II. Pathophysiology
- Arsenic blocks cellular respiration (Oxidative Phosphorylation) and Gluconeogenesis at multiple pathway sites
- Also affects glutathione metabolism
- Arsenic has a Garlic-like odor when ingested
- Arsenic Ingestion (or less commonly by skin absorption or inhalation)
III. Pharmacokinetics
- Gastrointestinal absorption is rapid
- Inorganic forms (trivalent, pentavalent) are more toxic than organic forms
- Lethal dose
- Child: >2 mg/kg
- Adult: >120 to 200 mg
IV. Findings: Acute Poisoning
- Gastrointestinal Symptoms (within minutes to hours of ingestion)
- Nausea or Vomiting
- Abdominal Pain
- Watery Diarrhea
- Cardiopulmonary symptoms and signs
- Hypotension to Cardiovascular collapse
- Tachycardia
- Acute Respiratory Distress Syndrome (ARDS)
- QTc Prolongation
- Dysrhythmia
- Paradoxically low Systemic Vascular Resistance (vasoplegia)
- Systemic Inflammatory Response Syndrome (SIRS)
- Neurologic Symptoms
- Headache
- Vertigo
- Fatigue
- Encephalopathy with Delirium
- Peripheral Neuropathy (motor and sensory) is delayed
- Paresthesia
- Paralysis
- Skin
- Skin irritation
- Mucosal burning Sensation
- Miscellaneous
V. Findings: Chronic Poisoning
- Mottled brown skin
- Hyperkeratosis of palms and soles
- Cutis edema
- Transverse striate Leukonychia
- Perforation of nasal septum
- Eyelid Edema
- Coryza
- Limb paralysis
- Reduced Deep Tendon Reflexes
- Carcinogenic with chronic exposure
VI. Labs
- See Unknown Ingestion
- Comprehensive metabolic panel
- Urinalysis
- Complete Blood Count and Peripheral Smear
- Arsenic Concentration
- Urine Arsenic (24 hour level)
- Abnormal if >100 mcg
- May also be positive with seafood ingestion
- Urine Arsenic (24 hour level)
- Tissue Exam reveals Arsenic deposits
- Urine
- Nails
- Hair
VII. Diagnostics
VIII. Imaging
- Abdominal XRay
- Arsenic is radiopaque
IX. Management
- See Unknown Ingestion
- Consult poison control
- ABC Management
- Intravenous Fluids
- Antidote (symptomatic patients)
- Hemodialysis is NOT typically effective
- Dimercaptosuccinic acid (succimer) 10 mg/kg orally every 8 hours for 5 days
- Dimercaprol 3-5 mg/kg IM every 4 to 6 hours
- Indicated in severe Poisonings
X. References
- Kinker and Glauser (2021) Crit Dec Emerg Med 35(9): 19-27
- Tomaszewski (2022) Crit Dec Emerg Med 37(1): 32
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| Definition (CHV) | A poisonous chemical used to kill weeds and pests |
| Definition (CHV) | A poisonous chemical used to kill weeds and pests |
| Definition (CHV) | A poisonous chemical used to kill weeds and pests |
| Definition (MEDLINEPLUS) |
Arsenic is a natural element found in soil and minerals. Arsenic compounds are used to preserve wood, as pesticides, and in some industries. Arsenic can get into air, water, and the ground from wind-blown dust. It may also get into water from runoff. You may be exposed to arsenic by
Exposure to arsenic can cause many health problems. Being exposed to low levels for a long time can change the color of your skin. It can cause corns and small warts. Exposure to high levels of arsenic can cause death. Agency for Toxic Substances Disease Registry |
| Definition (MSHCZE) | Arsenicum, As (Z=33, Ar=74,9216). Prvek V.A skup. period. soustavy. Má více modifikací. Nejč. jako stříbřitě šedý kov, další modif. je žlutý a černý a. Slouč. velmi jedovaté, zejm. oxid arsenitý (arsenik čili otrušík, zvaný též jed Borgiů) a plynný arsenovodík (páchne po česneku). V soudním lékař. slouží k důkazu a. Marshova zkouška. Slouč. působí toxicky na kardiovask. systém, GIT, CNS, ledviny, játra, kůži. Má též karcinogenní a teratogenní úč. Dříve se slouč. a. užívalo k léčbě syfilis (Salvarsan). Slouč. a. byly známy již ve starověku, čistý připravil r. 1250 Němec Albertus Magnus. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (NCI) | An element with atomic symbol As, atomic number 33, and atomic weight 74.92. |
| Definition (NCI_NCI-GLOSS) | A poisonous chemical used to kill weeds and pests. Also used in cancer therapy. |
| Definition (MSH) | A shiny gray element with atomic symbol As, atomic number 33, and atomic weight 75. It occurs throughout the universe, mostly in the form of metallic arsenides. Most forms are toxic. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985), arsenic and certain arsenic compounds have been listed as known carcinogens. (From Merck Index, 11th ed) |
| Definition (CSP) | widely distributed element with atomic symbol As, atomic number 33, and atomic weight 75; occurs mostly in the form of metallic arsenides; most forms are toxic and carcinogenic. |
| Concepts | Hazardous or Poisonous Substance (T131) , Element, Ion, or Isotope (T196) |
