[Assessment of injuries caused by diethyl sulfate poisoning]

OBJECTIVE

To develop criteria to assess injuries due to diethyl sulfate poisoning.

METHODS

Patients were evaluated with respect to their toxic status and outcomes, in comparison to typical cases.

RESULTS

Among 44 poisoned patients, 4 patients were classified as major injuries, 4 person as minor injuries, and the rest of 36 patients were classified as not poisoned according to poisoning diagnostic criteria by No.GBZ40-2002 "Diagnostic Criteria of Occupational Acute Diethyl Sulfate Poisoning".

CONCLUSION

In assessment of the injuries caused by diethyl sulfate poisoning, one should follow diagnostic criteria set by National Occupational Acute Poisoning due to Chemicals and Drugs and "Criteria for Assessment of Human Body Injury."

Nine cases of accidental exposure to dimethyl sulphate--a potential chemical weapon

Dimethyl sulphate (DMS) is an innocuous appearing, widely used, and highly toxic chemical. It is used both as a methylating agent in industrial chemical synthesis and in medical laboratories for chemical cleavage of DNA. It is readily absorbed through the skin, mucous membranes, and gastrointestinal tract. Delayed toxicity allows potentially fatal exposures to occur prior to development of any warning symptoms. Toxicity is manifested initially by mucosal inflammation of eyes, nose, oropharynx, and airways. This can progress to severe airway oedema and necrosis, and non-cardiogenic pulmonary oedema. Other systemic effects include convulsions, delirium, coma, and renal, hepatic, and cardiac failure. All these features make DMS a potential chemical weapon. We report nine cases of varying degrees of inhalational exposure to DMS, occurring as a result of a single chemical spillage incident in the United Kingdom. Industrial poisoning is surprisingly rare and there are few previous reports in the literature outside China.

Operation Castle Cascade: managing multiple casualties from a simulated chemical weapons attack

In the wake of the recent terrorist attack on the United States, there is an ever-increasing need for the defense against weapons of mass destruction. The use of explosive devices in combination with chemical agents could result in a community disaster with multiple traumatic and medical injuries. Military medical personnel may be the first called upon due to their unique training and equipment. Operation Castle Cascade was a large-scale exercise on a military instillation involving the apprehension of hostages and detonation of an explosive device containing dimethyl sulfate. We will provide details on the medical management of 50 patients with simulated chemical and traumatic injuries. Issues relating to on-site chemical identification, triage, decontamination, treatment, casualty collection, and transportation of casualties are addressed in this article.

Polymorphism of glutathione S-transferases and susceptibility to acrylonitrile and dimethylsulfate in cases of intoxication

In this paper, the difficulties of genetic screening of occupationally exposed subjects for the evaluation of retrospective, and prospective, health risk assessments is illustrated with reference to glutathione S-transferase (GST) function. Individual differences in the magnitude and half-life of adduct levels, derived from background and occupational exposure, are observed largely independently of genetically determined conjugator status. During detoxification, GSTs play a critical role in providing protection against electrophiles and products of oxidative stress. GSTs are a superfamily of enzymes that may have broad and overlapping substrate specificities. Deficiencies of GST isoenzymes may be compensated by the presence of other isoforms and by the use of alternative metabolic pathways. This may be one reason for the abundance of controversial data on GST polymorphisms and adverse health effects.

A possible chemical explanation for the events associated with the death of Gloria Ramirez at Riverside General Hospital

The events associated with the death of Gloria Ramirez at Riverside General Hospital on 19 February 1994 have been portrayed as a major medical mystery. A potential chemical explanation for this incident has been developed. The hypothetical scenario depends upon the oxidation of a common solvent, dimethyl sulfoxide, through dimethyl sulfone to dimethyl sulfate. The latter compound is a volatile and highly toxic agent that can be quite hazardous to humans in small amounts. It is also environmentally nonpersistent. Much of the mystery surrounding the circumstances at the hospital may be explainable if this postulated metabolic pathway took place at the time of the emergency room incident. Although dimethyl sulfate was not detected in any analyses pertinent to this event, there are plausible scientific explanations to account for that fact. The sulfate anion, a hydrolysis product of dimethyl sulfate, was measured at an appreciably elevated concentration in Ramirez' blood. The descriptions of the symptoms of the hospital-staff victims appear quite consistent with dimethyl sulfate exposures. This paper attempts to make some sense of the reported data and eyewitness accounts, and perhaps provide new insight for any future research that could further explain this reported occurrence of toxic exposure.

[Antidotal effects of 2,3-dimercaptopropane-1-sulfonate sodium (DMPS) and combined with diazepam on acute poisoning caused by sodium ammonium dimethyl-2-propano-1,3-dithiosulfate monohydrate (SCD)]

In mice, DMPS (250 mg/kg, i.v.) combined with diazepam (1.25 mg/kg, i.p.) could increase LD50 of p. o. SCD 5.3 times. DMPS (62.5 mg/kg, i.v.) antagonized completely the respiratory depression and neuromuscular blockade caused by SCD(7.5 mg/kg, i.v.) in rabbits. SCD (15 mg/kg, i.v.) caused tremor, tonic convulsion and the abnormal paroxysmal discharges in EEG in rabbits. DMPS (0.5 mg/kg, i.c.v) could not eliminate the abnormal paroxysmal discharges in EEG of rabbits. DMPS (62.5 mg/kg, i.v.) combined with diazepam (5 mg/kg, i.v.) completely and rapidly antagonize these toxic symptoms and the abnormal changes in EEG.

