By Kate Kelland, Health and Science Correspondent

LONDON, Aug 23 (Reuters) - Even those who survived the suspected chemical weapons attack in Damascus - and many hundreds didn't - may have life-long disabilities and health problems for which there are few effective treatments.

The death toll from the incident, the latest grisly episode in Syria's two-and-a-half-year civil war, could well rise in coming days as doctors and other health workers who suffered secondary exposure via the direct victims start to succumb to the agent's poison.

Antidotes and emergency treatments do exist for patients suffering the immediate effects of poisoning by a nerve agent - something many experts fear happened to the thousands affected in rebel-held areas of the Syrian capital on Wednesday.

But if no help comes within the first hour or so, the chances become slim that an antidote drug like atropine or oxime, or the sedative diazepam, will do much good.

"(Treatment) needs to be immediate. The damage is done very quickly," said Ray Zilinskas, a chemical and biological weapons expert at the Monterey Institute of International Studies in the United States.

"Longer term, the major risk is the result of significant restricted breathing," which could also lead to brain damage, said Alastair Hay, a professor of environmental toxicology and chemical weapons expert at Britain's Leeds University.


ONE BREATH COULD BE DEADLY

Nerve gases are the most potent and deadly of the known chemical agents. "They are rapidly lethal and are hazardous by any route of exposure," says Sharon Ruetter of the U.S. Army Edgewood Chemical Biological Center in Maryland.

In a review of chemical weapons hazards in the Environmental Health Perspectives journal, Ruetter said it was theoretically possible to release nerve gases in high enough concentrations that "one breath would be incapacitating or deadly".

Nerve gases include tabun, soman and sarin - the agent experts think is most likely to have been used in Syria.

They interfere with transmissions between nerves, or between nerves and muscle cells, causing muscle weakness or paralysis, including paralysis of the diaphragm and heart. They also cause seizures, loss of body control, restricted breathing, sweating, profuse nasal and lung secretions and constricted pupils.

"With the number of casualties we've seen - the figures I'm seeing at the moment are up to 2,000 dead - and the sorts of symptoms, the rapidity of death ... the only plausible explanation is a chemical weapon," said Hamish de Bretton-Gordon, the former commander of the chemical, biological and nuclear counter-terrorism unit at Britain's defence ministry.

"If it is a chemical weapon, it's most likely to be a nerve agent - and we know that sarin has been used in the past in Syria. We know that Assad has very large stockpiles of sarin, and a delivery of sarin would create these kinds of casualties."

Hay said that from pictures and videos he'd seen, nasal and lung secretions - signs consistent with nerve gas poisoning - were "very evident in many of the victims".


ANTIDOTE STOCKPILES?

Then there's the question of whether the antidote is available - and if so, in what quantities.

If the victims - whose writhing bodies and agonised faces shocked the world when Syrian activists published pictures and videos - did suffer a nerve agent attack, then atropine would be the treatment of choice.

A generic medicine, it is used in anaesthesia as a premedication, in emergency situations or during surgery to make the heart beat faster, and to reverse the effects of poisons that make people hyper-salivate, or foam at the mouth.

Troops at risk of chemical weapons attacks often carry atropine auto-injectors to administer into thigh muscles.

Since it is a core medicine on the World Health Organization's "Essential Drugs List" - a list of minimum medical needs for any basic healthcare system - hospitals in Syria should have it, but may not have enough to treat a large number of people quickly.

"We have emergency (atropine) stockpiles here in the United States that could be accessed in a short time - and most industrialised countries would be the same," said Zilinskas.

In Syria, while most hospitals should have small amounts when they are functioning properly, the fear now is that supplies will be severely limited, and that any stockpiles are most likely to be held by the military.

"The question is how quickly would the military share? How quickly would they get it to victims?" said Zilinskas. "It doesn't do much good if it arrives two or three hours later." (Reporting by Kate Kelland; Editing by Will Waterman)





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  • Syrian refugee, Ahmed al Delly, 59, from Daraa in Syria, reacts as he speaks about his wife, four sons, and two daughters, who are still in Daraa but he has had no contact with them, after the prayer of Eid al-Fitr, that marks the end of the holy fasting month of Ramadan, at Zaatari Syrian refugee camp, in Mafraq, Jordan, Thursday, Aug. 8, 2013. (AP photo/Mohammad Hannon)




  • This image provided by Shaam News Network on Thursday, Aug. 22, 2013, which has been authenticated based on its contents and other AP reporting, purports to show mourners next to bodies of victims of an attack on Ghouta, Syria on Wednesday, Aug. 21, 2013. (AP Photo/Shaam News Network)




  • This image provided by by Shaam News Network on Thursday, Aug. 22, 2013, which has been authenticated based on its contents and other AP reporting, purports to show several bodies being buried in a suburb of Damascus, Syria during a funeral on Wednesday, Aug. 21, 2013. (AP Photo/Shaam News Network)




