Blisters resembling second degree burns
- Within 4-8 hours: erythema + burning → vesicle and bullae formation
- Airway
- Dose-dependent ranging from nasopharyngeal irritation to hemorrhagic necrosis of bronchioles
- Eye
- Systemic
- Bone marrow suppression leading to neutropenia within 3-5 days → development of secondary infections
- Local
Differential Diagnosis
Chemical weapons
- Blister chemical agents (Vesicants)
- Lewisite (L)
- Sulfur mustard (H)
- Phosgene oxime (CX)
- Pulmonary chemical agents (Choking agents)
- Incendiary agents
- Cyanide chemical weapon agents (Blood agents)
- Prussic acid (AKA hydrogen cyanide, hydrocyanic acid, or formonitrile)
- Nerve Agents (organophosphates)
- Acetylcholinesterase inhibitors
- Household and commercial pesticides (diazinon and parathion)
- G-series (sarin, tabun, soman)
- V-series (VX)
- Lacrimating or riot-control agents
- Pepper spray
- Chloroacetophenone
- CS
Evaluation
Management
- Immediate decontamination, 0.5% hypochlorite solution will inactivate sulfur mustard but not appropriate for pediatric patients
- No antidotes for mustard agents