Medical Aspects of Chemical Warfare (2008) - The Black Vault

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Medical Diagnosticsisolation of the globin from the RBCs, the globin isreacted with pentafluorophenyl isothiocyanate to forma thiohydantoin compound, which is further derivatizedbefore analysis (Figure 22-10). The derivatizedcompound can then be analyzed using negative ionchemical ionization GC-MS (Exhibit 22-3). 113,114Human serum albumin was found to be alkylatedby sulfur mustard at the cysteine-34 position. Fol-Table 22-10Published Reports (1995–2006) of Laboratory Analysis of Human Urine Samples forHydrolysis Metabolites Following Suspected Exposure to Sulfur MustardPatient Sample Glucuronidase Glucuronidase IncubationInformation* Incubation † TiCl 3Reduction ‡ TDG-sulfoxide & TiCl 3Reduction §Iranian casualties, 3 of 5 nm patient C1: 69 ng/ml nm nmindividuals, treated at P patient C2: 28 ng/mLGhent hospital, P patient C5: 33 ng/mLcollected 10 days after Ccontrol: 11 ng/mLincident (March 9,1984) 1Kurdish casualties, 2 nm patient L1: 11 ng/ml nm nmindividuals, treated at P patient L2: 11 ng/mLLondon hospital, C control: 11 ng/mLcollected 13 days afterincident (March 17,1988) 1Accidental exposure to Patient S1: 2 ng/mL Patient S1: 77 ng/mL Patient S1: 69 ng/mL NMWWI munition, 2 Patient S2: 2 ng/mL Patient S2: 54 ng/mL Patient S2: 45 ng/mLindividuals, collected C control: 4.5 ng/mL Control: 5 ng/mL2–3 days after incident(1992) 2Accidental laboratory Maximum excretion NM nm nmexposure, 1 individual, rate: 20 µg/day oncollected 2–14 days day 3; concentrationafter incident (1990) 3 > 10 ng/mL for 1week postexposureAccidental exposure to Patient D1: 24, 9, 5, 14, nm nm patient D1: 50, 17, 11, 28, 24,WWI munition, 2 11, 6, 2, 2, 1.5, 1.2 14, 4.5, 9, 5, 6 ng/mL forindividuals, collected ng/mL for days 2 days 2 to 11 after exposure,2–42 days after incident to 11 after exposure, respectively(July 19, 2004) 4 respectivelypatient D2: not nm nm patient D2: 1.8, 3, 4.4 ng/mLdetected days 2, 4, 7for days 2, 4, 7, respectively*These are the known details of the incident and sample collection time after suspected exposure.† Assay measures TDG (free plus glucuronide-bound).‡ Assay measures free TDG, free TDG-sulfoxide, and acid-labile esters of both.§ Assay measures TDG (free plus bound), TDG-sulfoxide (free plus bound), and acid-labile esters of both.NM: not measuredTDG: thiodiglycolTiCl 3: titanium trichlorideWWI: World War IData sources: (1) Black RM, Read RW. Improved methodology for the detection and quantitation of urinary metabolites of sulphur mustardusing gas chromatography-tandem mass spectrometry. J Chromatogr B Biomed Appl. 1995;665:97–105. (2) Black RM, Read RW. Biological fateof sulphur mustard, 1,1’-thiobis(2-chloroethane): identification of beta-lyase metabolites and hydrolysis products in human urine. Xenobiotica.1995;25:167–173. (3) Jakubowski EM, Sidell FR, Evans RA, et al. Quantification of thiodiglycol in human urine after an accidentalsulfur mustard exposure. Toxicol Methods. 2000;10:143–150. (4) Barr JR, Young CL, Woolfit AR, et al. Comprehensive quantitative tandemMS analysis of urinary metabolites and albumin adducts following an accidental human exposure to sulfur mustard. In: Proceedings of the53rd Conference of the American Society of Mass Spectrometry. San Antonio, Tex: June 5–9, 2005.719
Medical Aspects of Chemical WarfareTable 22-11Published Reports (1995–2006) of Laboratory Analysis of Human Urine Samples forGlutathione Reaction Products Following a Suspected Exposure to Sulfur MustardBis-(N-acetylcysteine)Patient Sample Information* β-lyase Metabolites † β-lyase Metabolites ‡ Conjugate §Iranian casualties, 5 of 5 individuals. Patient C1: 220 ng/ml nm nmtreated at Ghent hospital, collected Patient C2: 0.5 ng/mL10 days after incident (March 9, Patient C3: 1 ng/mL1984) 1 patient C4: 5 ng/mLpatient C5: 1 ng/mLKurdish casualties, 2 individuals, Patient L1: 0.1 ng/mL Patient L1: MSMTESE = NMtreated at London hospital,
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The Coat of Arms1818Medical Departm
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Textbooks of Military MedicinePubli
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MEDICAL ASPECTS o fCHEMICAL WARFARE
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ContentsContributorsForeword by The
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ContributorsMICHAEL ADLER, PhDResea
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DONALD M. MAXWELL, MSResearch Chemi
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ForewordThe US military has been co
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PrefaceA significant concern for th
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PrologueThe original edition of Med
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xxii
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Medical Aspects of Chemical Warfare
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Nerve AgentsChapter 5NERVE AGENTSFR
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Nerve AgentsAbout 10,000 to 30,000
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Nerve Agentsphorofluoridate (DFP) w
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Nerve AgentsFig. 5-2. This schemati
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Nerve AgentsExhibit 5-1 continuedis
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Nerve Agentsactivity but only 15% t
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Nerve AgentsTABLE 5-3CHEMICAL, PHYS
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Nerve AgentsTABLE 5-4EFFECTS OF EXP
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Nerve Agentsaffecting the other eye
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Nerve Agentsmay cause severe rhinor
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Nerve Agentsof jerks and tremor.Cen
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Nerve Agentsand they were decreased
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Nerve Agentsnerve agent toxicity on
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Nerve Agentspatient. Decontaminatio
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Nerve AgentsFig. 5-5. The Mark I ki
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Nerve Agentsadministered intramuscu
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Nerve Agentsthat hydroxamine reacti
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Nerve AgentsOral administration may
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Nerve AgentsTABLE 5-7RECOMMENDED TH
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Nerve Agentsimpairment such as whee
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Nerve Agentssuboptimal, manner. The
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Nerve Agentsthan those who did not.
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Nerve Agentssible for binding nerve
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Nerve Agentsfor comparison was not
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Nerve AgentsTABLE 5-11EFFECTS OF PY
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Nerve Agentstivity of smooth muscle
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Nerve Agents38. Grob D, Lilienthal
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Nerve Agents77. McDonough JH, Shih
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Nerve Agents117. McLeod CG Jr, Sing
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Nerve Agents154. Tryphonas l, Veino
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Nerve Agents193. Funckes AJ. Treatm
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Nerve Agents235. Suzuki T, Morita H
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Nerve Agents274. Pellegrini JE, Bak
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PROCESSMedical Aspects of Chemical
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Triage of Chemical CasualtiesChapte
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Triage of Chemical Casualtiesreceiv
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Triage of Chemical Casualtiesentran
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Triage of Chemical Casualtiescatego
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Triage of Chemical CasualtiesIn a f
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Triage of Chemical Casualtiesnose)
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Triage of Chemical CasualtiesWith n
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Triage of Chemical Casualties14. Sa
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Decontamination of Chemical Casualt
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Abbreviations and AcronymsAbBreviat
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Abbreviations and AcronymsPADPRP: p
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Medical Aspects of Chemical Warfare (2008) - The Black Vault

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