CBRNE - Vomiting Agents - Dm, Da, Dc Workup

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

Laboratory Studies

  • No rapid tests are available that enable health care providers to definitively determine exposure to vomiting agents. Consider these agents when exposure to an unknown substance inflicts pulmonary and ophthalmic irritation and then progresses to nausea, vomiting, abdominal cramps, and diarrhea.
  • Obtain a complete blood count, electrolytes, clotting studies, and renal and liver function tests in any person who potentially was exposed to a chemical warfare agent.
  • If a patient is markedly agitated or comatose, obtain a urine myoglobin and/or creatine phosphokinase to exclude rhabdomyolysis.
  • If considering chemical warfare agent poisoning in the differential, obtain extra blood and urine samples for subsequent toxicologic testing.
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Imaging Studies

  • A chest radiograph may need to be obtained to exclude chemical pneumonitis in a patient exposed to vomiting agents who presents with marked pulmonary irritation.
  • Rarely, vomiting agents may cause altered mental status. If the etiology is uncertain, obtain a head CT scan to exclude other intracranial pathology.
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Other Tests

  • ECG: Vomiting agents are not reported to cause significant cardiac dysrhythmias. Sinus tachycardia may result from the stress of the event. In symptomatic persons at risk for coronary artery disease or in those with preexisting disease, obtain an ECG to exclude evidence of ischemia. When the causative agent is not identified definitively, obtaining an ECG is a reasonable approach to exclude conductive disturbances induced by other toxins.
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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

  1. Sanderson H, Fauser P, Thomsen M, Sorensen PB. Screening level fish community risk assessment of chemical warfare agents in the Baltic Sea. J Hazard Mater. Jun 15 2008;154(1-3):846-57. [Medline].

  2. Ishii K, Tamaoka A, Otsuka F, et al. Diphenylarsinic acid poisoning from chemical weapons in Kamisu, Japan. Ann Neurol. Nov 2004;56(5):741-5. [Medline].

  3. Kato K, Mizoi M, An Y, et al. Oral administration of diphenylarsinic acid, a degradation product of chemical warfare agents, induces oxidative and nitrosative stress in cerebellar Purkinje cells. Life Sci. Nov 10 2007;81(21-22):1518-25. [Medline].

  4. Compton, JAF. Military Chemical and Biological Agents: Chemical and Toxicological Properties. 1988:194-204.

  5. Ellison DH. Vomiting agents. In: Handbook of Chemical and Biological Warfare Agents. 2000:149-150.

  6. Haas R, Tsivunchyk O, Steinbach K. Conversion of adamsite (phenarsarzin chloride) by fungal manganese peroxidase. Appl Microbiol Biotechnol. Feb 2004;63(5):564-6. [Medline].

  7. Henriksson J, Johannisson A, Bergqvist PA, Norrgren L. The toxicity of organoarsenic-based warfare agents: in vitro and in vivo studies. Arch Environ Contam Toxicol. Feb 1996;30(2):213-9. [Medline].

  8. Holstege CP, Bechtel LK, Reilly TH, et al. Unusual but potential agents of terrorists. Emerg Med Clin North Am. May 2007;25(2):549-66; abstract xi. [Medline].

  9. Hu H, Somani SM, eds. Toxicodynamics of riot-control agents (lacrimators). In: Chemical Warfare Agents. 1992:271-288.

  10. Kohler M, Hofmann K, Volsgen F. Bacterial release of arsenic ions and organoarsenic compounds from soil contaminated by chemical warfare agents. Chemosphere. Feb 2001;42(4):425-9. [Medline].

  11. Pitten FA, Muller G, Konig P, et al. Risk assessment of a former military base contaminated with organoarsenic-based warfare agents: uptake of arsenic by terrestrial plants. Sci Total Environ. Feb 9 1999;226(2-3):237-45. [Medline].

  12. Sidell FR. Riot control agents. In: Management of Chemical Warfare Agent Casualties. 1995:93-99.

  13. Tornes JA, Opstad AM, Johnsen BA. Determination of organoarsenic warfare agents in sediment samples from Skagerrak by gas chromatography-mass spectrometry. Sci Total Environ. Mar 1 2006;356(1-3):235-46. [Medline].

  14. Zajtchuck R, ed. Riot control agents. In: Textbook of Military Medicine. 1997:308-324.

 
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