Agent 15 Poisoning Workup

  • Author: Geoffrey M Fitzgerald, MD; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Mar 13, 2012
 

Laboratory Studies

  • The paucity of distinct diagnostic signs and the lack of any sort of field detector make the diagnosis of Agent 15 toxicity extremely difficult.
  • Maintain a high index of suspicion in scenarios in which terrorist or enemy chemical attack is possible. Multiple casualties exhibiting delirium indicate this diagnosis.
  • Most standard urine toxicology screens do not detect the presence of Agent 15.
  • Confirmatory testing is available at select reference laboratories.
  • Routine laboratory tests can be helpful in ruling out other causes of delirium. These include a CBC, electrolytes, BUN and/or creatinine, glucose, LFTs, toxicology screen, ABG, ammonia level, thyroid stimulating hormone, and lumbar puncture for cerebral spinal fluid.
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Geoffrey M Fitzgerald, MD  Consulting Staff, Concord Emergency Medical Associates

Disclosure: Nothing to disclose.

Coauthor(s)

David P Sole, DO, FACEP  Associate Director of Emergency Medical Service Programs, Clinical Assistant Professor of Surgery (Emergency Medicine), Department of Emergency Medicine & Residency Program, Geisinger Medical Center

David P Sole, DO, FACEP is a member of the following medical societies: American College of Emergency Physicians and National Association of EMS Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Suzanne White, MD  Medical Director, Regional Poison Control Center at Children's Hospital, Program Director of Medical Toxicology, Associate Professor, Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine

Suzanne White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, American College of Epidemiology, American College of Medical Toxicology, American Medical Association, and Michigan State Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

References

  1. Goldfrank L, Flomenbaum N, Lewin N, et al. Anticholinergic poisoning. J Toxicol Clin Toxicol. Mar 1982;19(1):17-25. [Medline].

  2. Bowen TE. Emergency War Surgery. Revisionist Press; 1988:93-94.

  3. Burns MJ, Linden CH, Graudins A, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. Apr 2000;35(4):374-81. [Medline].

  4. Goldfrank LR, Flomenbaum NE. Goldfrank's Toxicologic Emergencies. Appleton & Lange; 1998.

  5. Ketchum JS, Sidell FR. Incapacitating agents. In: Textbook of Military Medicine, Warfare, Weaponry and the Casualty: Medical Aspects of Chemical and Biological Warfare. United States Government Printing Office; 1997:287-306.

  6. Schneir AB, Offerman SR, Ly BT, Davis JM, Baldwin RT, Williams SR, et al. Complications of diagnostic physostigmine administration to emergency department patients. Ann Emerg Med. Jul 2003;42(1):14-9. [Medline].

  7. Shannon M. Toxicology reviews: physostigmine. Pediatr Emerg Care. Jun 1998;14(3):224-6. [Medline].

  8. Tintinalli JE. Anticholinergic toxicity. In: Emergency Medicine: A Comprehensive Study Guide. McGraw Hill; 2000:1182-1185.

 
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