REVIEW
Clinical management of casualties exposed to lung damaging agents: a critical review
1 Health Protection Agency, Chemical Hazards and Poisons Division, Cardiff, UK
2 Health Protection Agency, Chemical Hazards and Poisons Division, Newcastle, UK
3 dstl, Porton Down, Salisbury, Wiltshire
Correspondence to:
Correspondence to:
Dr David Russell
Health Protection Agency, Chemical Hazards and Poisons Division, Colchester Avenue, Cardiff, CF61 1ZB, UK; drussell{at}uwic.ac.uk
There is no specific antidote for the treatment of casualties exposed to chlorine, phosgene, or mustards; therefore, management is largely supportive. Corticosteroid treatment has been given to casualties accidentally exposed to chlorine. Clinical data on efficacy are inconclusive as the numbers given steroids have been small and the indications for administration unclear. There have been no clinical controlled studies. There is a stronger evidence base from animal studies, particularly from porcine and rodent models. Lung injury induced by phosgene and mustard appears to be mediated by glutathione depletion, lipid peroxidation, free radical generation, and subsequent cellular toxicity. There is limited evidence to suggest that repletion of glutathione reduces and/or prevents lung damage by these agents. This may provide an opportunity for therapeutic intervention.
Abbreviations: DBcAMP, dibutyryl adenosine 3’5’-cyclic monophosphate; ETYA, 5,8,11,4-eicosatetraynoic acid; GSH, glutathione; LDA, lung damaging agent; NAC, N-acetyl cysteine
Keywords: chemical terrorism; chlorine; lung damaging agents; mustard; phosgene
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Emerg. Med. J. 2006 23: 415.
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