CBRNE - Vomiting Agents - Dm, Da, Dc Clinical Presentation

  • Author: Christopher P Holstege, MD; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Mar 16, 2010
 

History

  • A history of exposure to an aerosolized substance that resulted in ophthalmic and pulmonary irritation and then progressed to nausea, vomiting, abdominal cramps, and headache suggests exposure to a vomiting agent.
  • In the early phases of an emergency response, the toxin's identification would be unknown and the history misleading and inaccurate.
    • Fear, anxiety, and mistrust are likely to affect victims, emergency responders, bystanders, and the entire community after such an incident.
    • Overwhelming emotions in some patients, rescuers, and hospital staff are likely to cause acute anxiety reactions and mass psychogenic illness. Patients truly suffering from vomiting-agent poisoning and those suffering from mass psychogenic illness would be difficult to separate, because the symptoms are similar. Patients with either condition may complain of nausea, vomiting, diarrhea, headache, tearing, dizziness, chest tightness, and shortness of breath.
    • Because differentiating mass hysteria from a true vomiting-agent poisoning may be difficult, treat all patients experiencing symptoms as true toxic emergencies. The potential exists for patients with mass psychogenic illness to overwhelm the entire emergency response system and hinder timely treatment of those with true toxic emergencies.
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Physical

The signs and symptoms encountered in a person exposed to a vomiting agent may vary. Factors that determine clinical effects include the amount of the agent encountered and the route of exposure. Depending on these variables, the progression of signs and symptoms can range from mild mucosal irritation to cardiovascular collapse and death. The following list constitutes findings that may be noted on physical examination following exposure to vomiting agents:

  • Eye - Conjunctival injection, tearing, and blepharospasm
  • Nose - Excessive nasal discharge, sneezing, mucosal injection, and edema
  • Throat - Mucosal injection and edema
  • Lungs - Excessive cough, wheezing, rhonchi, prolonged expiratory phase, and tachypnea
  • Heart - Tachycardia
  • Abdomen - Hyperactive bowel sounds, intestinal cramps, emesis, and diarrhea
  • Skin - Erythema and edema at the site of dermal contact
  • Mental status - Central nervous system depression, syncope, and death (possible with significant exposure)
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Causes

Human exposures to vomiting agents rarely have been reported. Potential causes of exposure to these agents are laboratory accidents, terrorist events, or military conflicts.

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Contributor Information and Disclosures
Author

Christopher P Holstege, MD  Associate Professor of Emergency Medicine and Pediatrics, University of Virginia; Director, Division of Medical Toxicology, Center of Clinical Toxicology; Medical Director, Blue Ridge Poison Ctr, Associate Medical Toxicology Fellowship Director, VA Dept of Health

Christopher P Holstege, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Association for the Advancement of Science, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, Medical Society of Virginia, Society for Academic Emergency Medicine, Society of Toxicology, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer S Boyle, MD, PharmD  Fellow in Toxicology, University of Virginia Health System

Disclosure: Nothing to disclose.

Specialty Editor Board

Fred Henretig, MD  Director, Section of Clinical Toxicology, Professor, Medical Director, Delaware Valley Regional Poison Control Center, Departments of Emergency Medicine and Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Rick Kulkarni, MD  Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital

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

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