NationMaster - Encyclopedia: Agent 15

3-quinuclidinyl benzilate (QNB), empirical formula C₂₁H₂₃N O₃, full chemical name 1-azabicyclo[2.2.2]oct-3-yl α-hydroxy-α-phenylbenzeneacetate, is an odorless military incapacitating agent. Its NATO code is BZ. The Iraqi incapacitating agent Agent 15 is believed either to be the same as or similar to BZ. Taken from Image:WMD.png by Wapcaplet File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Chemical warfare is warfare (and associated military operations) using the toxic properties of chemical substances to kill, injure or incapacitate the enemy. ... Weapons of mass destruction (WMD) generally include nuclear, biological, chemical and, increasingly, radiological weapons. ... A blood agent (also called a cyanogen agent) is a compound that prevents the normal transfer of oxygen from the blood to the body tissues, resulting in chemical asphyxiation. ... Cyanogen chloride, also known as CK, is a highly toxic blood agent first proposed for use in warfare by the French. ... Hydrogen cyanide is a chemical compound with chemical formula H-Câ‰¡N. A solution of hydrogen cyanide in water is called hydrocyanic acid or prussic acid. ... A vesicant (also known as a blister agent) is a chemical agent that causes blistering of the skin. ... Chemical structure of Lewisite Lewisite is a chemical compound from a chemical family called arsines. ... Chemical Structure of Mustard Gas Compound Mustard gas (HD) is a chemical compound that was first used as a chemical weapon in World War I. In pure form, it is a colorless, odorless, viscous liquid at room temperature and causes blistering of the skin. ... Nerve agents (also known as nerve gases, though these chemicals are liquid at room temperature) are a class of phosphorus-containing organic chemicals (organophosphates) that inhibit the acetylcholinesterase enzyme in animals. ... Tabun or GA (Ethyl N,N-dimethylphosphoramidocyanidate) is an extremely toxic substance that is one of the worlds most dangerous weapons of war. ... Sarin or GB (O-Isopropyl methylphosphonofluoridate) is an extremely toxic substance. ... Boiling point 198 Â°C (388 Â°F) Freezing/melting point âˆ’42 Â°C (âˆ’44 Â°F) Vapor pressure 0. ... Cyclosarin or GF (Cyclohexyl methylphosphonofluoridate) is an extremely toxic substance that is one of the worlds most dangerous weapons of war. ... VE (S-(Diethylamino)ethyl O-ethyl ethylphosphonothioate) is a V-series nerve agent closely related to the better-known VX nerve gas. ... VG (also called Amiton or Tetram) is a V-series nerve agent closely related to the better-known VX nerve agent. ... VM (Phosphonothioic acid, methyl-, S-(2-(diethylamino)ethyl) O-ethyl ester) is a V-series nerve agent closely related to the better-known VX nerve agent. ... The VX nerve agent is the most well-known of the V-series of nerve agents. ... Categories: Chemical weapons | Stub ... General Name, Symbol, Number chlorine, Cl, 17 Chemical series halogens Group, Period, Block 17, 3, p Appearance yellowish green Atomic mass 35. ... Chloropicrin is a slightly oily, colorless liquid of the formula CCl3NO2. ... Phosgene (also known as carbonyl chloride, COCl2) is a highly toxic gas or refrigerated liquid that was used as a chemical weapon in World War I. It has no color, but is detectable in air by its odor, which resembles moldy hay. ... Diphosgene (ClCO2CCl3) Diphosgene (Trichloromethyl chloroformate, ClCO2CCl3) is a chemical originally developed for chemical warfare, a few months after the first use of phosgene. ... The term incapacitating agent is defined by the U.S. Department of Defense as An agent that produces temporary physiological or mental effects, or both, which will render individuals incapable of concerted effort in the performance of their assigned duties. ... KOLOKOL-1 is an opiate-derived incapacitating agent. ... A riot control agent is a type of lachrymatory agent (or lacrimatory agent). ... Pepper spray is a non-lethal chemical agent which is used in riot control, crowd control and personal self-defense, including defense against dogs. ... chemical structure of CS gas CS gas (commonly called tear gas), or ortho-chloro-benzal malonitrile, is a usually non-lethal riot control agent. ... Categories: Stub | Chemical weapons | Less-lethal weapons ... CR gas or dibenzoxazepine, chemically dibenz[b,f][1,4]oxazepine, is an incapacitating agent, a lachrymatory agent. ... Mrs. ... // Overview The Q code is a standardized collection of three-letter signals, all starting with the letter Q, initially developed for commercial radiotelegraph communication, and later adopted by other radio services, especially amateur radio. ... QNB is a joke on the Q code used in Amateur Radio, and in particular the fact that each Q code has one question form and an answer form. ... In chemistry, the empirical formula of a chemical is a simple expression of the relative number of each type of atom (called a chemical element) in it. ... General Name, Symbol, Number carbon, C, 6 Chemical series nonmetals Group, Period, Block 14, 2, p Appearance black (graphite) colorless (diamond) Atomic mass 12. ... General Name, Symbol, Number hydrogen, H, 1 Chemical series nonmetals Group, Period, Block 1, 1, s Appearance colorless Atomic mass 1. ... General Name, Symbol, Number nitrogen, N, 7 Chemical series nonmetals Group, Period, Block 15, 2, p Appearance colorless Atomic mass 14. ... General Name, Symbol, Number oxygen, O, 8 Chemical series nonmetals Group, Period, Block 16, 2, p Appearance colorless Atomic mass 15. ... The term incapacitating agent is defined by the U.S. Department of Defense as An agent that produces temporary physiological or mental effects, or both, which will render individuals incapable of concerted effort in the performance of their assigned duties. ... The NATO flag NATO 2002 Summit in Prague The North Atlantic Treaty Organisation (NATO), sometimes called North Atlantic Alliance, Atlantic Alliance or the Western Alliance, is an international organisation for defence collaboration established in 1949, in support of the North Atlantic Treaty signed in Washington, D.C., on April 4...

