Tetsu Okumura

Intravenous detergent poisoning

Case Report: In the literature regarding surfactant poisoning, the route of exposure has almost always been oral. We report a case in which about 40 mL of bath detergent for home use was self-injected. The primary pathophysiologic effects were relative hypovolemia and cardiac dysfunction. The patient experienced frequent ventricular tachycardia, acute renal failure, rhabdomyolysis, hemolysis, and coagulation dysfunction. Intensive care included the administration of antiarrythmial agents and hemodialysis. The patient survived and was discharged from our hospital without sequelae.

The Tokyo Subway Sarin Attack: Toxicological Whole Truth

Publisher Summary This chapter discusses sarin toxicity based on experiences of the attacks in Matsumoto and the Tokyo subway, and also the Iran–Iraq war. The chapter provides some conclusions drawn from the toxicological issues related to sarin. Given the low concentration and means of dispersal, the Tokyo subway sarin attack can be referred to as a ‘‘passive’’ attack. The implication of such an assumption is therefore that mankind has not yet witnessed a ‘‘full-scale’’ sarin attack in any major city. While valuable information can certainly be gained from the Tokyo subway sarin attack; the experience obtained from the more aggressive Matsumoto sarin attack, and the Iran–Iraq war should also be considered when developing initiatives directed at dealing with a potential ‘‘full-scale’’ attack in the future, where the effects will be more serious. Importantly, reliable epidemiologic data is lacking regarding the long-term effects of sarin toxicity, whether low dose exposure to sarin has any long-term effects, and specific effects on children, pregnant women, and fetuses. The sporadic and limited epidemiologic surveys undertaken to date suggest that some long-term effects are present. Thus, well-designed international epidemiologic studies should be conducted in victims exposed to sarin in Japan, Iran, and during the Persian Gulf War.Publisher Summary This chapter discusses sarin toxicity based on experiences of the attacks in Matsumoto and the Tokyo subway, and also the Iran–Iraq war. The chapter provides some conclusions drawn from the toxicological issues related to sarin. Given the low concentration and means of dispersal, the Tokyo subway sarin attack can be referred to as a ‘‘passive’’ attack. The implication of such an assumption is therefore that mankind has not yet witnessed a ‘‘full-scale’’ sarin attack in any major city. While valuable information can certainly be gained from the Tokyo subway sarin attack; the experience obtained from the more aggressive Matsumoto sarin attack, and the Iran–Iraq war should also be considered when developing initiatives directed at dealing with a potential ‘‘full-scale’’ attack in the future, where the effects will be more serious. Importantly, reliable epidemiologic data is lacking regarding the long-term effects of sarin toxicity, whether low dose exposure to sarin has any long-term effects, and specific effects on children, pregnant women, and fetuses. The sporadic and limited epidemiologic surveys undertaken to date suggest that some long-term effects are present. Thus, well-designed international epidemiologic studies should be conducted in victims exposed to sarin in Japan, Iran, and during the Persian Gulf War.

Severe respiratory distress following sodium oleate ingestion.

CASE REPORT Oleic acid and oleate are pulmonary toxins used to create laboratory models of acute respiratory distress syndrome, but there is little information on human toxicity. We report the intentional ingestion of 50 mL sodium oleate 20% by a 22-year-old woman with no symptoms for the first 2 days after ingestion. Her respiratory status deteriorated rapidly on day 3 progressing to acute respiratory distress syndrome (PaO2/FIO2 < 100 mm Hg) on day 4. Treatment with high-dose steroids and intensive respiratory support including high-frequency jet ventilation were associated with gradual but complete recovery by day 39. The delayed onset of symptoms suggested that the lung injury was due to the systemic circulation of oleate to the lungs rather than to direct aspiration. In oral poisoning by sodium oleate, the lung is the first and most lethally affected target organ in humans. This case demonstrates that ingestion of a relatively small amount of sodium oleate can cause delayed, progressively severe, lung injury.

The Tokyo Subway Sarin Attack: Acute and Delayed Health Effects in Survivors

On the morning of March 20, 1995, 15 stations in the Tokyo subway system were filled with a noxious substance that later was identified as a diluted form of sarin. A total of five subway commuter cars were affected during the Monday morning rush hour. Fortunately, only a relatively small number of victims died, but the details of the incident suggest that it was not a full-scale attack. What this means is that humanity has not yet experienced a full-scale sarin attack in a modern major city. This chapter describes the emergency treatment, signs and symptoms, and laboratory findings connected with this and similar incidents. The medical treatment required for responding to a chemical terrorist attack on the general public will require a different strategy to that employed for such attacks in a military setting. From the standpoint of international security, collaborative research on drugs for treating chemical terrorism and a global agreement on standard treatment is needed.

CHAPTER 4 – The Tokyo Subway Sarin Attack: Toxicological Whole Truth

Publisher Summary This chapter discusses sarin toxicity based on experiences of the attacks in Matsumoto and the Tokyo subway, and also the Iran–Iraq war. The chapter provides some conclusions drawn from the toxicological issues related to sarin. Given the low concentration and means of dispersal, the Tokyo subway sarin attack can be referred to as a ‘‘passive’’ attack. The implication of such an assumption is therefore that mankind has not yet witnessed a ‘‘full-scale’’ sarin attack in any major city. While valuable information can certainly be gained from the Tokyo subway sarin attack; the experience obtained from the more aggressive Matsumoto sarin attack, and the Iran–Iraq war should also be considered when developing initiatives directed at dealing with a potential ‘‘full-scale’’ attack in the future, where the effects will be more serious. Importantly, reliable epidemiologic data is lacking regarding the long-term effects of sarin toxicity, whether low dose exposure to sarin has any long-term effects, and specific effects on children, pregnant women, and fetuses. The sporadic and limited epidemiologic surveys undertaken to date suggest that some long-term effects are present. Thus, well-designed international epidemiologic studies should be conducted in victims exposed to sarin in Japan, Iran, and during the Persian Gulf War.Publisher Summary This chapter discusses sarin toxicity based on experiences of the attacks in Matsumoto and the Tokyo subway, and also the Iran–Iraq war. The chapter provides some conclusions drawn from the toxicological issues related to sarin. Given the low concentration and means of dispersal, the Tokyo subway sarin attack can be referred to as a ‘‘passive’’ attack. The implication of such an assumption is therefore that mankind has not yet witnessed a ‘‘full-scale’’ sarin attack in any major city. While valuable information can certainly be gained from the Tokyo subway sarin attack; the experience obtained from the more aggressive Matsumoto sarin attack, and the Iran–Iraq war should also be considered when developing initiatives directed at dealing with a potential ‘‘full-scale’’ attack in the future, where the effects will be more serious. Importantly, reliable epidemiologic data is lacking regarding the long-term effects of sarin toxicity, whether low dose exposure to sarin has any long-term effects, and specific effects on children, pregnant women, and fetuses. The sporadic and limited epidemiologic surveys undertaken to date suggest that some long-term effects are present. Thus, well-designed international epidemiologic studies should be conducted in victims exposed to sarin in Japan, Iran, and during the Persian Gulf War.