[Acute poisoning by chemical warfare agent: sulfur mustard].
OBJECTIVE
To review story, mechanism of action, clinical and therapeutic bases of a sulfur mustard poisoning, by accidental, terrorism or war exposure.


METHODS
References were obtained from computerised bibliographic research (Medline), from personnel data (academic memoir, documents under approbation of the National Defense Office) and from the Library of Military Medical Service.


RESULTS
Sulfur mustard is a chemical warfare agent with peace time results: leak, accidental handling, acts of terrorism. Sulfur mustard is a vesicant agent, an organochlorine agent, who alkylate DNA. Under liquid or gas form its main target are skin and lungs. Clinical effects are like burns with loss of immunity, with respiratory failure, ophthalmic, gastrointestinal and haematological signs. The last studies have improved knowledge about the mechanism of action, detection, protection and treatment. Methods for determination of sulfur mustard are based on gas chromatographic method and mass spectrometry. During sulfur mustard contamination the first priorities of treatment are to remove victims from the contaminated place and to initiate decontamination. Emergency workers and materials must take protection to avoid secondary contamination of emergency unit. With treatment of vital functions and respiratory failure, the new ways of treatment are about N-acetyl cysteine for lung injury, poly (ADP-ribose) polymerase inhibitors, calmodulin antagonists and Ca(++) chelators. Interactions between sulfur mustard and anaesthetic agents are not well known and are based on clinical observations.


CONCLUSIONS
Emergency care unit can be confronted with sulfur mustard during accidental contamination or acts of terrorism. First and most efficacy priorities of treatment are to remove and to decontaminate victims. New means of detection and treatment are studied since several years but are not still appropriate to human victims or mass treatment.
Mérat
S
S
Département d'anesthésie-réanimation, HIA Percy, 101, avenue Henri-Barbusse, 92141 cedex, Clamart, France. schmart@free.fr <schmart@free.fr>
Perez
J P
JP
Rüttimann
M
M
Bordier
E
E
Lienhard
A
A
Lenoir
B
B
Pats
B
B
D000477:Alkylating Agents / Q000266:history / Q000494:pharmacology; D002618:Chemical Warfare / Q000266:history*; D002619:Chemical Warfare Agents / Q000266:history / Q000494:pharmacology / Q000506:poisoning*; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D009151:Mustard Gas / Q000266:history / Q000494:pharmacology / Q000506:poisoning*; D011041:Poisoning / Q000175:diagnosis / Q000266:history / Q000517:prevention & control; D023481:Terrorism
D000477:Alkylating Agents; D002619:Chemical Warfare Agents; D009151:Mustard Gas
Intoxication aiguë par arme chimique vésicante: l'ypérite.