TABLE 4

Clinical Syndromes Associated With Chemical and Biologic Agents

CategoryClinical SyndromePotential Etiologies
Cellular hypoxiaAltered mental status, dyspnea, seizures, metabolic acidosisCyanide, carbon monoxide, hydrogen sulfide, sodium azide
Cholinergic crisisSalivation, diarrhea, lacrimation, bronchorrhea, diaphoresis, miosis, fasciculation, weakness, bradycardia, altered mental status, seizuresNicotine, nerve agents, organophosphates
Gastrointestinal illnessAbdominal pain, vomiting, profuse diarrhea, hypotension, cardiovascular collapseRicin, staphylococcal enterotoxin E, arsenic
LacrimationTearing, blepharospasm, incapacitationLacrimators (“Mace”), ammonia, halogens (chlorine, bromine)
Mucosal irritationTearing, nose and mouth burning, sore throatAmmonia, halogens
Muscle rigidityGeneralized muscle contractions, painful neck/limb spasm, seizure-like activityStrychnine
Muscle weaknessGeneralized muscle weakness, ptosis, respiratory embarrassmentBotulism
Peripheral neuropathyMuscle weakness or atrophy, “stocking-glove” sensory loss, depressed or absent deep tendon reflexesArsenic, thallium
Respiratory distress, acute onsetCough, wheeze, shortness of breath, generalized mucosal irritationAmmonia, halogens
Respiratory distress, delayedCough, respiratory distress, wheeze, hypoxia, pulmonary edemaPhosgene, sulfur mustard