Chemical Weapons Poisoning

Basics

Chemical agents that affect CNS, pulmonary, cardiovascular, dermal, ocular, or GI systems when exposed to victims

Blood agents: Cyanide:
- Inhibition of cellular respiration by binding to ferric ion in cytochrome oxidase a-a3 and uncoupling oxidative phosphorylation
Blister agents: Sulfur mustard, nitrogen mustard, lewisite, phosgene oxime:
- Alkylation and cross-linking of purine bases of DNA and amino acids resulting in change in structure of nucleic acid, proteins, and cellular membranes
Lachrymators and riot control agents: 1-chloroacetophenone (CN; Mace), o-chlorobenzylidene malononitrile (CS), oleoresin capsaicin-pepper spray (OC), chloropicrin, adamsite (DM):
- Mucous membrane irritators
Pulmonary irritants (choking agents):
- High water solubility: Ammonia:
  - Mucous membrane irritation of eyes and upper airway
- Intermediate water solubility: Chlorine:
  - Forms hydrochloric acid, hydrochlorous acids, which form free radicals causing upper airway and pulmonary irritation
- Low water solubility: Phosgene:
  - Mild irritant effects initially, then delayed pulmonary edema as late as 24 hr
  - Direct pulmonary damage after hydrolysis in lungs to hydrochloric acid
Nerve agents:
- Anticholinesterase inhibitors—causes cholinergic overstimulation at muscarinic, nicotinic, and CNS sites
Incapacitating agents: 3-quinuclidinyl benzilate (BZ):
- Anticholinergic (antimuscarinic)

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