Treatment arsenic poisoning update

Arsine gas is a non-irritating, colorless and nearly tasteless gas that may be a byproduct in the mining process, and is used in the production of semiconductors. It is lethal at low doses, and affected individuals may not notice the toxicity until hours after exposure. Classic symptoms of arsine gas toxicity include headache, nausea, vomiting, diarrhea, "port wine" hued urine and jaundice.

IN cases of suspected arsenic exposure it is imperative to call for immediate transfer to the nearest hospital. If there is a concern for recurrent occupational exposure Occupational Safety and Health Administration OSHA should be contacted at to investigate. For further recommendations, the phone number for the American Association of Poison Control Center is Arsenic can cross the placenta and is teratogenic.

Arsenic demonstrates poor excretion through lactation, and studies have shown that exclusive breastfeeding decreases arsenic exposure risk to infants in pandemic regions.

Serum arsenic levels are not an effective or reliable marker for arsenic toxicity due to rapid clearance of arsenic from the bloodstream. Early identification is key to survival rates, a team-based approach allowing open communication and dialog between nurses and physicians will help to recognize signs and symptoms of this challenging to identify the condition. If suspicious of acute exposure, chelation therapy should commence before laboratory confirmation.

Special care should be focused on monitoring and maintaining electrolytes, volemic status, and cardiac stability. Dealing with arsenic and other toxicities requires an interprofessional team approach, including physicians, toxicologists, specialty-trained nursing, and pharmacists, working collaboratively to enhance patient outcomes.

This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Affiliations 1 McLaren Oakland. Continuing Education Activity Arsenic poisoning is a global health issue affecting millions of people worldwide through environmental and occupational exposure, as well as intentional suicide and homicide attempts.

Introduction Arsenic poisoning is a global health issue affecting millions of people worldwide through environmental and occupational exposure, as well as intentional suicide and homicide attempts. Etiology Arsenic is a naturally occurring metalloid element with ubiquitous distribution throughout the earth's crust and groundwater; it is also found in lower levels in the air and food products, particularly, crustaceans and seafood.

Epidemiology Chronic arsenic exposure through contaminated drinking supply is a global health concern. Pathophysiology The metabolism of arsenic has a direct impact on its toxic effects, although the exact mechanism of action is not fully understood, there are several hypotheses.

History and Physical Acute: Classic acute toxicity presents with gastroenteritis followed by hypotension. Subacute 1 to 3 weeks : Neurologic: Reversible sensorimotor polyneuropathy is a well-documented symptom of arsenic toxicity, typically seen one to three weeks after acute exposure, but it may occur insidiously with chronic exposure.

Chronic: Dermatologic: Multiple dermatologic signs have been documented, prominently diffuse or spotted hyperpigmentation, described as having a "raindrop appearance" which may be preceded by hypopigmentation occurs six months to three years after exposure.

Evaluation History of severe gastroenteritis followed hypotension with occupational or environmental hazard risk should raise clinicians index of suspicion. Tests to order: The best indicator of arsenic exposure is an elevated arsenic level in a hour urine collection.

Samples should be collected in a metal-free polyethylene container. Abdominal radiograph: may demonstrate intestinal radiopaque metallic flecks in arsenic ingestion. CBC: Anemia, thrombocytopenia, and relative eosinophilia may present, reticulocyte count may become elevated secondary to hemolytic anemia.

Arrhythmias including torsades de pointe have been reported. In the case of ventricular tachycardia or torsades de point, treat as necessary with magnesium sulfate, lidocaine, amiodarone, and defibrillation. Potassium, calcium, magnesium levels should be monitored and maintained within normal limits to avoid worsening of QT prolongation.

Differential Diagnosis Arsenic toxicity has been mistaken for Guillain-Barre in the past secondary similarities in ascending neuropathic symptoms. Prognosis The prognosis of arsenic toxicity is highly variable dependent on the arsenic state, amount ingested and duration of exposure. Complications Please see chronic symptomatology section of the history and physical for complications of arsenic exposure.

Deterrence and Patient Education Arsenic is a naturally found metalloid that is a significant toxin worldwide found in the earth's crust and can act as a contaminate in drinking water.

Arsenic is toxic as a solute, as well as in a gaseous form. Pearls and Other Issues Arsenic can cross the placenta and is teratogenic. Enhancing Healthcare Team Outcomes Early identification is key to survival rates, a team-based approach allowing open communication and dialog between nurses and physicians will help to recognize signs and symptoms of this challenging to identify the condition.

Any patient admitted to the hospital for arsenic toxicity should be admitted to the ICU. Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Tidsskr Nor Laegeforen. Environ Health Perspect.