BZ is a glycolate anticholinergic compound related to atropine, scopolamine, hyoscyamine, and other deliriants. Dispersal would be as an aerosolized solid (primarily for inhalation) or as agent dissolved in one or more solvents for ingestion or percutaneous absorption. Ethylene glycol (IUPAC name:ethane-1,2-diol) is a chemical compound widely used as an automotive antifreeze (coolant). ... An anticholinergic agent is a member of a class of pharmaceutical compounds which serve to reduce the effects mediated by acetylcholine in the central nervous system and peripheral nervous system. ... Structure of atropine (hyoscyamine) Atropine is a tropane alkaloid extracted from the deadly nightshade (Atropa belladonna) and other plants of the family Solanaceae. ... Scopolamine, also known as hyoscine, is an tropane alkaloid drug obtained from plants of the Solanaceae family (Nightshade), such as henbane or jimson weed (Datura stramonium). ... Hyoscyamine is a chemical compound, a tropane alkaloid it is the levo-isomer to atropine. ... Wikipedia does not yet have an article with this exact name. ...

Acting as a competitive inhibitor of acetylcholine at postsynaptic and postjunctional muscarinic receptor sites in smooth muscle, exocrine glands, autonomic ganglia, and the brain, BZ decreases the effective concentration of acetylcholine seen by receptors at these sites. Thus, BZ causes peripheral nervous system (PNS) effects that in general are the opposite of those seen in nerve agent poisoning. Central nervous system (CNS) effects include stupor, confusion, and confabulation with concrete and panoramic illusions and hallucinations, and with regression to automatic "phantom" behaviors such as plucking and disrobing. This article is being considered for deletion in accordance with Wikipedias deletion policy. ... Confusion can have the following meanings: Unclarity, e. ... Confabulation is the confusion of imagination as memory, and true memories as false ones. ... An illusion is a distortion of a sensory perception. ... A hallucination is a sensory perception experienced in the absence of an external stimulus, as distinct from an illusion, which is a misperception of an external stimulus. ...

Physostigmine, which increases the concentration of acetylcholine in synapses and in neuromuscular and neuroglandular junctions, is a specific antidote. Physostigmine is a parasympathomimetic, specifically, a reversible cholinesterase inhibitor obtained from the Calabar bean. ... The chemical compound acetylcholine, often abbreviated as ACh, was the first neurotransmitter to be identified. ... An antidote is a substance which can counteract a form of poisoning. ...

Production of BZ is controlled under schedule 2 of the Chemical Weapons Convention. Schedule 2 substances, in the sense of the Chemical Weapons Convention, are either toxic enough to be used as chemical weapons, or precursors of other listed substances. ... Chemical Weapons Convention Opened for signature January 13, 1993 at Paris Entered into force April 29, 1997 Conditions for entry into force Ratification by 50 states and the convening of a Preperatory Commission Parties 170 The Chemical Weapons Convention is an arms control agreement which outlaws the production, stockpiling and...

