Toxicodynamics of sulfur mustard

Mustards have become an important topic of global discussion in recent years. The latest extensive reports and conference of 145 nations in Paris (January 13, 1989) reveal that several countries have stockpiled large quantities of mustard gas. This situation creates an imminent danger to accidental or intentional exposure of this gas to civil populations throughout the world. In view of the sparse literature on the toxic nature of mustard gas, we have tried to present an integrated panorama of this compound and its derivatives. In this article, efforts were made to review mustard gas--its chemical nature, mode of action, methods available for its analysis in biological fluids and target organs, absorption, distribution, metabolism and excretion and its toxicity to various organs. The effects of mustard poisoning may be local, systemic, or both, depending on environmental conditions, exposed organs, and the extent and duration of exposure. The toxic effects of mustard include inhibition of mitosis, NAD depletion, decreased tissue respiration and finally cell death. Most of the toxic effects are related to alkylation of DNA. Mustards are also selective in their accumulation in fat tissue. The immediate organs affected after mustard exposure are skin, eyes, and lungs. Sulfur mustard has also been reported to be a potent carcinogen. Burns caused by mustard are severe and require long healing periods. Depending on the type and time of exposure, mustard renders persons disabled temporarily or permanently. Various antidotes such as sodium thiosulfate, dexamethasone, promethazine, heparin, vitamin E and atropine have been recommended for combating mustard poisoning. Protective clothing can substantially reduce the toxic effects of mustard exposure. The best possible way of eliminating mustard hazard is to ban its use completely.