Mustard gas: imminent danger or eminent threat?
OBJECTIVE
To increase awareness of the widespread environmental prevalence of the chemical warfare agent mustard gas, examine the acute and chronic toxic effects to exposed humans, and discuss medical treatment guidelines for mustard gas exposures.


METHODS
Literature retrieval of medical case reports and clinical studies was accomplished using PubMed and the Cochrane Database (1919-March 2007). Search terms included mustard, mustard gas, sulfur mustard, chemical warfare, blister agents, vesicants, and war gas. Historical information and current events were accessed through military field manuals and Internet searches.


METHODS
All articles in English identified from the data sources were evaluated. Adult and pediatric populations were included in the review.


RESULTS
Mustard gas and other chemical weapons are feared for their use as weapons of terror; however, the major threat of mustard gas lies elsewhere. Tons of this chemical agent were produced for war, then subsequently buried in landfills, disposed of at sea, or left to decay in storage facilities. There are documented and anecdotal reports of chemical weapon burial sites and ocean dumps across the globe spanning from the Arctic Circle to Australia. Numerous accidental exposures have occurred over the past decade. Mustard gas is corrosive to the skin, eyes, and respiratory tract. Extensive exposures can also affect other organ systems. Its ability to cause harm to multiple organ systems at extremely low doses in virtually any environmental condition makes it an extremely dangerous agent. Immediate decontamination of people exposed to mustard gas liquids and vapors is paramount. Supportive care and long-term followup is necessary for exposed persons. Research is under way to find antidotes or treatment methods for mustard gas exposure, but currently there are no definitive treatment guidelines.


CONCLUSIONS
Mustard gas is a weapon, but also a prevalent environmental threat. Recognizing the immense environmental presence of mustard gas disposal sites and the signs and symptoms of exposure will help speed treatment to those accidentally or purposefully exposed.
Geraci
Matthew J
MJ
Emergency Medicine, Department of Pharmacy, Baptist Medical Center Downtown, 800 Prudential Dr., Jacksonville, FL 32207, USA. matthew.geraci@bmcjax.com
D000208:Acute Disease; D000818:Animals; D002619:Chemical Warfare Agents / Q000009:adverse effects* / Q000737:chemistry / Q000493:pharmacokinetics / Q000506:poisoning; D002908:Chronic Disease; D003666:Decontamination / Q000379:methods; D004781:Environmental Exposure / Q000009:adverse effects / Q000517:prevention & control; D006801:Humans; D009151:Mustard Gas / Q000009:adverse effects* / Q000737:chemistry* / Q000493:pharmacokinetics / Q000506:poisoning
D002619:Chemical Warfare Agents; D009151:Mustard Gas