To the Editor.
—The terrorist attack using the nerve gas sarin that took place in the Tokyo subways on March 20, 1995, injured more than 5000 persons and caused 12 deaths. Two hundred thirty patients were seen at Toranomon Hospital. All of the patients were treated with 0.5 mg of intramuscular atropine sulfate, 10 mg of intravenous hydrocortisone, and 500 mL lactated Ringer's solution by intravenous drip. We encountered one patient with severe sarin poisoning who was resistant to this pharmacologic therapy, but whose condition significantly improved following blood purification.A 45-year-old woman was brought to our hospital approximately 2 hours after the terrorist attack. On admission she was in a deep coma, had shallow respirations, and a blood pressure measurement of 160/80 mm Hg. Coarse crepitations were heard throughout both lung fields, and pupillary constriction (size of pupils, 1 mm in diameter) was observed. Chest radiography revealed severe pulmonary
Yokoyama K, Ogura Y, Kishimoto M, Hinoshita F, Hara S, Yamada A, Mimura N, Seki A, Sakai O. Blood Purification for Severe Sarin Poisoning After the Tokyo Subway Attack. JAMA. 1995;274(5):379. doi:10.1001/jama.1995.03530050027013