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 | ||
*A [[blister chemical agents|blister chemical agent]] (vesicant) type of [[chemical weapon]] | *A [[blister chemical agents|blister chemical agent]] (vesicant) type of [[chemical weapon]] | ||
*Mustard vapor exposure greater medical concern than liquid form | *Mustard vapor exposure greater medical concern than liquid form | ||
*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 | |||
==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>== | ||
[[File:Mustard gas burns.jpg|thumb|[[Chemical burn]] caused by exposure to mustard gas (World War I).]] | |||
[[File:Blister_formation_after_vesicant_exposure_2016-01-07_19-13.jpg|thumbnail|Bullae formation after blister chemical agent exposure (Wikimedia Commons).]] | |||
*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 | ||
*Penetrates skin, rubber gloves, clothing | *Penetrates skin, rubber gloves, clothing | ||
*Causes both local and systemic toxicity | |||
===Local toxicity=== | |||
*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 | |||
===Systemic toxicity=== | |||
*Bone marrow suppression leading to [[neutropenia]] within 3-5 days → development of secondary infections | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Toxicology]] | |||
Latest revision as of 23:45, 17 November 2021
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]
Chemical burn caused by exposure to mustard gas (World War I).
- 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 toxicity
- 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
Systemic toxicity
- Bone marrow suppression leading to neutropenia within 3-5 days → development of secondary infections
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