Arsenic Poisoning
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Contents |
Introduction
Pathology
- reversible interaction with multiple sulfhydryl-containing proteins
- arsine gas is the most toxic form or arsenic
- can cause intravascular hemolysis & acute renal failure
- > 30 ppm of arsine gas may be fatal
- a fatal dose of arsenic trioxide is 120 mg
Clinical-manifestations
- toxicity generally manifested within 1 hours of ingestion
- most commonly presents with gastrointestinal symptoms
- dry mouth
- dysphagia
- nausea/vomiting
- abdominal pain
- diarrhea, watery or bloody
- hematemesis[2]
- odor of garlic on the breath
- metallic taste
- cardiovascular manifestations
- oliguria, acute renal failure
- pulmonary edema
- headache
- vertigo
- increased fatigability
- paralysis of extremities
- mental impairment
- painful sensory polyneuropathy
- occurs late, 1-2 weeks after ingestion
- NO upper motor neuron signs
- mottled brown pigmentation of skin
- hyperkeratosis on palms & soles
- edema of cutis
- transverse striate leukonychia
- perforation of nasal septum
- edema of eyelids
- rhinitis
- decreased deep tendon reflexes
Laboratory
-
- arsenic in urine > 50 ug/L
- arsenic in hair, nails
- complete blood count: macrocytic anemia
Management
- gastric lavage
- dimercaprol combines with arsenic through sulfhdryl groups to produce water soluble complexes
- 2,3-dithioerythritol may be less toxic than dimercaprol
- hemodialysis may be used to remove dimercaprol- arsenic complexes [2]
More General Terms
Additional Terms
References
- DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 866
- Henry's Clinical Diagnosis & Management by Laboratory Methods, 21st edition, McPherson RA & Pincus MR (es), W.B. Saunders Co., Philadelphia, PA. 2007, pg 322
