title: Pyridostigmine used as a nerve agent pretreatment under wartime conditions.
abstract: OBJECTIVE
  To determine the adverse effects of pretreatment with pyridostigmine bromide for nerve agent exposure during wartime.
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  Southwest Asia.
  
  
  METHODS
  Personnel who provided medical support to the XVIII Airborne Corps. These medical officers supplied information pertaining to symptoms and disposition of 41,650 soldiers who received pyridostigmine at the onset of hostilities of Operation Desert Storm.
  
  
  METHODS
  Pyridostigmine bromide, 30 mg orally, was self-administered every 8 hours while under the threat of nerve agent attack (for 1 to 7 days).
  
  
  METHODS
  Physiologic changes attributable to pyridostigmine that resulted in need for medical attention, discontinuation of the drug, hospitalization, and/or evacuation from Southwest Asia.
  
  
  RESULTS
  About half of the population noted physiologic changes that were not incapacitating, such as increased flatus, abdominal cramps, soft stools, and urinary urgency. Approximately 1% of the soldiers believed they had effects that warranted medical attention, but fewer than 0.1% had effects sufficient to discontinue the drug. Nonincapacitating symptoms often occurred; however, military mission performance was not impaired.
  
  
  CONCLUSIONS
  While under the threat of nerve agent attack, pyridostigmine can be administered to virtually all soldiers.
authors.affiliation: US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Md. 21010-5425.
authors.forename: J R
authors.initials: JR
authors.lastname: Keeler
authors.forename: C G
authors.initials: CG
authors.lastname: Hurst
authors.forename: M A
authors.initials: MA
authors.lastname: Dunn
mesh_terms: D002619:Chemical Warfare Agents / Q000506:poisoning*; D002800:Cholinesterase Inhibitors / Q000506:poisoning; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008297:Male; D009422:Nervous System Diseases / Q000139:chemically induced; D011292:Premedication; D011729:Pyridostigmine Bromide / Q000009:adverse effects / Q000627:therapeutic use*; D011976:Receptors, Muscarinic / Q000187:drug effects; D012189:Retrospective Studies
chemical_list: D002619:Chemical Warfare Agents; D002800:Cholinesterase Inhibitors; D011976:Receptors, Muscarinic; D011729:Pyridostigmine Bromide