  • Columns of smoke rising from heavy shelling in the Jobar neighborhood in west Damascus, in Cairo, Syria, Thursday, Aug. 22, 2013. (AP Photo/Hassan Ammar)




  • In this citizen journalism image provided by the Media Office Of Douma City, which has been authenticated based on its contents and other AP reporting, a Syrian man mourns over a dead body after an alleged poisonous gas attack fired by regime forces, according to activists, in Douma town, Damascus, Syria on Wednesday, Aug. 21, 2013. (AP Photo/Media Office Of Douma City)




  • Syrian refugees cross into Iraq at the Peshkhabour border point in Dahuk, 260 miles (430 kilometers) northwest of Baghdad, Iraq, Tuesday, Aug. 20, 2013. (AP Photo/Hadi Mizban)




  • This citizen journalism image provided by the Local Committee of Arbeen which has been authenticated based on its contents and other AP reporting, shows a Syrian man reacts as he carries a dead body of a Syrian girl, after an alleged poisonous gas attack fired by regime forces, according to activists in Arbeen town, Damascus, Syria, Wednesday, Aug. 21, 2013. (AP Photo/Local Committee of Arbeen)




  • This citizen journalism image provided by the Local Committee of Arbeen which has been authenticated based on its contents and other AP reporting, shows Syrian citizens trying to identify dead bodies, after an alleged poisonous gas attack fired by regime forces, according to activists in Arbeen town, Damascus, Syria, Wednesday, Aug. 21, 2013. (AP Photo/Local Committee of Arbeen)




  • This citizen journalism image provided by the Local Committee of Arbeen which has been authenticated based on its contents and other AP reporting, shows dead bodies of Syrian citizens in Arbeen town, Damascus, Syria, Wednesday, Aug. 21, 2013. (AP Photo/Local Committee of Arbeen)




  • A Syrian family sits in a tent at Kawergost refugee camp in Irbil, 217 miles (350 kilometers) north of Baghdad, Iraq, Wednesday, Aug. 21, 2013. (AP Photo/Hadi Mizban)




  • Syrian refugees stand in a queue to receive free food at Kawergost refugee camp in Irbil, 217 miles (350 kilometers) north of Baghdad, Wednesday, Aug. 21, 2013. (AP Photo/Hadi Mizban)




  • Syrian refugees wait to receive a tent at Kawergost refugee camp in Irbil, 217 miles (350 kilometers) north of Baghdad, Iraq, Wednesday, Aug. 21, 2013. (AP Photo/Hadi Mizban)




  • Syrian refugees wait to receive a tent at Kawergost refugee camp in Irbil, 217 miles (350 kilometers) north of Baghdad, Iraq, Wednesday, Aug. 21, 2013. (AP Photo/Hadi Mizban)




  • Syrian refugees gather for food aid at Kawergost refugee camp in Irbil, 217 miles (350 kilometers) north of Baghdad, Iraq, Wednesday, Aug. 21, 2013. (AP Photo/Hadi Mizban)




  • Syrian refugees wait for food aid at Kawergost refugee camp in Irbil, 217 miles (350 kilometers) north of Baghdad, Iraq, Wednesday, Aug. 21, 2013. (AP Photo/Hadi Mizban)




  • A Syrian military soldier holds his AK-47 with a sticker of Syrian President Bashar Assad and Arabic that reads, "Syria is fine," as he stands guard at a check point on Baghdad street, in Damascus, Syria, Wednesday, Aug. 21, 2013. (AP Photo/Hassan Ammar)




  • A Syrian military soldier holds his AK-47 with a sticker of Syrian President Bashar Assad and Arabic that reads, "Syria is fine," as he stands guard at a check point on Baghdad street, in Damascus, Syria, Wednesday, Aug. 21, 2013. (AP Photo/Hassan Ammar)




  • This citizen journalism image provided by the Local Committee of Arbeen which has been authenticated based on its contents and other AP reporting, shows a Syrian man receiving treatment, in Arbeen town, Damascus, Syria, Wednesday, Aug. 21, 2013. (AP Photo/Local Committee of Arbeen)




  • Syrian refugees cross into Iraq at the Peshkhabour border point in Dahuk, 260 miles (430 kilometers) northwest of Baghdad, Iraq, Tuesday, Aug. 20, 2013. (AP Photo/Hadi Mizban)




  • Syrian refugees cross into Iraq at the Peshkhabour border point in Dahuk, 260 miles (430 kilometers) northwest of Baghdad, Iraq, Tuesday, Aug. 20, 2013. (AP Photo/Hadi Mizban)




  • A general view of the Kawergost refugee camp in Irbil, 217 miles (350 kilometers) north of Baghdad, Iraq, Wednesday, Aug. 21, 2013. (AP Photo/Hadi Mizban)




