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may cause a hemolytic anemia similar to that seen with arsine exposure (Goldman and Dacre, 1989). As before, there are no data regarding hematological effects on humans.

Neurological Effects

Extremely high exposures to mustard agents can cause central nervous system excitation leading to convulsions in animals (Anslow and Houck, 1946). Cardiac rhythm irregularities including atrioventricular block may also occur at high levels of exposure (Anslow and Houck, 1946). Renal changes have also been reported, but usually as a late complication in fatal exposures (Papirmeister et al., 1991).

In humans, acute neurological symptoms are common with high exposures to mustard agents, including severe depression and changes in mentation. These symptoms are produced both directly by the chemical and secondarily to other physiological changes (see also Chapter 11). Follow-up of workers in German chemical warfare plants showed a high prevalence of various neurological disorders including impaired concentration, diminished libido, and sensory hypersensitivity (Lohs, 1975). To what extent these can be attributed to mustard agents rather than other chemical warfare agents is unclear, but other exposures at this facility included known nerve agents. Renal and cardiac effects do not appear to occur after human exposures to mustard gas other than as secondary effects in severely affected individuals.

Neurological effects have not been documented in animals after acute exposures to Lewisite, but this apparently has not been well researched. Acute exposure to high levels of Lewisite leads to a shock syndrome due to increased capillary permeability (Goldman and Dacre, 1989). Some direct cardiotoxic effects can be seen with intravenous administration. No direct evidence exists that Lewisite may cause neurological problems in humans. However, arsenic is a well-known neurotoxin, and peripheral neuropathy has been described in humans after a single exposure to arsenic (LeQuesne and McLeod, 1977).

Conclusions

Gastrointestinal, hematological, and neurological effects are common after acute high exposures to mustard agents. These effects can be attributed primarily to the known toxicological effects of these agents and secondarily to effects on other organ systems (i.e., shock, burns). Although effects on these other organ systems have not been a focus of follow-up studies of people exposed to mustard agent, the available evidence provides no indication of persistent or delayed effects other



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