Thiosulfate as an Antidote to Mustard Poisoning, A Review of the Literature

摘要

This report reviews the multidisciplinary literature (from World War I to the present) on sodium thiosulfate as an antidote to sulfur and nitrogen mustards. Intramolecular cyclization of sulfur and nitrogen mustards yields the active form which is responsible for the varied effects upon an organism. Symptoms associated with mustard poisoning can be local (eyes, skin, and respiratory tract), systemic, or both. The toxic effects include cell death, inhibition of mitosis and decreased tissue respiration. A great deal of evidence indicates that the toxic effects are directly related to the alkylation of DNA. Sodium thiosulfate appears to be non-toxic and is predicted to remain in the extracellular fluid where it is quickly excreted. Sodium thiosulfate reacts with cyclized mustards and is most effective against mustards that cyclize rapidly (SN2 reactors) in the extracellular fluid. Post treatment with sodium thiosulfate is ineffective due to the rapid reaction of mustards in the body. Simultaneous injection with 200 mg or more of sodium thiosulfate per mg of mustard provided some protection. Comparable dosages of sodium thiosulfate injected 10 to 45 mins before mustard exposure was an effective antidote to SN2 reacting mustards. Effectiveness of topical application of sodium thiosulfate apparently is not known.