CBRNE - Mustard Agents - Hd, Hn1-3, H Workup

Updated: Mar 29, 2023
  • Author: Christopher P Holstege, MD; Chief Editor: Zygmunt F Dembek, PhD, MS, MPH, LHD  more...
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Laboratory Studies

No clinically available laboratory test exists to identify or quantify mustard exposure. Mustard is biotransformed in tissues within minutes of exposure. Detection of mustard metabolites (thiodiglycol (TDG), thiodigylocol sulfoxide (TDG-sulfoxide), 1-methylsulfinyl-2-[2-(methylthio)ethylsulfonyl]ethane (MSMTESE), 1,1’-sulfonylbis[2-(methylsulfinyl)ethane (SBMSE), and 1,1’-sufonylbis[2-S-(N-acteylcyteinyl)ethane]) requires more advanced detection methods. [32]

Results of blood studies include the following:

  • Complete blood count – Reactive leukocytosis occurs initially after chemical injury with leukopenia developing by day 3-5. Leukopenia < 200 cells/mm 3 is a poor prognostic sign. Thrombocytopenia and anemia follow due to bone marrow suppression.
  • Metabolic panel – Electrolyte derangements can occur from nausea/vomiting. Acute kidney injury may occur from dehydration.

Other Tests

The US military, as well as state and local emergency responders, have the capability to detect mustard agents on the battlefield or at the sites of suspected mustard agent release in the civilian environment. This capacity is effectively accomplished through the use of specialized equipment such as chemical detection papers, chemical detection alarms, gas detection tubes, photometric detection, ion mobility spectroscopy, Raman spectroscopy, and portable gas chromatography–mass spectroscopy. Some specific examples include the following [33, 34, 35, 36] :

  • M8 and M9 chemical detection paper
  • Joint Chemical Agent Detector (JCAD)
  • Improved chemical Agent Monitor (ICAM)
  • M256A1 chemical agent detector kit
  • M272 chemical agent water testing kit
  • M22 automatic chemical agent detector and alarm
  • M21 remote sensing alarm
  • M90 chemical agent detector
  • Joint Services Lightweight Standoff Chemical Agent Detector (JSLSCAD)
  • M93A1 Fox Nuclear Biological and Chemical Reconnaissance System

Imaging Studies

Inhalation of mustard vapor causes chemical pneumonitis, which may progress to pneumonia. Serial chest x-rays are recommended to track progression. Chest computed tomography (CT) is more sensitive than chest x-rays in detecting chronic changes caused by mustard exposure. [37]