  • In this image taken from video posted by Ugarit News, which has been authenticated based on its contents and other AP reporting, purports to show a fireball from an explosion at a weapons depot set off by rocket attacks that struck government-held districts in the central Syrian city of Homs on Thursday, Aug. 1, 2013. (AP Photo/Ugarit News via AP video)




  • Syrian refugees gather for food aid after cross into Iraq at the Peshkhabour border point in Dahuk, 260 miles (430 kilometers) northwest of Baghdad, Iraq, Tuesday, Aug. 20, 2013. (AP Photo/Hadi Mizban)




  • In this image taken from video obtained from the Shaam News Network, which has been authenticated based on its contents and other AP reporting, a Syrian man comforts a child injured by a missile strike in Raqqa, Syria, Wednesday, Aug. 7, 2013. (AP Photo/Shaam News Network via AP video)




  • Syrian refugees cross into Iraq at the Peshkhabour border point in Dahuk, 260 miles (430 kilometers) northwest of Baghdad, Iraq, Tuesday, Aug. 20, 2013. (AP Photo/Hadi Mizban)




  • In this citizen journalism Monday, Aug. 12, 2013, image provided by Aleppo Media Center AMC, which has been authenticated based on its contents and other AP reporting, buildings are seen damaged from the shelling of Syrian forces at Karm al-Jabal area in Aleppo province, Syria. (AP Photo/Aleppo Media Center, AMC)




  • In this citizen journalism Monday, Aug. 12, 2013, image provided by Aleppo Media Center AMC, which has been authenticated based on its contents and other AP reporting, Syrian rebels open fire as they battle against the Syrian forces in Aleppo, Syria. (AP Photo/Aleppo Media Center, AMC)




  • In this image released by the Syrian official news agency SANA, a Syrian army soldier stands behind his machine gun during a battle against the Syrian rebels at an unidentified location in Latakia province, Syria, Tuesday, Aug. 13, 2013. (AP Photo/SANA)




  • In this image taken from video obtained from the Shaam News Network, which has been authenticated based on its contents and other AP reporting, a Syrian man carries an injured child away from a missile strike in Raqqa, Syria, Wednesday, Aug. 7, 2013. (AP Photo/Shaam News Network via AP video)




  • In this image released by the Syrian official news agency SANA, a Syrian forces tank fires during a battle against the Syrian rebels at an unidentified location in Latakia province, Syria, Tuesday, Aug. 13, 2013. (AP Photo/SANA)




  • In this image taken from Sunday, Aug. 11, 2013, video obtained from the Sham News Network, which has been authenticated based on its contents and other AP reporting, a rebel fighter fires a gun in a valley in an unidentified location in Latakia province, Syria. (AP Photo/Sham News Network via AP video)




  • Mansour Mahameed, 26, from Daraa city in Syria, a former Free Syrian Army fighter who lost his leg last March after the Syrian troops bombing, prepares to sit for the Eid al-Fitr prayer that marks the end of the holy fasting month of Ramadan at Zaatari Syrian refugee camp in Mafraq, Jordan, Thursday, Aug. 8, 2013. (AP Photo/Mohammad Hannon)




  • Syrian refugees cross into Iraq at the Peshkhabour border point in Dahuk, 260 miles (430 kilometers) northwest of Baghdad, Iraq, Tuesday, Aug. 20, 2013. (AP Photo/Hadi Mizban)




  • In this image taken from video obtained from the Shaam News Network, which has been authenticated based on its contents and other AP reporting, a Syrian man carries an injured child away from a missile strike in Raqqa, Syria, Wednesday, Aug. 7, 2013. (AP Photo/Shaam News Network via AP video)




  • In this photo released by the Syrian official news agency SANA, dead bodies of Syrian rebels are seen on the ground, killed during ambush by Syrian forces near the Damascus suburb of Adra, Syria, Wednesday Aug. 7, 2013. (AP Photo/SANA)




  • In this image taken from video posted by Shaam News Network, which has been authenticated based on its contents and other AP reporting, purports to show a fireball from an explosion at a weapons depot set off by rocket attacks that struck government-held districts in the central Syrian city of Homs on Thursday, Aug. 1, 2013. (AP Photo/Shaam News Network via AP video)




  • This image posted on the official Facebook page of the Syrian Presidency on Thursday, Aug. 1, 2013 purports to show Syrian President Bashar Assad shaking hands with a soldier during Syrian Arab Army day in Darya, Syria. (AP Photo/Syrian Presidency via Facebook)




  • This image posted on the official Facebook page of the Syrian Presidency on Thursday, Aug. 1, 2013 purports to show Syrian President Bashar Assad walking with soldiers with during Syrian Arab Army day in Darya, Syria. (AP Photo/Syrian Presidency via Facebook)




  • In this image taken from video obtained from the Shaam News Network, which has been authenticated based on its contents and other AP reporting, a Syrian youths run away from the scene of a missile strike in Raqqa, Syria, Wednesday, Aug. 7, 2013. (AP Photo/Shaam News Network via AP video)