History / military use

Following World War II, the United States military investigated a wide range of possible nonlethal, psychobehavioral, chemical incapacitating agents to include psychedelic indoles such as lysergic acid diethylamide (LSD-25) and marijuana derivatives, certain tranquilizers like Ketamine or Fentanyl, as well as several glycolate anticholinergics. One of the anticholinergic compounds, 3-quinuclidinyl benzilate, was assigned the NATO code BZ and was weaponized beginning in the 1960s for possible battlefield use. This agent was reportedly employed by American troops as a counterinsurgency weapon in Vietnam, but supposedly otherwise never saw operational use. It has been rumored that BZ was administrated to american troops in order to increase their fighting power and improve their performance, but this rumor is very disputed. More information on this rumor is seen in the movie Jacob's Ladder. Destruction of American stockpiles began in 1988 and is now complete. World War II was a truly global conflict with many facets: immense human suffering, fierce indoctrination, and the use of new, extremely devastating weapons such as the atom bomb. ... Indole is an aromatic heterocyclic organic compound. ... LSD blotter paper D-Lysergic Acid Diethylamide, commonly called acid, LSD, or LSD-25, is a powerful semisynthetic hallucinogen and psychedelic entheogen. ... Species Cannabis indica Cannabis ruderalis Cannabis sativa Cannabis is a genus of flowering plant that includes one or more species. ... Ketamine is a general dissociative anaesthetic for human and veterinary use. ... Fentanyl is an opioid analgesic, first synthesized in Belgium in the late 1950s, with an analgesic potency of about 80 times that of morphine. ... The NATO flag NATO 2002 Summit in Prague The North Atlantic Treaty Organisation (NATO), sometimes called North Atlantic Alliance, Atlantic Alliance or the Western Alliance, is an international organisation for defence collaboration established in 1949, in support of the North Atlantic Treaty signed in Washington, D.C., on April 4... Jacobs Ladder DVD Jacobs Ladder is a 1990 thriller film directed by Adrian Lyne based on a screenplay by Bruce Joel Rubin. ...

In February 1998, the British Ministry of Defence released an intelligence report that accused Iraq of having stockpiled large amounts of a glycolate anticholinergic incapacitating agent known as Agent 15. Agent 15 is an alleged Iraqi incapacitating agent that is likely to be chemically either identical to BZ or closely related to it. Agent 15 was reportedly stockpiled in large quantities prior to and during the Gulf War. The combination of anticholinergic PNS and CNS effects aids in the diagnosis of patients exposed to these agents. An anticholinergic agent is a member of a class of pharmaceutical compounds which serve to reduce the effects mediated by acetylcholine in the central nervous system and peripheral nervous system. ... C Company, 1st Battalion, The Staffordshire Regiment, 1st UK Armoured Division The 1991 Gulf War was a conflict between Iraq and a coalition force of approximately 30 nations mandated by the United Nations and led by the United States. ... An anticholinergic agent is a member of a class of pharmaceutical compounds which serve to reduce the effects mediated by acetylcholine in the central nervous system and peripheral nervous system. ... The peripheral nervous system or PNS, is part of the nervous system, and consists of the nerves and neurons that reside or extend outside the central nervous system--to serve the limbs and organs, for example. ... CNS can refer to: in air traffic control, Communication, Navigation, Surveillance often associated with the acronym ATM (Air Traffic Management) as CNS/ATM. the central nervous system the title granted to a Clinical Nurse Specialist the mnemonic for the demogroup Conspiracy the IATA code for Cairns International Airport This is...

Also in 1998, there were allegations that elements of the Yugoslav People's Army used incapacitating agents against fleeing Bosnian refugees that caused hallucinations and irrational behavior. Physical evidence of BZ use in Bosnia remains elusive, however. Official language Serbian written in Cyrillic alphabet1 Capital Belgrade2 President3 Svetozar Marović Area - Total - % water Ranked 105th 102,350 km² 0. ... Bosnia and Herzegovina (officially Bosna i Hercegovina, shortened to BiH, also in English variously written Bosnia-Herzegovina, Bosnia and Hercegovina, Bosnia-Hercegovina) is a mountainous country in the western Balkans. ...

Sources other than military

BZ and related anticholinergic compounds can be synthesized in clandestine laboratories, but its illicit use is low, possibly because of some unpleasant effects. 3-quinuclidinyl benzilate, called QNB in the scientific community, is used in pharmacology as a muscarinic receptor antagonist. It has been suggested that Drug development be merged into this article or section. ... Categories: Biology stubs | Biochemistry | Pharmacology ...

