Nerve Agent Exposure Author: Elliot Rodriguez, MD, FACEP; Christine M. Stork, PharmD, DABAT
Editorial changes - 2009-10-30
Author information and module status
Prevention
Screening
Diagnosis
Consultation for Diagnosis
Hospitalization
Non-drug Therapy
Drug Therapy
Patient Education
Consultation for Management
Follow-up
Tables
References
Glossary
What's New
Patient Information
Additional Resources
Tools
References
1. 3Cox RD. Decontamination and management of hazardous materials exposure victims in the emergency department. Ann Emerg Med. 1994;23:761-70. (PMID: 8161045)
2. 2Nozaki H, Hori S, Shinozawa Y, Fujishima S, Takuma K, Sagoh M, et al. Secondary exposure of medical staff to sarin vapor in the emergency room. Intensive Care Med. 1995;21:1032-5. (PMID: 8750130)
3. 2Okudera H, Morita H, Iwashita T, Shibata T, Otagiri T, Kobayashi S, et al. Unexpected nerve gas exposure in the city of Matsumoto: report of rescue activity in the first sarin gas terrorism. Am J Emerg Med. 1997;15:527-8. (PMID: 9270397)
4. 2Nakajima T, Sato S, Morita H, Yanagisawa N. Sarin poisoning of a rescue team in the Matsumoto sarin incident in Japan. Occup Environ Med. 1997;54:697-701. (PMID: 9404315)
5. 2Barach P, Rivkind A, Israeli A, Berdugo M, Richter ED. Emergency preparedness and response in Israel during the Gulf War. Ann Emerg Med. 1998;32:224-33. (PMID: 9701306)
6. 3U.S. Army Medical Research Institute of Chemical Defense (USAMRICD). Nerve Agents. In: Medical Management of Chemical Casualities Handbook. 3rd ed. Aberdeen Proving Ground, MD; 2000:102-35.
7. 3Sidell FR, Borak J. Chemical warfare agents: II. Nerve agents. Ann Emerg Med. 1992;21:865-71. (PMID: 1610046)
8. 2Marino MT, Schuster BG, Brueckner RP, Lin E, Kaminskis A, Lasseter KC. Population pharmacokinetics and pharmacodynamics of pyridostigmine bromide for prophylaxis against nerve agents in humans. J Clin Pharmacol. 1998;38:227-35. (PMID: 9549661)
9. 3Liu DK, Wannemacher RW, Snider TH, Hayes TL. Efficacy of the topical skin protectant in advanced development. J Appl Toxicol. 1999;19 Suppl 1:S40-5. (PMID: 10594900)
10. 3Serpacwa. In: Drugdex Drug Evaluations, Micromedex Healthcare Series Vol. 120, expires July 2004.
11. 3Marrs TC. A history of human studies with nerve agents by the UK and USA. In: Marrs TC, Maynard RL, Sidell FR, eds. Chemical Warfare Agents: Toxicology and Treatment. New York: J Wiley; 1996:115-37.
12. 2Sidell FR. Soman and sarin: clinical manifestations and treatment of accidental poisoning by organophosphates. Clin Toxicol. 1974;7:1-17. (PMID: 4838227)
13. 2Okumura T, Takasu N, Ishimatsu S, Miyanoki S, Mitsuhashi A, Kumada K, et al. Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med. 1996;28:129-35. (PMID: 8759575)
14. 2Suzuki J, Kohno T, Tsukagosi M, Furuhata T, Yamazaki K. Eighteen cases exposed to sarin in Matsumoto, Japan. Intern Med. 1997;36:466-70. (PMID: 9240494)
15. 2Okudera H. Clinical features on nerve gas terrorism in Matsumoto. J Clin Neurosci. 2002;9:17-21. (PMID: 11749011)
16. 3Leikin JB, Thomas RG, Walter FG, Klein R, Meislin HW. A review of nerve agent exposure for the critical care physician. Crit Care Med. 2002;30:2346-54. (PMID: 12394966)
17. 3Nozaki H, Aikawa N, Fujishima S, Suzuki M, Shinozawa Y, Hori S, et al. A case of VX poisoning and the difference from sarin [Letter]. Lancet. 1995;346:698-9. (PMID: 7658832)
18. 3Sidell FR. Nerve agents. In: Zajtchuk R, Bellamy RF (eds). Textbook of Military Medicine. Part I. Warfare, weaponry and the casualty. Medical aspects of chemical and biological warfare. 1st ed. Washington, DC: Borden Institute, Walter Reed Medical Center; 1997:129-79.
