Methyl bromide

Background

• Fumigant and pesticide. Also reported as pulmonary chemical weapon
• Colorless, non-flammable gas that has no odor except at high levels
• Binds to and damages DNA
• Neurotoxic, though inhalational injury is most common cause of death acutely
• Long term exposure to low levels can affect CNS

Clinical Features

• Onset of symptoms several minutes to 48h after exposure
• Corrosive to skin and eyes, can cause irritation and blistering, though poorly absorbed through skin
• Neurotoxic
  • Effects may be long-lasting
  • HA, visual disturbances, fatigue
  • Nausea/vomiting
  • Cerebellar dysfunction (e.g. nystagmus, ataxia)
  • AMS
  • Seizure, paralysis
• Inhalational exposure causes direct respiratory irritation --> pulmonary edema

Differential Diagnosis

Chemical weapons

• Blister chemical agents (Vesicants)
  • Lewisite (L)
  • Sulfur mustard (H)
  • Phosgene oxime (CX)
• Pulmonary chemical agents (Choking agents)
  • Ammonia toxicity
  • Methyl isocyanate
  • Methyl bromide
  • Hydrochloric acid
  • Chlorine gas
  • Phosgene
• Incendiary agents
  • Agent orange
  • White phosphorus
• 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

• Evaluate for alternate diagnoses

Management

• Decontaminate
• Supportive

Disposition

• Dependant on severity of toxicity

References

• CDC Agency for Toxic Substances and Disease Registry https://www.atsdr.cdc.gov/MMG/MMG.asp?id=818&tid=160
• National Pesticide Information Center http://npic.orst.edu/factsheets/MBgen.pdf