Lewisite

CAS RN: 541-25-3

Health Effects

0.2.1 SUMMARY OF EXPOSURE
  • 0.2.1.1 ACUTE EXPOSURE
    • A) Lewisite is a vesicant or a blistering-type military poison that is extremely toxic by all routes of exposure. As a chemical warfare agent it can cause severe blistering and chemical burns, but may also act systemically to produce: diarrhea, restlessness, hypothermia, weakness, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) and hypotension. The main route of absorption that results in systemic toxicity is through the respiratory tract, however, systemic effects may be seen after ingestion or through dermal contact.
    • B) Lewisite acts first as a vesicant (since first contact is usually through dermal exposure), then as a pulmonary irritant and finally as a systemic poison. It can cause violent sneezing, severe pain and terror. It has similar toxic effects to mustard gas in that its main target organs are the skin, eyes and airways (the main organs affected); however, it differs in that its clinical effects appear within seconds of exposure. Data on human exposure is few; most information on its clinical effects is based on animal studies.
    • C) After inhalation, mucous membranes are affected, causing severe irritation. Vocal cord paralysis and chemical pneumonitis may result. After severe inhalation exposures, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) and death due to respiratory failure may occur. Systemic absorption can result in increased capillary permeability, causing loss of fluid from the vasculature, resulting in hemoconcentration, shock, and death.
    • D) Dermal contact results in immediate stinging and burning sensations, and erythema within 30 minutes. Formation of sharply circumscribed, painful blisters, may occur in 2 to 13 hours after exposure. As little as five minutes of dermal exposure may result in a gray area of dead epithelium similar to that seen with corrosive burns. Itching and irritation may occur for about 24 hours, whether or not a blister is seen.
    • E) Severe burns can result from dermal exposure. Skin burns are generally deeper than those with mustard gas. Skin penetration can result from contact with either liquid or vapor forms. Very small amounts (0.5 mL) can produce systemic effects; as little as 2 mLs can be fatal.
    • F) Eye exposure results in rapid damage. Contact causes an immediate stinging and burning sensation. Blepharospasm may occur instantly, however, conjunctival and lid edema, iris inflammation, and corneal haziness occurs over several hours.
    • G) Temporary blindness due to blistering and swelling of the eyelids and mucous membranes can occur. Erosion of the corneal epithelium may heal spontaneously, however, corneal scars may develop after initial recovery and reduce visual acuity. Moreover, permanent blindness is possible without prompt decontamination (within 1 minute).
0.2.3 VITAL SIGNS
  • 0.2.3.1 ACUTE EXPOSURE
    • A) Hypotension, tachycardia, and hypothermia may develop.
0.2.4 HEENT
  • 0.2.4.1 ACUTE EXPOSURE
    • A) Lacrimation, burns and/or strong irritation may occur after eye exposure. A geranium-like odor may be detectable on the victim.
0.2.5 CARDIOVASCULAR
  • 0.2.5.1 ACUTE EXPOSURE
    • A) "Lewisite shock" (refractory hypotension) may result due to increased capillary permeability and subsequent leakage following Lewisite exposures.
0.2.6 RESPIRATORY
  • 0.2.6.1 ACUTE EXPOSURE
    • A) Severe respiratory irritation leading to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) and chemical pneumonitis may occur following acute exposure to Lewisite.
  • 0.2.6.2 CHRONIC EXPOSURE
    • A) The incidence of chronic obstructive lung disease and bronchitis have been elevated in former poison gas employees. Recurrent pneumonia has been described in a family, but the relationship to arsenic exposure is not clear.
0.2.7 NEUROLOGIC
  • 0.2.7.1 ACUTE EXPOSURE
    • A) Restlessness and weakness may occur following systemic absorption.
  • 0.2.7.2 CHRONIC EXPOSURE
    • A) Toxic encephalopathy and peripheral neuropathy may also occur with chronic arsenic poisoning. Seizures have occurred in the children of one family.
0.2.8 GASTROINTESTINAL
  • 0.2.8.1 ACUTE EXPOSURE
    • A) Nausea, vomiting and salivation may occur with exposure to Lewisite.
    • B) Gastroenteritis, sometimes with watery or bloody diarrhea, may occur after acute exposure to Lewisite.
  • 0.2.8.2 CHRONIC EXPOSURE
    • A) A sensation of dryness or burning in the mouth, and nausea and vomiting may occur with chronic exposure to arsenic.
0.2.9 HEPATIC
  • 0.2.9.1 ACUTE EXPOSURE
    • A) Hepatic necrosis has been reported in exposed animals.
0.2.10 GENITOURINARY
  • 0.2.10.1 ACUTE EXPOSURE
    • A) Acute toxic exposures may result in renal dysfunction.
0.2.12 FLUID-ELECTROLYTE
  • 0.2.12.1 ACUTE EXPOSURE
    • A) Significant intravascular volume depletion may occur.
    • B) Electrolyte abnormalities may occur in conjunction with fluid losses.
0.2.13 HEMATOLOGIC
  • 0.2.13.1 ACUTE EXPOSURE
    • A) Hemolytic anemia due to "Lewisite shock" with subsequent hemoconcentration has been reported in one case. Lewisite does NOT cause bone marrow damage.
0.2.14 DERMATOLOGIC
  • 0.2.14.1 ACUTE EXPOSURE
    • A) Severe blistering and chemical burns have occurred following liquid and vapor exposure to Lewisite.
  • 0.2.14.2 CHRONIC EXPOSURE
    • A) Lewisite can cause contact dermatitis. Painful irritation or ulceration of the skin may occur. Basal cell and squamous cell cancers of the skin may also be seen years after exposure.
0.2.19 IMMUNOLOGIC
  • 0.2.19.1 ACUTE EXPOSURE
    • A) Unlike mustard gas, Lewisite does NOT produce immunosuppression.
  • 0.2.19.2 CHRONIC EXPOSURE
    • A) Lewisite was allergenic in occupational exposures.
0.2.20 REPRODUCTIVE HAZARDS
  • A) At the time of this review, no human reproductive studies were found for Lewisite.
0.2.21 CARCINOGENICITY
  • 0.2.21.1 IARC CATEGORY
    • A) IARC Carcinogenicity Ratings for CAS541-25-3 (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004):
      • 1) Not Listed
  • 0.2.21.2 HUMAN OVERVIEW
    • A) Lewisite is considered a suspect carcinogen because of its arsenic content.
0.2.22 GENOTOXICITY
  • A) Lewisite was inactive in the Ames Salmonella assay and proved inconclusive in D melanogaster for sex-linked lethal mutations assay.
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