CBRNE - Vesicants, Organic Arsenicals - L, ED, MD, PD, HL Medication

Updated: Apr 29, 2015
  • Author: Geoffrey M Fitzgerald, MD; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
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Medication

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.

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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.

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Analgesics

Class Summary

Pain is common and can be severe.

Morphine sulphate (Duramorph, Astramorph, MS Contin)

Mechanism of action is via the opiate receptors.

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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.

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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.

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