Nerve Agent Symptom Recognition

TIME COURSE: Exposure to nerve agents may be rapidly fatal. Health effects from mild to moderate exposure may be delayed up to 18 hours; larger exposures may cause death within minutes to hours.

EFFECTS OF SHORT-TERM (LESS THAN 8-HOURS) EXPOSURE: Nerve agents cause the same health effects regardless of the route of exposure. Nerve agents interfere with the normal functioning of the nervous system. Skeletal muscles, certain organs of the body, and the central nervous system (CNS) may all be affected by exposure to the nerve agent.

EYE EXPOSURE: Contracted or pinpoint pupils (miosis), redness of the membranes (conjunctiva), pain in and around the eye, dim and/or blurred vision, a sensation of pressure with heaviness, and reflex nausea and vomiting (emesis). Effects are usually local, occurring from direct contact with nerve agent vapor, aerosol, or liquid; but exposure by other routes can also affect the eyes.

INGESTION EXPOSURE: Nausea, vomiting (emesis), diarrhea, abdominal pain, and cramping.

INHALATION EXPOSURE: Mild to moderate: Contracted or pinpoint pupils (miosis), runny nose (rhinorrhea), narrowing of the large airways (bronchoconstriction), fluid build up within the airways of the lungs, slight to moderate difficulty breathing or shortness of breath (dyspnea). Severe: In addition to the symptoms described above, there can be loss of consciousness; seizures; muscular twitching (fasciculations); floppy (flaccid) paralysis; increased fluid build up within the airways and within the digestive tract, resulting in secretions from the nose and mouth; cessation of breathing (apnea); and death.

SKIN EXPOSURE: Mild to moderate: Health effects may be immediate or may be delayed up to 18 hours. Profuse sweating (diaphoresis) and muscular twitching (fasciculations) at the site of contact, nausea, vomiting (emesis), diarrhea, and weakness (malaise). Severe: Health effects may appear quickly; 2 to 30 minutes post-exposure. In addition to the symptoms described above, there can be loss of consciousness; seizures; muscular twitching (fasciculations); floppy (flaccid) paralysis; increased fluid build up within the airways and within the digestive tract, resulting in secretions from the nose and mouth; cessation of breathing (apnea); and death.

See ATSDR Medical Management Guidelines for Nerve Agents for more detailed recommendations, http://www.atsdr.cdc.gov/MHMI/mmg166.pdf.