- TIME COURSE: Clinical effects do not appear until hours after nitrogen mustard exposure. Nitrogen mustards penetrate and bind quickly to cells of the body, but their health effects develop slowly. The full extent of cellular injury may not be known for days. The sooner after exposure that health effects occur, the more likely it is that the patient/victim was exposed to a high concentration of mustard. Similarly, the sooner that health effects occur, the more likely it is that they will progress and become severe. Eye exposure: The eyes are the organs that are most sensitive to mustard vapor; eye injury may occur within 1 to 2 hours after severe exposure, or 3 to 12 hours after a mild to moderate exposure. Inhalation exposure: Airway injury may occur within 2 to 6 hours after severe exposure and within 12 to 24 hours after mild exposure. Skin exposure: The symptom-free (latent) period is 6 to 12 hours in temperate conditions; hot, humid weather strikingly increases the action of nitrogen mustards. Some skin injury may appear as late as 48 hours after exposure.
- EFFECTS OF SHORT-TERM (LESS THAN 8-HOURS) EXPOSURE: Nitrogen mustards damage the tissues of the eyes, skin, and respiratory tract. The skin healing process following mustard exposure is very slow. In addition to being blister agents (vesicants), nitrogen mustards are alkylating agents: when absorbed into the body, they can injure the bone marrow, lymph nodes, and spleen, causing a drop in white blood cell counts and increasing the risk of developing infections. Internal bleeding (hemorrhage) and a deficiency of red blood cells (anemia) may also result from bone marrow injury. Nitrogen mustards also affect the central nervous system (CNS). Nitrogen mustard exposure may be fatal; the cause of death is usually respiratory failure.
- EYE EXPOSURE:
- Mild (onset within 4 to 12 hours): Tear production (lacrimation), irritation, itching, burning, spasmodic blinking (blepharospasm), dryness or gritty feeling, and possible pinpoint pupils (miosis).
- Moderate (onset within 3 to 6 hours): Above plus increased redness, fluid accumulation (edema) in the eyelids, and moderate pain.
- Severe (usually from liquid agent; onset within 1 to 2 hours): Increased fluid accumulation (edema) in eyelids, painful sensitivity to light (photophobia), damage to the cornea (ulceration), blindness, and severe pain.
- INGESTION EXPOSURE:
- Nausea, vomiting (emesis), pain, hemorrhagic diarrhea, and chemical burns of the gastrointestinal (GI) tract.
- INHALATION EXPOSURE:
- Mild (onset within 2 to 24 hours): Runny nose (rhinorrhea), sneezing, nosebleed (epistaxis), hoarseness progressing to "toneless" voice, barking cough, loss of taste and smell, wheezing and difficulty breathing or shortness of breath (dyspnea) in smokers and asthmatics, and nasal and sinus pain (occurring later).
- Severe (onset within 2 to 6 hours): Same as above, plus acute inflammation of the upper and lower airways; tissue death (necrosis) of the airway lining (respiratory epithelium); possible obstruction of both upper and lower airways due to formation of a false membrane or fibrous deposit (pseudomembrane); airway blockage (occlusion) from inflamed and dead (necrotic) cells; and death, due to inflammatory lung disease (pneumonia).
- Exposures to higher concentrations of vapor result in health effects that occur sooner and are more severe.
- Damage to the airways (and to tissues immediately surrounding the airways) begins with the upper airways and descends to the lower airways. The severity of damage increases as the concentration of nitrogen mustard increases.
- SKIN EXPOSURE:
- Tender skin, the moist lining of body passages and cavities (mucous membranes), and perspiration-covered skin are more sensitive to the effects of nitrogen mustard.
- Skin effects of liquid mustard occur sooner than do the effects of mustard vapor.
- Mild to moderate: Erythema (redness) begins to appear 1 to 24 hours after exposure (typically within 4 to 8 hours); blistering (vesication) begins 2 to 18 hours after onset of redness; possible intense itching (pruritus) and burning pain.
- Severe: As above, with more severe blistering (vesication) and areas of central tissue death (necrosis), plus whole-body (systemic) health effects including weakness (malaise), vomiting (emesis), fever, and complete exhaustion (prostration).
- Skin exposure to nitrogen mustard can be fatal. An area of redness (erythema), with or without blistering (vesication), which covers 25% or more of the body’s surface area, suggests a lethal exposure.
|