To the Editor.
—The recent article by Keeler et al1 regarding the effects of pyridostigmine bromide on the troops in Operation Desert Storm is pertinent. We have recently had experience with a unique first trimester exposure related to Operation Desert Storm. With the initial return of 2000 troops to Hawaii, two young women presented to Tripler Army Medical Center, Honolulu, Hawaii for counseling because of first trimester exposure to pyridostigmine and anthrax vaccine.Chemical agents classified as nerve gases are organophosphate compounds and act primarily by inhibiting acetylcholinesterase at cholinergic receptor sites. As a result, the neurotransmitter acetylcholine accumulates, causing hyperactivity at both muscarinic and nicotinic receptors.2Pyridostigmine, an acetylcholinesterase inhibitor used to treat myasthenia gravis, can be used as a pretreatment for these chemical agents because it occupies the active site of acetylcholinesterase, thereby blocking the action of the nerve agent. The drug has been used in
Sarno AP. More on Desert Storm. JAMA. 1991;266(23):3282. doi:10.1001/jama.1991.03470230040014