select search filters
briefings
roundups & rapid reactions
before the headlines
Fiona fox's blog
Yulia Skipral, poisoned by a nerve agent – Novichok – alongside her father Sergei Skripal, has been discharged from hospital.
Prof Alastair Hay, Professor Emeritus of Environmental Toxicology, University of Leeds, said:
“After exposure to something as toxic as a nerve agent, crucial medical intervention involves ensuring good oxygenation of the body. This will prevent damage to the heart, brain and other vital organs. So, prompt intervention by paramedics is crucial. They would have had the task of ensuring that the airways were open; removing any fluid or vomit from the airways; ensuring the pair were breathing or, if not, assisting with breathing; checking that circulation and heart function were normal; and preventing seizures.
“If all these functions were maintained whilst the pair were taken to A&E, the doctors who received the Skripals would have had the chance to make a detailed assessment when they arrived in hospital.
“Other treatments would follow once it was recognised – and I have no idea how long that took – what it was that was likely to have caused the Skripals’ condition. The signs the pair were showing – and remember, they were unconscious and not able to say how they were feeling – would provide clues to indicate it was poisoning with an organophosphate-type agent. It would be recognised that it was some external agent that was the probable cause as it was two people that were affected.
“Treatment for organophosphate poisoning – even for something as toxic as a nerve agent – is well known. That is, treatment with the antidote atropine to counteract the effect of the nerve agent at certain nerve-muscle junctions; treatment with an oxine (although the specific one for a Novichok-type nerve agent is unknown); and treatment to prevent seizures with an anticonvulsant like diazepam. Atropine, oxines and diazepam are standard, recognised treatments for nerve agent poisoning.
“Given that the consequences of being exposed to a nerve agent include the risk of heart attack and damage to the brain through poor oxygenation, it is essential to prevent this from happening. Given that the pair’s breathing would have been seriously impaired, both through the failure of normal muscle action and the secretion of fluids into the lungs, it would have been important to ensure the drainage of fluid from the lungs, and to give treatment to prevent fluid going into the lungs (which atropine will prevent). It is very likely that breathing would need to be assisted, and this care would have been provided in the hospital.
“There may be other general consequences on blood sugar and blood electrolytes as a result of nerve agent exposure, but these would have been well managed by doctors in intensive care, who are used to giving this sort of treatment all the time. It is probable that the pair were kept sedated for some time to prevent overactivity of nerves in the brain, to prevent seizures and other damage.
“The specific action of the nerve agent is to block the enzyme acetylcholinesterase, which regulates messages down nerves and at junctions between nerves and muscle. The body is always making new acetylcholinesterase, and will eventually re-establish enzyme function in the nerves and a fully functioning nervous system, enabling recovery.
“Evidence from other nerve agent exposures indicate that in the vast majority of cases, as long as there is no damage to the brain, the victims make a full physical recovery, albeit delayed in some cases. There may, and always is, a risk of some psychological impairment, and many report a post traumatic stress disorder-type syndrome. PTSD-type symptoms would not be surprising in this case given that someone has tried to kill the Skripals. These are symptoms that will need to be managed, and it is highly likely that the pair will require counselling.
“The slower recovery of Mr Skripal compared with that of his daughter may be a function of the dose of agent he was poisoned with, his age, and his general physical fitness.
“I’m delighted the pair are continuing to make good progress, and I wish them well.”
All our previous output on this subject can be seen at these weblinks:
Declared interests
Prof Alastair Hay: “No conflicts of interest. I worked on UK government committees (from 1989 until 2015) and an EU committee (2005-14) that recommended standards for chemical exposure in the workplace. Over the years I have investigated some 6 allegations of use of chemical weapons.”