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The Nerve Agent Sarin: History, Clinical Manifestations, and Treatment Nobuo Yanagisawa 1 1School of Health Sciences, Tokyo University of Technology Keyword: 有機リン中毒 , 農薬中毒 , サリン , ムスカリン作用 , コリンエステラーゼ , テロリズム , organic phosphate , Sarin , muscarinic effects , cholinesterase activity , oximes , terrorism pp.561-569
Published Date 2014/5/1
DOI https://doi.org/10.11477/mf.1416101794
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Abstract

Organic phosphate pesticides were used worldwide after World War II and experiences on poisoning and treatment have been accumulated. An organic phosphate "nerve agent" Sarin was used in two terrorist attacks in Japan in the 1990s. Sarin effects on humans were well documented in these two incidents. Sarin gas inhalation caused instantaneous death by respiratory arrest in several victims in Matsumoto. Severely injured victims presenting with coma and generalized convulsion were resuscitated and recovered rapidly without sequelae. Miosis and blurred-dark vision, ocular pain, copious secretions from respiratory and gastrointestinal tract (muscarinic effects), and headache were common in severely to slightly affected victims. Plasma cholinesterase (ChE) activity decreased in parallel with the severity of signs and symptoms in victims. Oximes, atropine sulphate, diazepam, and ample intravenous infusion were effective treatments. Follow-up examinations on victims were conducted up to 10 years in Matsumoto, and 5 years in Tokyo. No neurological sequelae or abnormalities were observed after 1 year, except for a few EEG abnormalities or delay in sensory nerve conduction velocity. Posttraumatic stress disorder (PTSD) was observed in several of the victims in the 5-year follow up, irrespective of the severity of poisoning at Matsumoto. Psychological symptoms continue in victims of both incidents.


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電子版ISSN 1344-8129 印刷版ISSN 1881-6096 医学書院

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