Lewisite toxicity

Background

WWII Lewisite poster

• Abbreviation: L
• A blister chemical agent (vesicant) type of chemical weapon
• Arsenic-containing compound

Clinical Features

Lewisite (top row) and mustard gas test with concentrations from 0.01% to 0.06%

• Odor of geraniums
• Pain with immediate contact
• May turn skin grayish color around vesicles

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

Management

• British antilewisite (BAL) – chelating agent to reduce systemic effects from lewisite exposure.
  • Won’t alter the blistering effects on skin or airway.
  • Only used for patients with shock or severe pulmonary injury given BAL side effect
  • Relative contraindications to BAL: Renal disease, pregnancy

See Also

• Blister chemical agents