Novichok: How to treat neurotoxic gas poisoning of the Soviet era

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This question became relevant to doctors in Amesbury, England on Saturday when a couple came into contact with a neurotoxic agent of the Soviet era. And it was relevant earlier this year when the same agent – Novichok – almost killed a former Russian double agent and his daughter.

The latest victims, Charlie Rowley, 45, and Dawn Sturgess, 44, occupy hospital beds in intensive care According to a statement issued by the UK's Home Secretary, Sajid Javid, Sergei Skripal and his daughter Yulia were treated in March, according to a statement issued by the UK Department of the Interior. a different location of the sites that were part of the initial clean-up operation, "said Javid.He also stated that all areas decontaminated after Skripal poisoning are safe and pose no" significant risk " for the public

The militarized neurotoxic agents commonly referred to as Novichok, VX and sarin "for the most part possess the same chemical backbone as other organophosphorus pesticides," said Mr. Chai. "But they have been modified to make them powerful. "

In a word, mortal.

The cure itself is also far from pleasant.

Yulia Skripal, who spent 20 days in a coma after having been poisoned by Novichok, described the treatment as "invasive, painful and depressing, our recovery was slow and extremely painful."
Chai's research paper on these chemical compounds – "n ovichok "means" newcomer "in Russian – and potential therapies were released last week.

"A feeling of fear"

Andrei Zheleznyakov, a Russian military researcher, is the first person known to be exposed to one of Novichok's neurological agents. In 1987, while he was working on a secret initiative of Soviet chemical weapons, he was exposed to the chemical compound when his hood malfunctioned.

"Circles appeared before my eyes: red and orange, a buzzing in my ears, I caught my breath and a feeling of fear: as if something was going to happen, I sat on a Chair and I told the guys "Zheleznyakov survived the exhibition but developed difficulties and withdrew, according to his colleague Vil Mirzayanov, who described the incident and the program Soviet chemical weapons in his memoirs, said Zheleznyakov. "State Secrets: Chronicle of an insider of the Russian program of chemical weapons."

British doctors worry about Skripals & # 39; long-term health after poisoning

Although today we know better these neurotoxic agents, most doctors have little from direct experience with them. Generally, nerve agents are colorless and odorless, although they may have a fruity, chocolatey smell or even mothballs if they are unclean.

When treating a patient who has been exposed to Novichok, there are three major steps. "First, you have to recognize that this has happened to someone, you can not handle it if you do not think about it," he said. Recognition is the "cornerstone", he said, because "the most common symptoms in people are blurred vision, sweating and nausea and, if you think about it, are rather nonspecific. "

The 10-year-old boy faces a long recovery from pesticide poisoning

Other Signs exposure: small pupils, constriction of the respiratory tract and respiratory arrest, memory and loss of concentration and loss of consciousness, according to the medical manual "Respond to terrorism".

Symptom management

"The number two is the immediate management of symptoms, so we treat these people with atropine, high doses of atropine," added Chai . Atropine is a medicine derived from the plant belladonna, also known as mortal nightshade.

Chai explained that people intoxicated by Novichok and other nerve agents basically die from secretions – vomiting, diarrhea and urinary incontinence – and Atropine counteracts these effects.

Sarin in a few words

"If you look at people poisoned by sarin gas in Syria for example, if you look at these videos , everyone foams at the mouth, "he said." So we immediately give atropine to prevent this. "

Atropine works in two ways, he said. With the drying up of secretions, it increases heart rate, which slows down after exposure to a nerve agent. "This essentially gives you time to give an antidote," said Chai.

Antidote

Give the antidote, a chemical compound containing nitrogen known as an oxime, is the third step.

Novichok and other nerve agents bind to a receptor site in the brain where they disrupt cholinesterase, a type of enzyme necessary for the proper functioning nervous system, explains Chai.

The antidote "bypasses" the organophosphorus neurotoxic agent and "essentially cleans the binding site so that you essentially release the sealed cholinesterase and allow it to function again."

Novichok is so deadly in part because it's "essentially designed to prevent the antidote from working," Chai said.

However, with any neurotoxic agent, the speed with which a patient develops symptoms depends in part on the method of exposure – that he has inhaled an aerosolized neurotoxic agent, by example, or consumed it in liquid form.

Former Soviet chemist shares the details of the neurotoxic agent Novichok

The Nerve agents can also be absorbed through the skin and mucous membranes, according to "Respond to Terrorism." Kim Jong Nam, half-brother of North Korean leader Kim Jong Un, was killed in 2017 when his face was smeared by the nerve agent VX.

Kim had immediate symptoms, said Chai.

Decontamination

Patients should also be decontaminated to avoid further exposure, notes the medical manual: "The clothes should be removed and the skin washed with soap and water. the eyes are completely irrigated for at least 5 to 10 minutes. "

Many details in the case of the British couple have not been discovered, but the known facts suggest that the nerve agent with which they are entered is durable. 19659005] "These agents can persist in the environment for days or months," said Chai. Experts say "data-src-mini =" // cdn.cnn.com/cnnnext/dam/assets/150904185138-kids-playing-sandbox-small-169.jpg "data-src-xsmall =" // cdn. cnn.com/cnnnext/dam/assets/150904185138-kids-playing-sandbox-medium-plus-169.jpg "data-src-small =" http://cdn.cnn.com/cnnnext/dam/assets/150904185138 -kids-playing-sandbox-wide-169.jpg "data-src-medium =" // cdn.cnn.com/cnnnext/dam/assets/150904185138-kids-playing-sandbox-exlarge-169.jpg "data- src-large = "// cdn.cnn.com/cnnnext/dam/assets/150904185138-kids-playing-sandbox-super-169.jpg" data-src-full16x9 = "// cdn.cnn.com/cnnnext/ dam / assets / 150904185138-kids-playing-sandbox-full-169.jpg "data-src-mini1x1 =" // cdn.cnn.com/cnnnext/dam/assets/150904185138-kids-playing-sandbox-small-11 .jpg "data-demand-load =" not-loaded "data-eq-pts =" mini: 0, xsmall: 221, small: 308, medium: 461, large: 781 "src =" data: image / gif; base64, R0lGODlhEAAJAJEAAAAAAP /////// wAAACH5BAEAAAIALAAAAAAQAAkAAAIKlI + py + 0Po5yUFQA7 "/>

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As for long-term effects, Chai says it is hard to say.

"In a certain subset of people who are poisoned by organophosphates … you may develop long-term neuropathy and a weakness and cognitive problem due to long-lasting and life-long poisoning. He warns that this is only a speculation, adding: "Zheleznyakov developed a kind of debilitating neuropathy, so he had a numbness in the arms and joints." legs, and he's finally dead of that. "

Not a DIY Project

Novichok may sound as dark as a Siberian winter, but there are some news full of 39, hope.

Andrea Sella, a professor of inorganic chemistry at University College London, said in a statement that "nerve agents are not materials that can be made at home"

Since they are too toxic to r be manufactured elsewhere than in specialized facilities, the "key question in this area is to identify impurities and residues that could provide clues to the precise chemical process used to make the material".

"There is no doubt that the authorities will look for the container used to deliver the material because the chemical content would be a gold mine," he said. "With this information, it might be possible to trace the origin of the substance, as was done for the [sarin] attack in Syria."

As Chai noted, attacks of nerve agents "are occurring more and more in our world," but hospitalization of the British couple "gives an important lesson for us to the states United States that we think about chemical weapons. "

" It's a rare event that, hopefully, we'll never have to see in our emergency services, "he said. said Mr. Chai. "But we must be aware and know how to respond to these things. It's about taking care of the patient."

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