Chemical Weapon

Latency

Initial Symptoms

Sulfur mustard

Nitrogen mustard

see page 136

2–48 hr

4–6 hr

Begins as a sunburn-like erythema with itching, stinging, and/or burning, and progresses to vesicles, then blisters. Ocular symptoms include pain and redness with photophobia, blepharospasm, and corneal ulcers. Respiratory symptoms include nasal, sinus, and throat burning, redness and pain, epistaxis, possible laryngitis, hoarseness, and cough, rare chemical pneumonitis, and/or pulmonary edema.

Lewisite

see page 138

Minutes for pain, 2–3 hr for blisters

Immediate onset of dermal, ocular, and upper respiratory pain, followed by grayish skin patches after 5 min and erythema in 30 min. Painful blisters in 2–3 hr. Ocular symptoms include pain, blepharospasm, corneal clouding, and edema (eyes may be swollen shut). Respiratory symptoms include nasal and sinus pain & burning, epistaxis, sore throat, laryngitis, & cough that may leave progress to necrotizing tracheobronchitis with pseudomembrane formation. Occasional pneumonitis, pulmonary edema, and respiratory failure in severe cases.

Phosgene oxime

see page 140

Immediate pain, rash in 30 min

Immediate onset of dermal, ocular, and upper respiratory pain, followed by patches of skin redness surrounding blanched areas in 30 seconds, progressing to wheal formation in 30 min. Ocular symptoms include intense pain, redness, tearing, blepharospasm, and lid edema, with corneal clouding, ulceration, and perforation in severe cases. Respiratory symptoms include nasal and sinus burning, sore throat, laryngitis, & cough that may progress to sloughing of airway mucosa, pneumonitis, pulmonary edema, and respiratory failure.

Anhydrous ammonia Sulfur dioxide

Hydrogen chloride

see page 142

Seconds to minutes

Immediate onset of skin stinging pain, redness and blistering, severe eye pain, redness, tearing, and swelling, with corneal clouding, ulceration and/or perforation, sore throat, nasal pain, sneezing, rhinorrhea, cough, chest tightness, wheezing, nausea, vomiting, tachycardia, cyanosis, and airway obstruction due to sloughed tissue, edema and bronchospasm.

Hydrogen fluoride

see page 144

Seconds

Immediate onset of skin pain, redness & blistering, sore throat, nasal pain, sneezing, rhinorrhea, cough, eye pain, tearing, and redness, with corneal clouding, ulceration and/or perforation. In severe cases, there may be dyspnea, wheezing, tachycardia, cyanosis, and laryngeal swelling and laryngospasm with airway obstruction. Systemic effects include severe hypocalcemia, hypomagnesemia, and hyperkalemia.

Hydrogen sulfide

see page 132

Seconds

Low to moderate exposure—rapid onset of skin irritation and redness, nasal irritation, sneezing and rhinorrhea, sore throat, dyspnea, painful tracheobronchitis, eye pain, tearing, photophobia, blepharospasm, blurred vision, and keratoconjunctivitis with corneal clouding.

Moderate to severe exposure—rapid onset of gasping breaths, sweating, tachypnea, hypertension, tachycardia, flushing, headache and dizziness, rapidly followed by nausea, vomiting, confusion, agitation, seizures, cyanosis, and coma. Blistering and burns may also be noted.

Trichothecene (T-2) mycotoxins (biological weapon) see page 104

Minutes to hours

Skin itching and burning pain, redness, & blistering, anorexia, nausea, vomiting, crampy abdominal pain, watery and/or bloody diarrhea, arthralgias, nasal itching and pain, sneezing, epistaxis, rhinorrhea, mouth and/or throat pain, cough, dyspnea, chest pain, wheezing, and hemoptysis.