Appendix E: Differential Diagnosis of Chemical Nerve Agent, Botulinum

Toxin and SEB Intoxication following Inhalation Exposure

       

 

Chemical Nerve Agent

Botulinum Toxin

SEB

Time to Symptoms

Minutes

Hours (12-48)

Hours (1-6)

Nervous

Convulsions,

Progressive paralysis

Headache

Muscle aches

Cardiovascular

Slow heart rate

Normal rate

Normal or Rapid

Heart Rate

Respiratory

Difficult breathing, airways constriction

Normal, then

progressive paralysis

Nonproductive cough

Severe cases;chest

pain/difficult breathing

Gastrointestinal

Increased motility, pain, diarrhea

Decreased mobility

Nausea, vomiting and/or diarrhea

Ocular

Small pupils

Droopy eyelids

May see "red eyes" (conjuntival injection)

Salivary

Profuse, watery

saliva

Normal; difficulty swallowing

May be slightly increased quantities of saliva

Death

Minutes

2-3 days

Unlikely

Response to Atropine/2PAM-Cl

Yes

No

Atropine may reduce gastrointestinal symptoms