Physiochemical characteristics

BZ is odorless. It is stable in most solvents, with a half-life of three to four weeks in moist air; even heat-producing munitions can disperse it. It is extremely persistent in soil and water and on most surfaces. It is also soluble in propylene glycol, DMSO, and other solvents. Half-Life For a quantity subject to exponential decay, the half-life is the time required for the quantity to fall to half of its initial value. ... Chemical structure of propylene glycol Propylene glycol (C3H8O2; CAS no. ... Flash point 95 Â°C R/S statement R: 36/37/38 S: 26-37/39 RTECS number PV6210000 Supplementary data page Structure and properties n, Îµr, etc. ...

Detection and protection

Because BZ is odorless and nonirritating, and because clinical effects are not seen until after a latent period of 30 minutes to 24 hours, exposure could occur without the knowledge of casualties. No currently available field military or civilian detector is designed to disclose the presence of BZ or other anticholinergic compounds in the environment. Confirmation of the exact chemical involved in an incapacitating agent exposure would have to await laboratory analysis of environmental specimens containing the agent. The HEPA filter in the canister of the chemical protective mask prevents exposure of the face and respiratory tract to aerosolized BZ. The chemical protective ensemble protects the skin against contact with BZ or other incapacitating agents dispersed as fine solid particles or in solution. Protection against ingestion would depend upon a high index of suspicion for BZ contaminated food or drink.

Toxicokinetics

BZ may be dispersed as an aerosolized collection of small particles. Alternately, it may be dissolved in a solvent such as DMSO to enhance percutaneous absorption. Bioavailability via ingestion and by inhalation of particles 1 micrometre in size approximates 80%, and 40 to 50%, respectively, of a parenterally delivered dose of BZ. Percutaneous absorption of BZ dissolved in propylene glycol yields, after a latent period of up to 24 hours, serum levels approximately 5 to 10% of those achieved with intravenous or intramuscular administration. Although inhalation of aerosolized BZ is probably the greatest risk on the battlefield, terrorists may choose to disseminate BZ in forms that provide significant opportunities for ingestion and absorption through the skin. http://visibleearth. ... A solvent is a liquid that dissolves a solid, liquid, or gaseous solute, resulting in a solution. ... Flash point 95 Â°C R/S statement R: 36/37/38 S: 26-37/39 RTECS number PV6210000 Supplementary data page Structure and properties n, Îµr, etc. ... Chemical structure of propylene glycol Propylene glycol (C3H8O2; CAS no. ... Blood plasma is a component of blood. ... Battlefield can mean: A place where a battle occurs. ... Look up terrorist in Wiktionary, the free dictionary. ... Model of the layers of human skin In zootomy and dermatology, skin is an organ of the integumentary system; which is composed of a layer of tissues that protect underlying muscles and organs. ...

Following absorption, BZ is systemically distributed to most organs and tissues of the body. Its ability to reach synapses and neuromuscular and neuroglandular junctions throughout the body is responsible for its PNS effects, whereas its ability to cross the blood-brain barrier confers upon it the ability to cause CNS effects. Atropine and hyoscyamine both cross the placenta and can be found in small quantities in breast milk; whether this is also true for BZ is unclear. Illustration of the major elements in a prototypical synapse. ... Structure of atropine (hyoscyamine) Atropine is a tropane alkaloid extracted from the deadly nightshade (Atropa belladonna) and other plants of the family Solanaceae. ... Hyoscyamine is a chemical compound, a tropane alkaloid it is the levo-isomer to atropine. ... Human placenta shown a few minutes after birth. ...

Metabolism of BZ would be expected to occur primarily in the liver, with elimination of unchanged agent and metabolites chiefly in the urine. Santorio Santorio (1561-1636) in his steelyard balance, from Ars de statica medecina, first published 1614 Metabolism (from Î¼ÎµÏ„Î±Î²Î¿Î»Î¹ÏƒÎ¼Î¿Ï‚ (metabolismos), the Greek word for change, or overthrow (Etymonline)), is the biochemical modification of chemical compounds in living organisms and cells. ... The liver is an organ in vertebrates, including humans. ... Urine is liquid waste excreted by the kidneys and eventually expelled from the body in a process known as urination. ...

