Sulfur mustard

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Background[1]

  • 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[2]

  • 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 toxicity

  • 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 toxicity

  • Bone marrow suppression leading to neutropenia within 3-5 days → development of secondary infections

Differential Diagnosis

Chemical weapons

Evaluation

Management

  • Immediate decontamination, 0.5% hypochlorite solution will inactivate sulfur mustard but not appropriate for pediatric patients
  • No antidotes for mustard agents

Disposition

See Also

External Links

References

  1. Walls, R., & Rosen, P. (2018). Rosen's emergency medicine: Concepts and clinical practice (9th ed.). Philadelphia, PA: Elsevier/Saunders.
  2. Walls, R., & Rosen, P. (2018). Rosen's emergency medicine: Concepts and clinical practice (9th ed.). Philadelphia, PA: Elsevier/Saunders.