If patients have respiratory symptoms hours after the exposure, they should be treated as chemical pneumonitis; albuterol should aggressively be utilized, and invasive airway management should be considered early in the treatment plan if the patient is not responding to albuterol. Systemic steroids have been recommended if albuterol is not effective, but further immune suppression may not be advisable. Inhaled sodium bicarbonate has been suggested as a possible treatment as well, but there is not robust evidence to support its use. Other antioxidants and scavengers such as sodium thiosulfate have shown some benefit in animal studies, but there is no human data to support their use. These therapies should only be considered in patients’ refractory to supportive care when the benefit of unproven therapy outweighs potential risks.

Bone marrow suppression usually peaks around 9-10 days. Granulocyte colony stimulating factor analogues may be administered. Severe bone marrow suppression may be an indication for bone marrow transplant.

The antidote for Lewisite is British Anti-Lewisite (BAL), also known as Dimercaprol. BAL should only be used in a hospital setting and is given as an IM injection. BAL is a chelating agent, but due to the possibility of severe acute renal failure and other side effects, BAL is only recommended for patients who have severe respiratory symptoms or Lewisite shock.