Toxicity

The characteristic that makes BZ an incapacitating rather than a toxic chemical warfare agent is its high safety ratio. The amount required to produce effects is a thousand or more fold less than a fatal dose of the compound. In terms of Ct products (admittedly a sometimes problematic way of measuring dosage received after aerosol exposure), the ICt50 (the Ct product needed to produce incapacitation in 50% of an exposed group) for BZ is 112 mg·min/m³, whereas the Ld50 is estimated to be 200,000 mg·min/m³.

Toxicodynamics (mechanism of action)

The agent BZ and other anticholinergic glycolates act as competitive inhibitors of the neurotransmitter acetylcholine neurons (1) at postjunctional muscarinic receptors in cardiac and smooth muscle and in exocrine (ducted) glands and (2) at postsynaptic receptors in neurons. As the concentration of BZ at these sites increases, the proportion of receptors available for binding to acetylcholine decreases and the end organ "sees" less acetylcholine. (One way of visualizing this process is to imagine BZ coating the surface of the end organ and preventing acetylcholine from reaching its receptors.) Because BZ has little to no agonist activity with respect to acetylcholine, high concentrations of BZ essentially substitute a "dud" for acetylcholine at these sites and lead to clinical effects reflective of understimulation of end organs. An anticholinergic agent is a member of a class of pharmaceutical compounds which serve to reduce the effects mediated by acetylcholine in the central nervous system and peripheral nervous system. ... Muscarine, L-(+)-muscarine, or muscarin is a natural product found in certain mushrooms, particularly in Inocybe and Clitocybe species. ...

Clinical effects

The PNS effects of BZ are, in general, readily understood as those of understimulation of end organs and are qualitatively similar to those of atropine. Decreased stimulation of eccrine and apocrine sweat glands in the skin results in dry skin (an affected patient can be "dry as a bone") and a reduction in the ability to dissipate heat by evaporative cooling. The skin becomes warm ("hot as a hare") partly from decreased sweating and partly from compensatory cutaneous vasodilatation (the patient becomes "red as a beet," with a so-called atropine flush) as the body attempts to shunt a higher proportion of core-temperature blood as close as possible to the surface of the skin. With decreased heat loss, the core temperature itself rises. An abnormally dilated pupil. ...

Understimulation of other exocrine glands leads to xerostomia (dry mouth, another way in which the patient is "dry as a bone"), thirst, and decreased secretions from lacrimal, nasal, bronchial, and gastrointestinal glands.

Decreased cholinergic stimulation of pupillary sphincter muscles allows alpha-adrenergically innervated pupillary dilating muscles to act essentially unopposed, resulting in mydriasis. (In fact, the cosmetic effect of mydriasis in women who applied extracts of deadly nightshade topically to their eyes explains the name "belladonna" given to this plant.) Similar effects on cholinergic ciliary muscles produce paralysis of accommodation. Classically, the patient is described as being "blind as a bat." Other smooth muscle effects from BZ intoxication include decreased bladder tone and decreased urinary force with possibly severe bladder distention (yet another way in which the patient may be said to be "dry as a bone"). An abnormally dilated pupil. ... Binomial name Atropa belladonna L. Deadly nightshade or belladonna (Atropa belladonna) is a well-known, hardy perennial shrub, a member of the nightshade family. ... For information on the erotic actress Belladonna see: Belladonna. ...

BZ typically raises the heart rate initially, but hours later, depending on the dose of BZ, the heart rate falls to normal or may become slow. Either the peripheral vagal blockade has ceased or the stimulation of the vagal nucleus has occurred.

Neither atropine nor BZ can act directly at the postjunctional nicotinic receptors found in skeletal muscle, but BZ-exposed patients nonetheless exhibit muscle weakness. This weakness, along with incoordination, heightened stretch reflexes, and ataxia, is probably due to the effects of BZ at CNS sites. Ataxia (from Greek ataxiÄ, meaning failure to put in order) is unsteady and clumsy motion of the limbs or trunk due to a failure of the fine coordination of muscle movements. ...

The PNS effects of BZ are essentially side effects that are useful in diagnosis, but incidental to the CNS effects for which the incapacitating agents were developed. These CNS effects include a dose-dependent decrease in the level of consciousness, beginning with drowsiness and progressing through sedation to stupor and coma. The patient is often disoriented to time and place. Disturbances in judgment and insight appear. The patient may abandon socially imposed restraints and resort to vulgar and inappropriate behavior. Perceptual clues may no longer be readily interpretable, and the patient is easily distracted and may have memory loss, most notably short-term memory. In the face of these deficits, the patient still tries to make sense of his environment and will not hesitate to make up answers on the spot to questions that confuse him. Speech becomes slurred and often senseless, and loss of inflection produces a flat, monotonous voice. References become concrete and semiautomatic with colloquialisms, clichés, profanity, and perseveration. Handwriting also deteriorates. Semiautomatic behavior may also include disrobing (perhaps partly because of increased body temperature), mumbling, and phantom behaviors such as constant picking, plucking, or grasping motions ("woolgathering" or carphology).