19. 2Nozaki H, Hori S, Shinozawa Y, Fujishima S, Takuma K, Kimura H, et al. Relationship between pupil size and acetylcholinesterase activity in patients exposed to sarin vapor. Intensive Care Med. 1997;23:1005-7. (PMID: 9347376)
20. 2Dressel TD, Goodale RL Jr, Arneson MA, Borner JW. Pancreatitis as a complication of anticholinesterase insecticide intoxication. Ann Surg. 1979;189:199-204. (PMID: 426552)
21. 2Hsiao CT, Yang CC, Deng JF, Bullard MJ, Liaw SJ. Acute pancreatitis following organophosphate intoxication. J Toxicol Clin Toxicol. 1996;34:343-7. (PMID: 8667474)
22. 3Brennan RJ, Waeckerle JF, Sharp TW, Lillibridge SR. Chemical warfare agents: emergency medical and emergency public health issues. Ann Emerg Med. 1999;34:191-204. (PMID: 10424921)
23. 2Woodall J. Tokyo subway gas attack [Letter]. Lancet. 1997;350:296. (PMID: 9242833)
24. 2Yokoyama K, Yamada A, Mimura N. Clinical profiles of patients with sarin poisoning after the Tokyo subway attack [Letter]. Am J Med. 1996;100:586. (PMID: 8644774)
25. 2Nozaki H, Aikawa N. Sarin poisoning in Tokyo subway. Lancet. 1995;345:1446-7. (PMID: 7760643)
26. 2Nozaki H, Aikawa N, Shinozawa Y, Hori S, Fujishima S, Takuma K, et al. Sarin poisoning in Tokyo subway [Letter]. Lancet. 1995;345:980-1. (PMID: 7715305)
27. 2Suzuki T, Morita H, Ono K, Maekawa K, Nagai R, Yazaki Y. Sarin poisoning in Tokyo subway [Letter]. Lancet. 1995;345:980. (PMID: 7715304)
28. 2John M, Oommen A, Zachariah A. Muscle injury in organophosphorous poisoning and its role in the development of intermediate syndrome. Neurotoxicology. 2003;24:43-53. (PMID: 12564381)
29. 2Volans GN, Karalliedde L. Long-term effects of chemical weapons. Lancet. 2002;360 Suppl:s35-6. (PMID: 12504496)
30. 3Gur I, Bar-Yishay E, Ben-Abraham R. Biphasic extrathoracic cuirass ventilation for resuscitation. Am J Emerg Med. 2005;23:488-91. (PMID: 16032617)
31. 2Thompson DF. Pralidoxime chloride continuous infusions [Letter]. Ann Emerg Med. 1987;16:831-2. (PMID: 3592350)
32. 2Thompson DF, Thompson GD, Greenwood RB, Trammel HL. Therapeutic dosing of pralidoxime chloride. Drug Intell Clin Pharm. 1987;21:590-3. (PMID: 3301250)
33. 2Tush GM, Anstead MI. Pralidoxime continuous infusion in the treatment of organophosphate poisoning. Ann Pharmacother. 1997;31:441-4. (PMID: 9101007)
34. 3Kassa J. Review of oximes in the antidotal treatment of poisoning by organophosphorus nerve agents. J Toxicol Clin Toxicol. 2002;40:803-16. (PMID: 12475193)
35. 3Shemesh I, Bourvin A, Gold D, Kutscherowsky M. Chlorpyrifos poisoning treated with ipratropium and dantrolene: a case report. J Toxicol Clin Toxicol. 1988;26:495-8. (PMID: 2466131)
36. 3Bozeman WP, Dilbero D, Schauben JL. Biologic and chemical weapons of mass destruction. Emerg Med Clin North Am. 2002;20:975-93, xii. (PMID: 12476890)
37. 1Shih TM, Duniho SM, McDonough JH. Control of nerve agent-induced seizures is critical for neuroprotection and survival. Toxicol Appl Pharmacol. 2003;188:69-80. (PMID: 12691725)
38. 2Page WF. Long-term health effects of exposure to sarin and other anticholinesterase chemical warfare agents. Mil Med. 2003;168:239-45. (PMID: 12685692)
39. 3de Jong RH. Nerve gas terrorism: a grim challenge to anesthesiologists. Anesth Analg. 2003;96:819-25, table of contents. (PMID: 12598268)
40. 2Yokoyama K, Araki S, Murata K, Nishikitani M, Okumura T, Ishimatsu S, et al. Chronic neurobehavioral effects of Tokyo subway sarin poisoning in relation to posttraumatic stress disorder. Arch Environ Health. 1998;53:249-56. (PMID: 9709988)
41. 2Kawana N, Ishimatsu S, Kanda K. Psycho-physiological effects of the terrorist sarin attack on the Tokyo subway system. Mil Med. 2001;166:23-6. (PMID: 11778423)
42. 2Nakajima T, Ohta S, Fukushima Y, Yanagisawa N. Sequelae of sarin toxicity at one and three years after exposure in Matsumoto, Japan. J Epidemiol. 1999;9:337-43. (PMID: 10616267)
43. 2McCauley LA, Rischitelli G, Lambert WE, Lasarev M, Sticker DL, Spencer PS. Symptoms of Gulf War veterans possibly exposed to organophosphate chemical warfare agents at Khamisiyah, Iraq. Int J Occup Environ Health. 2001;7:79-89. (PMID: 11373050)
New References of Interest
44. Worek F, Herkert NM, Koller M, Aurbek N, Thiermann H. Interaction of pentylsarin analogues with human acetylcholinesterase: a kinetic study. Toxicol Lett. 2009;187:119-23. (PMID: 19429253)
FAQs
Christine M. Stork, PharmD, DABAT has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Elliot Rodriguez, MD, FACEP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Jerrold B. Leikin, MD, editorial consultant, received royalties from McGraw-Hill, Taylor and Francis; editor of Toxicoterrorism (McGraw-Hill).
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP. Because all PIER modules are updated regularly, printed web pages or PDFs may rapidly become obsolete. Therefore, PIER users should compare the date of the last update on the website with any printout to ensure that the information being referred to is the most current available.
PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.