TABLE 4

Clinical Syndromes Associated With Chemical and Biological Agents

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