US EPA

7416727 

Journal Article 

Review 

Timing of decontamination and treatment in case of percutaneous VX poisoning: a mini review 

Joosen, MJ; van Der Schans, MJ; Kuijpers, WC; van Helden, HP; Noort, D; , 

2013 

Yes 

Chemico-Biological Interactions
ISSN: 0009-2797
EISSN: 1872-7786 

ELSEVIER IRELAND LTD 

CLARE 

203 

1 

149-153 

English 

23085122 

10.1016/j.cbi.2012.10.002 

WOS:000318201800031 

https://linkinghub.elsevier.com/retrieve/pii/S0009279712001998
Exit
 

Low volatile organophosphorous nerve agents such as VX, will most likely enter the body via the skin. The pharmacokinetics of drugs such as oximes, atropine and diazepam, are not aligned with the variable and persistent toxicokinetics of the agent. Repeated administration of these drugs showed to improve treatment efficacy compared to a single injection treatment. Because of the effectiveness of continuous treatment, it was investigated to what extent a subchronic pretreatment with carbamate (pyridostigmine or physostigmine combined with either procyclidine or scopolamine) would protect against percutaneous VX exposure. Inclusion of scopolamine in the pretreatment prevented seizures in all animals, but none of the pretreatments affected survival time or the onset time of cholinergic signs. These results indicate that percutaneous poisoning with VX requires additional conventional treatment in addition to the current pretreatment regimen. Decontamination of VX-exposed skin is one of the most important countermeasures to mitigate the effects of the exposure. To evaluate the window of opportunity for decontamination, the fielded skin decontaminant Reactive Skin Decontaminant Lotion (RSDL) was tested at different times in hairless guinea pigs percutaneously challenged with 4× LD50 VX in IPA. The results showed that RSDL decontamination at 15 min after exposure could not prevent progressive blood cholinesterase inhibition and therefore would still require additional treatment. A similar decontamination regimen with RSDL at 90 min showed that it still might effectively increase the time window of opportunity for treatment. In conclusion, the delay in absorption presents a window of opportunity for decontamination and treatment. The continuous release of VX from the skin presents a significant challenge for efficacious therapy, which should ideally consist of thorough decontamination and continuous treatment. 

Decontamination; Nerve agent; Percutaneous; Repeated treatment; VX; acetylcholinesterase; atropine; cholinesterase; diazepam; obidoxime; organophosphorus compound; procyclidine; pyridostigmine; scopolamine; volatile agent; acute drug administration; cholinergic system; chronic drug administration; clinical feature; conference paper; detoxification; diagnostic test; enzyme inhibition; guinea pig; intoxication; neurologic disease; nonhuman; percutaneous VX poisoning; seizure; skin absorption; skin decontamination; survival time; toxicokinetics; Acetylcholinesterase; Animals; Butyrylcholinesterase; Chemical Warfare Agents; Cholinesterase Inhibitors; Decontamination; Disease Models, Animal; Guinea Pigs; Organophosphate Poisoning; Organothiophosphorus Compounds; Procyclidine; Pyridostigmine Bromide; Scopolamine Hydrobromide; Skin; Time Factors; Animalia; Cavia 

International Meeting on Cholinesterases 

Kazan, RUSSIA