Abstract
Organophosphorus nerve agents (NAs) are known as the deadliest chemical warfare agents. The NAs have four classes G, V, and GV agents and Novichok family. They are highly lipophylic. NAs irreversibly inactivate acetylcholine esterase (AChE) and lead to accumulate toxic levels of acetylcholine. Respiratory system is the main organ that is affected by NAs and respiration may be arrested due to central and peripheral dysfunctions. NA exposure is detected through four methods: (I) measurement of AChE activity, (II) evaluation of hydrolysis products in plasma and urine, (III) fluoride reactivation of phosphylated binding sites, and (IV) determination of NAs and metabolites by mass spectrometric methods. The NA treatment should be started as soon as possible by removing victims from the field and administrating atropine and oximes by auto-injectors. Although atropine and different types of oximes are the main antidotes, there are also some adjuvant treatments for NA intoxication including magnesium sulfate, sodium bicarbonate, gacyclidine, benactyzine, tezampanel, hemoperfusion, antioxidants, and bioscavengers. We also review treatments of victims from high-risk groups, such as pregnant women, children, and elderly.
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