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Chemistries of Chemical Warfare Agents
Published in Brian J. Lukey, James A. Romano, Salem Harry, Chemical Warfare Agents, 2019
Terry J. Henderson, Ilona Petrikovics, Petr Kikilo, Andrew L. Ternay Jr., Harry Salem
Sulfur mustard is denser than water, only slightly water soluble, and hydrolyzes very slowly when dissolved in cold water. Therefore, it can remain a health threat for some time when present in bodies of water, even though it ultimately hydrolyzes to the relatively safe compound thiodiglycol. Depending on conditions, the hydrolysis also can produce 1,4-thioxane, O(CH2CH2)2S; 2-(vinylthio)ethanol, CH2=CHSCH2CH2OH; and a variety of other compounds, some in very small quantities (D’Agostino and Provost, 1985). For example, sulfur mustard can react with thiodiglycol to form monosulfonium or disulfonium ions (Yang et al., 1992; Munro et al., 1999):
Evidence of sulfur mustard exposure in victims of chemical terrorism by detection of urinary β-lyase metabolites
Published in Clinical Toxicology, 2020
Sermet Sezigen, Rusen Koray Eyison, Ertugrul Kilic, Levent Kenar
The first analysis of urine samples of previously reported Iranian victims were performed at hospitals in Ghent and Utrecht in the Netherlands. These analyses were focused on measuring thiodiglycol (TDG) in urine samples of patients for verification of SM exposure [24]. However, TDG is not a unique biomarker of SM exposure and it could be present in urine samples of unexposed individuals at trace levels [27,28]. On the other hand, ß-lyase metabolites are unambiguous biomarkers of potential SM poisoning as they are nonexistent in urine samples of an unexposed population [7,8]. There are a limited number of studies in literature measuring ß-lyase metabolites as SBMTE in urine samples of victims who were exposed to SM due to accidental or a deliberate exposure. Table 3 summarizes findings of three studies including the number of patients, the clinical symptoms, and amount of SBMTE in urine samples of patients that verified SM exposure [9,12,14]. Black et al. measured SBMTE levels in prepared urine samples of seven individuals that were collected approximately on the 10th and 13th days following SM exposure [14]. The maximum SBMTE level was 220 ng/mL. Barr et al. measured SBMTE in human urine samples (n = 2) collected two days after SM exposure as 41 ng/mL and 2.6 ng/mL, respectively [12]. Hua et al. found urine SBMTE levels of four individuals as 78.2, 6.30, 163, and 74.3 ng/mL three days following SM exposure [9].
Advances in treatment of acute sulfur mustard poisoning – a critical review
Published in Critical Reviews in Toxicology, 2019
Leila Etemad, Mohammad Moshiri, Mahdi Balali-Mood
The main metabolic pathway of SM is hydrolysis by which SM is converted to thiodiglycol and then s-oxidation creates sulfoxide and sulfone. Around half of the absorbed SM is excreted through this route (Hambrook et al. 1992; Ghorani-Azam and Balali-Mood 2015). However, the main metabolite of SM in the urine is thiodiglycol (Balali-Mood and Navaeian 1986; Balali-Mood and Hefazi 2005a; Rejaei et al. 2010; Ghorani-Azam and Balali-Mood 2015). The main elimination route of SM is urinary with the first order pattern (Ghorani-Azam and Balali-Mood 2015). Glutathione plays an important role in SM detoxification and free radicals scavenging. N-Acetyl cysteine (NAC) is able to reverse decreased content of cell glutathione. Majority of SM metabolites are conjugated to glutathione before excretion (Atkins et al. 2000) (Figure 1).
Acute intensive care unit management of mustard gas victims: the Turkish experience*
Published in Cutaneous and Ocular Toxicology, 2018
Ertugrul Kilic, Mesut Ortatatli, Sermet Sezigen, Rusen Koray Eyison, Levent Kenar
It is known that chemical weapon attacks mostly occurred in the Middle East after the First World War. SM was extensively used by forces in Yemen (1963–1967) and by the Iraq Army against Iranian troops12. We presented short-term results regarding the treatment of SM victims of the Syrian Civil War who were hospitalized in the ICU. Our patients had shown typical signs and symptoms that were similar to other SM casualties in the Great War and the Iran-Iraq War. In addition to clinical findings, SM exposure was also confirmed by observing elevated thiodiglycol levels in the urine samples of casualties using a modified version of the method used by Kenar et al.13.