Occurrence and stability of inorganic and organic arsenic species in wines, rice wines and beers from Central European market. Health effects of chronic arsenic exposure. J Prev Med Public Health. Curr Environ Health Rep. Hughes MF. Arsenic toxicity and potential mechanisms of action. Toxicol Lett. Pakulska D, Czerczak S. Hazardous effects of arsine: a short review.

Gorby MS. Arsenic poisoning. West J Med. Metabolism of arsenobetaine in mice, rats and rabbits. Sci Total Environ. In vivo and in vitro percutaneous absorption and skin decontamination of arsenic from water and soil. Fundam Appl Toxicol. Comparison of the urinary excretion of arsenic metabolites after a single oral dose of sodium arsenite, monomethylarsonate, or dimethylarsinate in man. Int Arch Occup Environ Health.

Non-carcinogenic effects of inorganic arsenic. Environ Geochem Health. Arsenic-induced torsade de pointes. Crit Care Med. Multiple organ failure with the adult respiratory distress syndrome in homicidal arsenic poisoning. Arsenical neuropathy. Goldsmith S, From AH. Arsenic-induced atypical ventricular tachycardia. N Engl J Med. Peripheral neuropathy caused by arsenical intoxication; a study of 41 cases with observations on the effects of BAL 2, 3, dimercapto-propanol.

Blackfoot disease in Taiwan: its link with inorganic arsenic exposure from drinking water. Oncogenomic disruptions in arsenic-induced carcinogenesis. An analysis of arsenic exposures referred to the Blodgett Regional Poison Center. Vet Hum Toxicol. Learning Objective. Upon completion of this section, you will be able to identify primary strategies for treating arsenic-associated diseases.

Some will be asymptomatic. Some will just be beginning to show signs of arsenic-associated disease, and others will have more established disease. The care provided, including any referrals made, will depend on the clinical status of the patient. Patients who demonstrate excessive occupational exposure urinary arsenic greater than 35 microgram per liter may benefit from early workplace intervention to prevent future hazardous exposure.

Treatment and Management—Acute Over Exposure. Aggressive intravenous fluid replacement therapy may be life—saving in severe poisoning. Gastric lavage may be useful soon after an acute ingestion to prevent further absorption. The efficacy of activated charcoal is controversial, but its administration together with a cathartic such as sorbitol is frequently recommended.

If profuse diarrhea is present, cathartics should be withheld. Hemodialysis may be beneficial in a patient with concomitant renal failure. All known chelating agents have adverse side effects and should be used with caution. In animal models, the efficacy of chelation therapy generally declines as the time elapsed since exposure increases.

If patients are treated within several hours after arsenic ingestion, chelation is likely to be beneficial. Therefore, even if arsenic ingestion is only suspected, but not confirmed, consultation with a clinical specialist with expertise in the treatment and management of arsenic poisoning is key. Treatment and Management —Chronic Over Exposure. Studies suggest that the use of vitamin A analogs retinoids may be useful in treating pre-cancerous arsenical keratoses [Elmariah et al.

Recovery from chronic arsenic toxicity, particularly from the resulting peripheral neuropathy, may take months and may not be complete. An established arsenical neuropathy is not improved by chelation therapy. Significant improvement of symptoms and signs of chronic arsenic poisoning has been demonstrated in a prospective single blind, placebo-controlled trial with DMPS [Mazumder et al. Because arsenic has no odor or taste, it is impossible to detect. However, arsenic poisoning symptoms may be a clue that someone has been exposed.

There are two types of arsenic:. Arsenic poisoning can be acute or chronic. Symptoms of acute poisoning include:. Without treatment, your cardiovascular and central nervous systems will begin to shut down, and death will occur within a few hours. You can also be exposed to small amounts of arsenic over a long period. Symptoms of chronic exposure include:.

Other potential long-term effects include:. While symptoms of acute arsenic poisoning usually happen within an hour, symptoms of chronic exposure can take up to eight weeks to present themselves. You can be exposed to arsenic in various ways, including through:. This substance is highly regulated because of toxicity and adverse effects linked to arsenic exposure.

The limit for foods is specific to those that typically contain higher levels of arsenic, such as rice cereal parts per billion. Symptoms of chronic exposure may also be more vague and difficult to identify. Testing for arsenic can be done using:. However, chelation therapy may help in some cases. This treatment involves injecting or ingesting a chelating agent. Once in your bloodstream, it combines with the toxic arsenic and helps expel it from the body.

Otherwise, treatment aims to manage symptoms. For example, a doctor might treat you with intravenous IV, infused into a vein hydration to counteract the effects of severe diarrhea. Arsenic is a heavy metal that occurs naturally. Ingesting or breathing in too much of it can cause harmful effects. Poisoning can be chronic over a long time or acute a sudden onset. Diagnosis involves various lab tests that check for arsenic. Treatment aims at managing symptoms. If you work somewhere where arsenic exposure is possible, ask about safety regulations in place to minimize chronic arsenic exposure.