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Chemical Weapons Poisoning

Chemical Weapons Poisoning is a topic covered in the 5-Minute Emergency Consult.

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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
  • Lacrimators 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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Rosen, Peter, et al., editors. "Chemical Weapons Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307180/all/Chemical_Weapons_Poisoning.
Chemical Weapons Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307180/all/Chemical_Weapons_Poisoning. Accessed April 26, 2019.
Chemical Weapons Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307180/all/Chemical_Weapons_Poisoning
Chemical Weapons Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307180/all/Chemical_Weapons_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Chemical Weapons Poisoning ID - 307180 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307180/all/Chemical_Weapons_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -