61 Tan et al, recently hypothesized that COPIND could be derived from withdrawal of OP pesticide after chronic low-level exposure or acute exposure.67 The most significant long-term neurologic effect of nerve agent exposure is hypoxic

encephalopathy, which is one of the most important long-term neurologic sequels of nerve agents.6 Sensory nerve dysfunction of the lower extremities is more prevalent than motor nerves, which was predominantly Inhibitors,research,lifescience,medical a distal sensory deficit.68 Temporary psychological effects such as depression, fatigue, insomnia, irritability, nervousness and impairment of memory have been described after nerve agents exposure.69-71 An electroencephalogram (EEG) in a patient intoxicated with sarin showed considerable slowing with bursts of high voltage waves at a rate of five per second Inhibitors,research,lifescience,medical epileptic type changes of EEG 11 months after the exposure.72,73 Soman induced increasing cyclooxygenase-2 in damaged Inhibitors,research,lifescience,medical brain regions such as hippocampus, amygdale, piriform cortex and thalamus that was correlated with seizure intensity.74 Biochemical and Hematological Abnormalities Acid-base and electrolyte disturbances are a common feature following severe OP poisoning. Nerve agent victims do not display a high

anion gap 5-Fluoracil order metabolic acidosis that is observed in acute cyanide poisoning.6 Hypokalemia, hyperglycemia, elevation Inhibitors,research,lifescience,medical of serum amylase (an indicator for acute pancreatitis), transient elevation of liver enzymes, hematuria, leukocyturia, and proteinuria may occur. Arterial blood gas analysis and estimation of serum electrolytes, liver and kidney function tests, serum amylase, creatin phosphokinase (CPK) and lactate dehydrogenase (LDH), blood cell count and other hematological tests may be disturbed, and thus required to be performed for the management of patients.42 Death after nerve agent Inhibitors,research,lifescience,medical first exposure and severe OP pesticides poisoning

is mainly due to respiratory failure resulting from depression of the respiratory center, paralysis of respiratory muscles and obstruction caused by bronchospasm and bronchial secretions. Some animal studies suggest that lack of central drive is the major factor.51 Cardiomyopathy in soman and sarin-intoxicated rats has been reported, which may be a contributory cause of death.58 Status seizures occurred in animals after very high doses of sarin, soman, or VX despite early treatment with atropine and pralidoxime. Prolonged seizures may cause anoxia and morphological brain damage which induces more morbidity and mortality.