Central effects

Central nervous system mediated perceptual disturbances in BZ poisoning include both illusions (misidentification of real objects) and hallucinations (the perception of objects or attributes that have no objective reality). (Although the phrase "mad as a hatter" refers to poisoning from mercury formerly used by hatters on felt, it can just as well serve as a reminder of CNS effects from anticholinergics.) Anticholinergic hallucinations differ from the often vague, ineffable, and often transcendent-appearing hallucinations induced by hallucinogenic indoles such as LSD. Hallucinations from BZ tend to be realistic, distinct, easily identifiable (often commonly encountered objects or persons), and panoramic. They also have the tendency to decrease in size during the course of the intoxication. Ataxia (from Greek ataxiÄ, meaning failure to put in order) is unsteady and clumsy motion of the limbs or trunk due to a failure of the fine coordination of muscle movements. ... Indole is an aromatic heterocyclic organic compound. ... D-lysergic acid diethylamide, commonly called acid, LSD, or LSD-25, is a powerful semisynthetic psychedelic drug. ...

Another prominent CNS finding in BZ poisoning is behavioral lability, with patients swinging back and forth between quiet confusion and self-absorption in hallucinations, to frank combativeness. Moreover, as other symptoms begin to resolve, intermittent paranoia may be seen. Automatic behaviors common during resolution include the crawling or climbing motions called "progresso obstinato" in old descriptions of dementia.

Time course of effects

Clinical effects from ingestion or inhalation of BZ appear after an asymptomatic or latent period that may be as little as 30 minutes, or as long as 20 hours; the usual range is 0.5 to 4 hours, with a mean of 2 hours. However, effects may not appear up to 36 hours after skin exposure to BZ.

Once effects appear, their duration is typically 72 to 96 hours and are dose-dependent. Following an ICt50 of BZ, severe effects may last 36 hours, but mild effects may persist for an additional day.

The clinical course from BZ poisoning can be divided into the following four stages:

Differential diagnosis

The differential diagnosis for irrational and confused patients is a long one and includes anxiety reactions as well as intoxication with a variety of agents, to include hallucinogenic indoles (such as LSD), cannabinoids (such as the delta-9-tetrahydrocannabinol in marijuana), lead, barbiturates, and bromides. All of these conditions can lead to restlessness, lightheadedness (with associated vertigo and ataxia), confusion, and erratic behavior with or without vomiting. Clues that specifically point to BZ or a related compound are the combination of anticholinergic PNS effects ("dry as a bone," "hot as a hare," "red as a beet," and "blind as a bat") with the CNS effects ("mad as a hatter") of slurred and monotonous speech, automatic behavior (perseveration, disrobing, and phantom behaviors ["woolgathering"]), and vivid, realistic, describable hallucinations (decreasing in size over time) in a patient slipping into and out of delirium.

Signs and symptoms

Etiology (alternately aetiology, aitiology) is the study of causation. ... Binomial name Agkistrodon piscivorous LacÃ©pÃ¨de,, 1789 The Cottonmouth, or water moccasin (Agkistrodon piscivorous), is a venomous snake closely related to the copperhead. ... Tachycardia is an abnormally rapid beating of the heart, defined as a resting heart rate of over 100 beats per minute. ... A hallucination is a sensory perception experienced in the absence of an external stimulus, as distinct from an illusion, which is a misperception of an external stimulus. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ...

