Synonym: Sulfur mustard (H); Distilled sulfur mustard (HD); Nitrogen mustard (HN1, HN2, and HN3); Lewisite (L); Phosgene oxime (CX)
Category: Chemical & Nuclear Weapons
Agent Type: Chemical
Acuity: Acute-Severe
Latency/Incubation: Seconds to hours; Sulfur mustard: 2-48 hours; Nitrogen mustard: 4-6 hours; Lewisite: minutes for pain and 2-3 hours for blisters; CX: immediate pain; 30 min. for wheals; 24 hours for necrosis;
[Weinstein, p. 140]
Initial Symptoms: Skin blisters or painful
wheals;
Comments: Vesicants are chemical weapons used to inflict chemical burns to the skin and respiratory tract. Mustard and Lewisite cause vesicles or blisters. Phosgene oxime causes immediately painful skin wheals followed by tissue necrosis. Mustard causes painful blisters after a delay of several hours, but it must be decontaminated within a minute or two to reduce tissue damage. Pain and irritation from Lewisite appear within seconds to minutes of exposure. Epithelium appears gray within 5 minutes of contact. British anti-Lewisite (BAL) can neutralize the toxic effects of Lewisite if applied topically within minutes after exposure. After mustard poisoning, leukocytosis may develop on the first day followed by leukopenia. A white blood cell count <500/uL is associated with a poor prognosis. Chemical pneumonitis develops within a few days after inhalation exposure. Hemorrhagic pulmonary edema may occur. Complications include pseudomembrane formation and airway obstruction. Conjunctivitis is common. Many victims recover within 1-2 weeks, but permanent corneal damage occurs in less than 1% of cases. Miosis may be seen as a cholinergic effect of mustard. Nausea and vomiting are common, but diarrhea is rare. Nitrogen mustards cause seizures in animal experiments.
[USAMRICD, p. 56-101] Mustard poisoning causes bone marrow injury, and patients may develop pancytopenia beginning 3-5 days after exposure. A lethal dose is about 1 teaspoon (7 grams) or enough to cover 25% of the body surface area. Patients die from pulmonary injury and immune deficiency 5-10 days after exposure. Blister fluid does not contain mustard. The metabolite thiodiglycol can be detected in the urine for about 1 week.
[Weinstein, p. 136]
Diagnostic: Mustard: odor and field chemical
test; [Jane, p. 61-2]
Signs & Symptoms: epistaxis; pharyngitis;
nausea, vomiting; anemia; leukocytosis; leukopenia; thrombocytopenia;
seizure; conjunctivitis, acute; lacrimation; miosis; cough; dyspnea, acute; inspiratory rales; burn,
skin vesicles; urticaria; diffuse infiltrates; ARDS; blindness; pulmonary edema;
sepsis; shock
Syndromes: Acute Respiratory, No Fever; 1st,
2nd, or 3rd Degree Burns;
Entry: Inhale; Eye/Skin
Warfare: Victim--air release of chemicals/toxins
