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Virtual Naval Hospital

Medical Management of Biological Casualties Handbook

Appendix E: Differential Diagnosis: Toxins/Nerve Agent

U.S. Army Medical Research Institute of Infectious Diseases,Fort Detrick, Frederick, Maryland
Peer Review Status: Internally Peer Reviewed

Time to Symptoms Minutes Hours (12-48) Hours (1-6)

Nervous Convulsions, Progressive Headache

Muscle twitching paralysis Muscle aches

Cardiovascular Slow heart rate Normal rate Normal or Rapid

Heart Rate

Respiratory Difficult breathing, Normal, then Nonproductive cough

airways constriction progressive Severe cases;chest

paralysis pain/difficult breathing

Gastrointestinal Increased motility, Decreased Nausea, vomiting and/or

pain, diarrhea motility diarrhea

Ocular Small pupils Droopy eyelids May see "red eyes"

(conjuntival injection)

Salivary Profuse, watery Normal; difficulty May be slightly increased

saliva swallowing quantities of saliva


Death Minutes 2-3 days Unlikely

Response to Yes No Atropine may reduce

Atropine/2PAM-Cl gastrointestinal symptoms


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