Anticholinergics

Atropine intoxication from MARK I autoinjector use in a patient not exposed to nerve agents may create similar PNS effects to those seen in BZ intoxication. However, marked confusion from atropine is not normally seen until a total of six or seven autoinjectors have been given (in a hot, dehydrated, or battle-stressed individual, less atropine would probably suffice). Circumstantial evidence may be helpful in this situation. Heat stroke may also generate hot, dry, and confused or stuporous casualties and needs to be considered in the differential diagnosis. Patients with anxiety reactions are usually oriented to time, place, and person but may be trembling, crying, or otherwise panicked. The classic picture of unconcern or "la belle indifférence" may characterize a patient with a conversion reaction, but these patients are also likely to be oriented and lack the anticholinergic PNS signs of BZ poisoning. Indole is an aromatic heterocyclic organic compound. ... Cannabinol, also known as CBN, is a non_psychoactive cannabinoid found in the hemp plant Cannabis sativa. ... Anxiety is a complex combination of the feeling of fear, apprehension and worry often accompanied by physical sensations such as palpitations, chest pain and/or shortness of breath. ... A reaction is the following: In physics, a reaction (physics) is defined by Newtons third law: For every action there is an equal and opposite reaction. The idea that any given force has a pair or opposite force. ...

Medical management

The admonition to protect oneself first may be difficult when dealing with any intoxication involving a latent period, since initially asymptomatic exposure to health care providers may already have occurred during the same time frame in which patients were exposed. Protection of medical staff from already absorbed and systemically distributed BZ in a patient is not needed.

General supportive management of the patient includes decontamination of skin and clothing (ineffective for already absorbed agent but useful in preventing further absorption of any agent still in contact with the patient), confiscation of weapons and related items from the patient, and observation. Physical restraint may be required in moderately to severely affected patients. The greatest risks to the patient's life are (1) injuries from his or her own erratic behavior (or from the behavior of similarly intoxicated patients) and (2) hyperthermia, especially in patients who are in hot or humid environments or are dehydrated from overexertion or insufficient water intake. A severely exposed patient might be comatose with serious cardiac arrhythmias and electrolyte disturbances. Management of heat stress assumes a high priority in these patients. Because of the prolonged time course in BZ poisoning, consideration should always be given to evacuation to a higher echelon of care.

As a competitive inhibitor of acetylcholine, BZ effectively decreases the amount of acetylcholine "seen" by postsynaptic and postjunctional receptors throughout the body. Specific antidotal therapy in BZ poisoning is therefore geared toward raising the concentration of acetylcholine in these synapses and junctions. Any compound that causes a rise in acetylcholine concentration can potentially overcome BZ-induced inhibition and restore normal functioning; even the nerve agent VX has been shown to be effective when given under carefully controlled conditions. The specific antidote of choice in BZ poisoning is the carbamate anticholinesterase physostigmine (eserine; Antilirium®), which temporarily raises acetylcholine concentrations by binding reversibly to anticholinesterase on the postsynaptic or postjunctional membrane. Physostigmine is similar in many ways to pyridostigmine and is equally effective when used as a pre-exposure antidotal enhancer ("pretreatment") in individuals at high risk for subsequently encountering soman. However, physostigmine is not used for this purpose because the doses required cause vomiting through CNS mechanisms. In the case of BZ poisoning, a nonpolar compound such as physostigmine is used specifically because penetration into the brain is required in those individuals who already have CNS effects from BZ.

In BZ-intoxicated patients, physostigmine is minimally effective during the first four hours after exposure but is very effective after four hours. Oral dosing generally requires one and a half times the amount of antidote as does IM or IV administration. However, effects from a single intramuscular injection of physostigmine last only about 60 minutes, necessitating frequent re-dosing. It must be emphasized that physostigmine does not shorten the clinical course of BZ poisoning and that relapses will occur if treatment is discontinued prematurely. The temptation to substitute a slow intravenous infusion for intramuscular injections should be tempered by the awareness that IV infusion may lead to nerve-agent-like bradycardia, and too rapid infusion might cause arrhythmias, excessive secretions (to the point of compromising air exchange), and convulsions. Moreover, the sodium bisulfite in commercially available preparations of physostigmine may cause life-threatening allergic responses.

Test dose: If the diagnosis is in doubt, a dose of 1 mg might be given. If a slight improvement occurs, routine dosing should be given.

Routine dosing: Doses of about 45 µg/kg for adults have been recommended. This might be modified by the response. A mental status examination should be done every hour and the dose and time interval of dosing should be modified according to whether the mental status is improved or not. As the patient improves, the dosage requirement will decrease.

