Sulfur mustard toxicity: Difference between revisions
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*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 | |||
***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 | |||
***Bone marrow suppression leading to neutropenia within 3-5 days → development of secondary infections | |||
<ref> Walls, R., & Rosen, P. (2018). Rosen's emergency medicine: Concepts and clinical practice (9th ed.). Philadelphia, PA: Elsevier/Saunders. </ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 20:57, 26 February 2018
Background
- 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
- 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