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ACUTE EXPOSURE INFORMATION
- Lewisite is a vesicant or a blistering-type military poison that is extremely toxic by all routes of exposure. As a chemical warfare agent it can cause severe blistering and chemical burns, but may also act systemically to produce: diarrhea, restlessness, hypothermia, weakness, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) and hypotension. The main route of absorption that results in systemic toxicity is through the respiratory tract, however, systemic effects may be seen after ingestion or through dermal contact.
- Lewisite acts first as a vesicant (since first contact is usually through dermal exposure), then as a pulmonary irritant and finally as a systemic poison. It can cause violent sneezing, severe pain and terror. It has similar toxic effects to mustard gas in that its main target organs are the skin, eyes and airways (the main organs affected); however, it differs in that its clinical effects appear within seconds of exposure. Data on human exposure is few; most information on its clinical effects is based on animal studies.
- After inhalation, mucous membranes are affected, causing severe irritation. Vocal cord paralysis and chemical pneumonitis may result. After severe inhalation exposures, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) and death due to respiratory failure may occur. Systemic absorption can result in increased capillary permeability, causing loss of fluid from the vasculature, resulting in hemoconcentration, shock, and death.
- Dermal contact results in immediate stinging and burning sensations, and erythema within 30 minutes. Formation of sharply circumscribed, painful blisters, may occur in 2 to 13 hours after exposure. As little as five minutes of dermal exposure may result in a gray area of dead epithelium similar to that seen with corrosive burns. Itching and irritation may occur for about 24 hours, whether or not a blister is seen.
- Severe burns can result from dermal exposure. Skin burns are generally deeper than those with mustard gas. Skin penetration can result from contact with either liquid or vapor forms. Very small amounts (0.5 mL) can produce systemic effects; as little as 2 mLs can be fatal.
- Eye exposure results in rapid damage. Contact causes an immediate stinging and burning sensation. Blepharospasm may occur instantly, however, conjunctival and lid edema, iris inflammation, and corneal haziness occurs over several hours.
- Temporary blindness due to blistering and swelling of the eyelids and mucous membranes can occur. Erosion of the corneal epithelium may heal spontaneously, however, corneal scars may develop after initial recovery and reduce visual acuity. Moreover, permanent blindness is possible without prompt decontamination (within 1 minute).
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