Agent orange

Background

• Member of chlorophenoxy pesticide group, and are often contaminated with dioxin
• Gained notoriety during Vietnam War

Mechanism

• Absorbed through skin, GI tract, and respiratory tract
• Acts on skeletal muscle but exact mechanism unknown

Clinical Features

• Serious toxic effects develop in 4-6 hours
• Non-specific dermal and GI irritation (nausea, vomiting, GI distress)
• Myotonia, muscle fasciculations, rhabdomyolysis, hyperthermia

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

• No specific tests for chlorophenoxy compounds
• Workup is aimed at detecting muscle injury and hepatic/renal function

Management

• Skin decontamination
• Supportive care
• Treat rhabdomyolysis, hyperthermia, and metabolic acidosis

See Also

• Chemical weapons