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A 47-year-old Japanese man new to your office arrives complaining of fatigability, lassitude, poor memory, irritability, and hypervigilance whenever he has to go to public places. As part of your standard social history, you learn that he was formerly a maintenance worker in the Tokyo subway system before emigrating to the United States in 1996. He tells you he was present during the Aum Shinrikyo attack in 1995. At that time, he experienced eye irritation, rhinorrhea, wheezing, cramps, nausea, and diarrhea. He was treated overnight at a local hospital. He has never felt the same and wonders if his current problems are related to the sarin gas attack. What do you tell him?

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In 1936, German scientist Gerhard Schrader discovered tabun, the first in a class of chemical weapons known as nerve agents. The discovery of a compound with similar effects, sarin, was made in 1938 (Fig. 25–1). Sarin would come into worldwide notoriety in the terrorist attack on the Tokyo underground system in March 1995 (Fig. 25–2). Nerve agents are compounds classified as organophosphates (OPs) which were originally developed for use as pesticides. The code names GA, GB, and GD, representing tabun, sarin, and soman, respectively, were standardized by the Tripartite pact after WWII. The “G” in these code names simply stands for German. Rapid analysis and trials of antidotes for these agents were begun as the Cold War loomed, though Soviet production of nerve agents began as early as 1946. As a practical matter, clinicians are far more likely to encounter occupational or environmental organophosphate poisoning than nerve agent exposure from terrorist incidents (Table 25–1). However, the knowledge gleaned is generalizable to their use as weapons.

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Figure 25–1
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Chemical structure of sarin gas (GB).

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Figure 25–2
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The headquarters of Aum Shinrikyo.

Courtesy of the Department of Health and Human Services/Office of Public Health Emergency Preparedness.

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Table Graphic Jump Location
Table 25–1 Quick Facts: Nerve Agents as Bioweapons

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