injuries poisoning
Nerve Chemical Warfare Agents
Prevention of Nerve Chemical Warfare Injuries
If exposure to a nerve agent is anticipated, pretreatment withpyridostigminebromide 30 mg orally every 8 hours should be considered. This compound is a reversible carbamate anticholinesterase. Becausepyridostigminecombines reversibly with acetylcholinesterase, it actually protects the enzyme from the essentially irreversible inhibition by subsequently delivered nerve agent; after the reversible bond is broken, the released cholinesterase can then help hydrolyze excess acetylcholine in target organs. Pyridostigminewas originally intended for potential exposure to the fast-aging nerve agent soman (GD) but is now authorized as pretreatment for all G-, V-, and A-series nerve agents. Thus, it could also make sense to usepyridostigmineduring the long latent period after suspected exposure to A-series agents. However, becausepyridostigminealso is an acetylcholinesterase inhibitor, it should not be given after the onset of cholinergic crisis or even if the heart rate or core temperature decreases by>25% from baseline during the latent period; such patients should be treated for cholinergic crisis. The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army, Department of Defense, or the US Government. 