History and toxicity of physostigmine

The antagonism between physostigmine (the elixir of calabar bean) and atropine (tincture of belladonna) was first reported in 1864 by a physician who successfully treated prisoners who had become delirious after drinking tincture of belladonna. Physicians did not notice this report until the 1950s when atropine coma (in which 50 mg or so of atropine were given to certain psychiatric patients) was successfully treated with physostigmine after the "therapeutic benefit" had been attained. Again, this went unnoticed until a controlled study, reported in 1967, indicated that anticholinergic intoxication could be successfully, albeit transiently, reversed by physostigmine. 1864 was a leap year starting on Friday (see link for calendar). ... For information on the erotic actress Belladonna see: Belladonna. ... // Events and trends The 1950s in Western society was marked with a sharp rise in the economy for the first time in almost 30 years and return to the 1920s-type consumer society built on credit and boom-times, as well as the the baby boom from returning GIs who... 1967 (MCMLXVII) was a common year starting on Sunday of the Gregorian calendar. ...

A recent textbook of emergency medicine stated that physostigmine should be used only as "a last resort." It would seem that when a patient needs "last resort" care is the absolute wrong time to administer a potent cholinesterase inhibitor.

The administration of physostigmine by the IV route in a delirious but conscious and otherwise healthy patient is not without peril. It is sometimes difficult to keep a delirious patient quiet long enough to administer the drug (at 1 mg/min is the marketed solution of 1 mg/ml). Even if administered correctly (very slowly), the heart rate may decline from 110 to 45 beat/min over a period of 1 to 2 minutes. The difference in the onset of the effects after IM and IV administration of physostigmine is a matter of only several minutes. Since its use is rarely lifesaving, this slight difference in time of response is inconsequential.

Physostigmine is a safe and effective antidote if used properly. In a conscious and delirious patient it will produce very effective but transient reversal of both the peripheral and central effects of cholinergic blocking compounds. Its use by the IV route is not without hazards. It absolutely should NOT be used in a patient with cardiorespiratory compromise, hypoxia, or acid-base imbalance with a history of seizure disorders or arrhythmias.

Triage

An immediate casualty (possible but unlikely) would be one with cardiorespiratory compromise or severe hyperthermia. Immediate attention to ventilation, hemodynamic status, and temperature control could be lifesaving. Because of its dangers in a hypoxic or hemodynamically challenged patient, physostigmine should be considered a second-line management option to be used only if adequate attention can simultaneously be given to temperature and other vital signs

The delayed casualty would present with pronounced or worsening anticholinergic signs. Physostigmine should definitely be considered in this kind of patient.

A minimal casualty from a strictly medical standpoint might have mild PNS or CNS anticholinergic effects. Given the time course of BZ intoxication, however, these patients should not be considered able to manage themselves or capable of routine return to duty and should be relieved of their weapons, observed, and, if the holding capacity at the current echelon is exceeded, evacuated.

An expectant casualty (also possible but unlikely) would have severe cardiorespiratory compromise in a situation in which treatment or evacuation resources are too limited to allow the necessary attention to be directed to him or her.

Return to duty

Given the time course of the intoxication, early return to duty is probably not a realistic possibility for the majority of casualties who may require observation and management for several days at the least.

The original version of this page is taken from the public domain source at [1] The public domain comprises the body of all creative works and other knowledge—writing, artwork, music, science, inventions, and others—in which no person or organization has any proprietary interest. ...

External Links

Deliriants (anticholinergic hallucinogens) edit

{3-quinuclidinyl benzilate} {Atropine} {Dimenhydrinate} {Diphenhydramine} {Hyoscyamine} {Scopolamine} The deliriants (or anticholinergics) are a special class of dissociative which are antagonists for the acetylcholine receptors (unlike muscarine which is an agonist of this receptor). ... An anticholinergic agent is a member of a class of pharmaceutical compounds which serve to reduce the effects mediated by acetylcholine in the central nervous system and peripheral nervous system. ... Certain drugs can affect the subjective qualities of perception, thought or emotion, resulting in altered interpretations of sensory input, alternate states of consciousness, or hallucinations. ... Structure of atropine (hyoscyamine) Atropine is a tropane alkaloid extracted from the deadly nightshade (Atropa belladonna) and other plants of the family Solanaceae. ... Dimenhydrinate, also known by the trade names Dramamine and Gravol, is an over-the-counter drug used to prevent motion-sickness (emesis). ... Diphenhydramine hydrochloride (trade name BenadrylÂ®, or Dimedrol outside the US) is an over-the-counter (OTC) antihistamine and sedative. ... Hyoscyamine is a chemical compound, a tropane alkaloid it is the levo-isomer to atropine. ... Scopolamine, also known as hyoscine, is an tropane alkaloid drug obtained from plants of the Solanaceae family (Nightshade), such as henbane or jimson weed (Datura stramonium). ...

Contents

History / military use GA_googleFillSlot("encyclopedia_square");