[A case of dimethyl sulfate intoxication manifested by persistent dyspnea]

A 35-year-old man had been exposed to the vapor of dimethyl sulfate which was split over the bed of a truck from an accidentally broken container. After receiving treatment at the critical care unit of our university hospital for respiratory failure, he was transferred to our ward with dyspnea persisting for one month. Chest X-ray showed diffuse nodular and infiltrative shadows and shadows suggestive of bronchial wall thickening. Bronchoscopy demonstrated tracheobronchial stenosis due to severe inflammation, and transbronchial lung biopsy revealed erosion and granulation in tissues of the bronchiolar walls. These findings suggested extensive inflammatory involvement of the respiratory tract extending from the trachea to the bronchioles. Treatment with antibiotics, especially agents with antipseudomonal activity, was effective against secondary pneumonia. Administration of corticosteroid for stenotic lesions of the airway was extremely beneficial. The clinical course of the respiratory lesion caused by dimethyl sulfate intoxication was following, including the bronchoscopic findings. The efficacy of treatment with corticosteroid and antibiotics was evaluated by successive bronchoscopic examinations of the lesions.

[Morpho-functional status of the lymph nodes of rats during rehabilitation after exposure to vapors of dimethyl sulfate]

By means of histological methods inferior tracheobronchial lymph nodes have been investigated in 48 Wistar rats in 2 weeks and 3 months after cessation of inhalation of DNSV at maximum possible dose (0.1 mg/m3) for 2 and 14 days. Cell composition of the lymph nodes and cross sections of structural components have been compared. The cross section of the cortex decreases, while that of the medulla increases in comparison with corresponding parameters of the acute experiment. In 2 weeks and 3 months after DMSV effect for 2 days the part (%) of poorly differentiated cells and middle lymphocytes increases, while content of plasma cells in the medullary cords decreases. During rehabilitation after DMSV effect for 14 days a low level plateau is noted (as in the acute experiment). However, in lymphoid nodules++ within content of the poorly differentiated cells and middle lymphocytes in the cortical germinative centers in 2 weeks and 3 months the number of the poorly differentiated and reticular cells increases essentially, as well as mitotically dividing cells (in comparison to the acute experiment). In the medullary cords of the lymph nodes after 3 months of rehabilitation content of immature plasma cells is essentially higher than in 2 weeks of rehabilitation and than in the acute experiment. During rehabilitation the level of cells destruction in the lymph nodes noticeably decreases in comparison to the acute experiment.

[Cellular composition of structural components of the lymph nodes of rats during rehabilitation after dimethyl sulfate poisoning]

By means of microanatomical methods the inferior tracheobronchial lymph nodes have been investigated in 48 Wistar rats in 2 weeks and 3 months after discontinuance of inhalation of dimethylsulfate (DMS) vapours for 2 and 14 days by the animals in concentration 2.0 mg/m3, that is to say during rehabilitation period. Comparison of relative parameters of the structural components areas and cell composition of the lymph nodes has been carried out. During rehabilitation period after DMS inhalation for 2 days the cortical and medullary areas in histological preparations do not essentially differ from corresponding parameters of an acute experiment (2 days, 2.0 mg/m3, without rehabilitation). Amount (%) of cells with mitotic figures in the lymphoid nodules++ increases in 2 weeks and in 3 months. Contents of poorly differentiated cells during rehabilitation periods increase in the cortical plateau, but keeps nearly at the same low level as during the acute experiment in the lymphoid nodules++. In 2 weeks after DMS influence for 14 days, the cortical and medullary area in the histological preparations reach the control levels. In the lymphoid nodules++ a relative amount of reticular, poorly differentiated, mitotically dividing cells increases, and in the medullary cords contents of middle and small lymphocytes become greater in comparison with the acute experiment (14 days, 2.0 mg/m3, without rehabilitation).(ABSTRACT TRUNCATED AT 250 WORDS)

Lung injury in dimethyl sulfate poisoning

Two manual laborers were exposed to dimethyl sulfate during work and sustained mucosal injury to the eyes and respiratory tract. In one of them, noncardiogenic pulmonary edema occurred and improved with high-dose methylprednisolone. On follow-up for 10 months, this patient developed persistent productive cough with no evidence of bronchiectasis or bronchial hyperreactivity.

Clinical report on 62 cases of acute dimethyl sulfate intoxication

Sixty-two cases of accidental acute intoxication from the inhalation of dimethyl sulfate (DMS) are reported. To facilitate clinical evaluation and treatment, as well as identification of capacity for physical labor, a grading system was established according to the history of exposure to DMS, symptoms and signs of respiratory mucosal irritation, findings on chest radiographs, and abnormalities of leukocyte count. Emergency treatment included prophylactic use of glucocorticoids, supplemental oxygen, sedatives, and antibiotics for prevention and treatment of laryngeal and pulmonary edema, pulmonary infections, and other complications. Follow-up studies for 2-12 years have found only mild to moderate impairment in ventilatory capacity in eight cases, with no abnormal findings in ECG, chest films, and routine blood tests. Nearly all patients have resumed their usual work.