Medication Summary
In addition to the medications mentioned in the preceding section, the organic arsenicals have an antidote in the form of British anti-lewisite agent (BAL, dimercaprol). BAL is a chelating agent that was developed at the end of World War I specifically to treat lewisite (L) casualties.
Chelating agents
Class Summary
As a chelating agent, BAL binds to the arsenic moiety, thereby preventing or reversing its binding to tissue enzymes. The BAL-arsenic moiety then is excreted renally. Dimercaprol currently is used as a chelating agent for heavy metals such as arsenic, gold, and mercury.
Dimercaprol (BAL in oil)
Packaged in 3-mL ampules with 100 mg/mL. Formerly supplied as an ophthalmic and dermatologic ointment during World War II; these preparations are no longer available.
Analgesics
Class Summary
Pain is common and can be severe.
Morphine sulphate (Duramorph, Astramorph, MS Contin)
Mechanism of action is via the opiate receptors.
Antipruritic agents
Class Summary
Cutaneous exposure can produce severe pruritus.
Diphenhydramine (Benylin, Benadryl)
For symptomatic relief of symptoms caused by release of histamine in allergic reactions.
Antibiotics
Class Summary
Cutaneous damage caused by vesicants can leave the victim susceptible to bacterial infection.
Silver sulfadiazine 1% (Silvadene)
Useful in prevention of infections. Has bactericidal activity against many gram-positive and gram-negative bacteria, including yeast.
Tables
Classification |
10 min |
30 min |
1 h |
4 h |
8 h |
AEGL-2 (disabling) |
1.3 mg/m3 (0.15 ppm) |
0.47 mg/m3 (0.055 ppm) |
0.25 mg/m3 (0.030 ppm) |
0.070 mg/m3 (0.0083 ppm) |
0.037 mg/m3 (0.0044 ppm) |
AEGL-3 (lethal) |
3.9 mg/m3 (0.46 ppm) |
1.4 mg/m3 (0.16 ppm) |
0.74 mg/m3 (0.087 ppm) |
0.21 mg/m3 (0.025 ppm) |
0.11 mg/m3 (0.013 ppm) |
