Organophosphorus nerve gases such as sarin, soman and VX act mainly by inhibiting cholinesterase at cholinergic synapses. The consequent accumulation of acetylcholine results in muscle twitching, glandular hypersecretion and cognitive and mood effects. High doses cause seizures and death from respiratory failure. Nerve agents affect both main types of cholinergic receptor--muscarinic and nicotinic. Treatment of nerve agent poisoning at present relies on two approaches. In the first, an oxime is given to detach the agent from cholinesterase, thus reactivating the enzyme. This mitigates both nicotinic and muscarinic effects, for those nerve agents against which oximes are effective (which do not include soman). In the second, the muscarinic antagonist atropine is used to quell the effects of excessive acetylcholine action. Atropine is of special value when the nerve agent is oxime-resistant or when symptoms are already severe. However, atropine targets only excessive muscarinic activity.
This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.
Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/research-integrity.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.