| MSH | D001151 |
| SnomedCT | 413576005, 47809000 |
| LNC | LP16802-8, MTHU004556 |
| English | Arsenic, As, Arsenic [Chemical/Ingredient], arsenic (As), arsenics, ARSENIC, As element, arsenic, As - Arsenic, Arsenic (substance), Arsenic, NOS, Arsenic product (product), Arsenic product |
| Swedish | Arsenik |
| Czech | arsen, arzén |
| Finnish | Arseeni |
| Russian | MYSH'IAK, МЫШЬЯК |
| Croatian | ARSEN |
| Latvian | Arsēns |
| Polish | Arsen |
| Norwegian | Arsen |
| Portuguese | Arsênio, Arsênico |
| Spanish | arsénico (sustancia), arsénico, producto con arsénico (producto), producto con arsénico, Arsénico |
| French | Arsenic |
| German | Arsen |
| Italian | Arsenico |
Ontology: Arsenic Poisoning (C0311375)
| Definition (MSH) | Disorders associated with acute or chronic exposure to compounds containing ARSENIC (ARSENICALS) which may be fatal. Acute oral ingestion is associated with gastrointestinal symptoms and an encephalopathy which may manifest as SEIZURES, mental status changes, and COMA. Chronic exposure is associated with mucosal irritation, desquamating rash, myalgias, peripheral neuropathy, and white transverse (Mees) lines in the fingernails. (Adams et al., Principles of Neurology, 6th ed, p1212) |
| Concepts | Injury or Poisoning (T037) |
| MSH | D020261 |
| ICD9 | 985.1 |
| ICD10 | T57.0 , T57.0X, T57.0X1 |
| SnomedCT | 81844008, 418685002 |
| English | Toxic effect of arsenic and its compounds, Arsenic and its compounds, As or As comp caus toxic effct, POIS ARSENIC NERVOUS SYSTEM, NERVOUS SYSTEM POIS ARSENIC, NEUROTOX SYNDROME ARSENICAL, ARSENIC POIS NERVOUS SYSTEM, ARSENIC POIS, Toxic effect of arsenic, poisoning by arsenic (diagnosis), poisoning by arsenic, Arsenic Poisoning, Nervous System, Nervous System Poisoning, Arsenic, Poisoning, Arsenic, Nervous System, Arsenic Poisoning, Poisoning, Arsenic, Arsenic Poisonings, Poisonings, Arsenic, Arsenical Neurotoxicity Syndrome, Arsenical Neurotoxicity Syndromes, Neurotoxicity Syndrome, Arsenical, Neurotoxicity Syndromes, Arsenical, Syndrome, Arsenical Neurotoxicity, Syndromes, Arsenical Neurotoxicity, Toxic effect arsenic, Arsenic Poisoning [Disease/Finding], arsenic poison, poison arsenic, arsenic poisoning, poisonings arsenic, Toxic effect of arsenic and its compounds NOS, Arsenic intoxication, Arsenic poisoning, Arsenical toxicity, Arsenic or arsenic compound causing toxic effect, Arsenic causing toxic effect, Toxic effect of arsenic AND/OR its compounds (disorder), Toxic effect of arsenic AND/OR its compounds, Toxic effect of arsenic and its compounds, NOS, Poisoning by arsenic or its compounds of undetermined intent (disorder), Poisoning by arsenic or its compounds of undetermined intent |
| Spanish | intoxicación por arsénico o sus compuestos con intención no determinada (trastorno), intoxicación por arsénico o sus compuestos con intención no determinada, Efecto tóxico del arsénico y de sus compuestos, Efecto tóxico por arsénico, Envenenamiento por Arsénico, efecto tóxico del arsénico Y/O sus derivados (trastorno), efecto tóxico del arsénico Y/O sus derivados, efecto tóxico del arsénico y sus derivados, intoxicación por arsénico, toxicidad arsenical, Intoxicación por Arsénico |
| Dutch | toxisch gevolg van arsenicum en zijn verbindingen, toxisch effect van arsenicum, Arseen en arseenverbindingen, Arsenicumvergiftiging, Vergiftiging, arsenicum- |
| French | Effet toxique de l'arsenic et ses composés, Effet toxique de l'arsénic, Arsénicisme, Intoxication par l'arsenic, Intoxication arsenicale, Intoxication à l'arsenic |
| German | toxischer Effekt von Arsen und seinen Verbindungen, toxischer Effekt von Arsen, Toxische Wirkung: Arsen und dessen Verbindungen, Arsenvergiftung |
| Portuguese | Efeito tóxico de arsénio e seus compostos, Efeito tóxico por arsénico, Intoxicação por Arsênico |
| Swedish | Arsenikförgiftning |
| Italian | Effetti tossici dell'arsenico e suoi composti, Effetto tossico dell'arsenico, Avvelenamento da arsenico sul sistema nervoso, Sindrome neurotossica da arsenico, Avvelenamento da arsenico |
| Czech | arsen - otrava, Toxický účinek arzenu a jeho sloučenin, Toxický účinek arzénu |
| Japanese | ﾋｿﾉﾁｭｳﾄﾞｸｻﾖｳ, 砒素の中毒作用, ヒ素中毒, 中毒-ヒ素, 慢性ヒ素中毒, 慢性砒素中毒, 砒素中毒, 砒素剤中毒, ヒ素剤中毒, 中毒-砒素 |
| Finnish | Arseenimyrkytys |
| Russian | MYSH'IAKOM OTRAVLENIE, МЫШЬЯКОМ ОТРАВЛЕНИЕ |
| Korean | 비소 및 그 화합물의 중독작용 |
| Polish | Zatrucie arsenem |
| Hungarian | Arzén toxikus hatása, Arzén és vegyületeinek toxikus hatása |
| Norwegian | Arsenforgiftning i nervesystemet, Arsenframkalte neurotoksiske skader, Arsenframkalte toksiske nerveskader, Forgiftning, arsen, Forgiftning i nervesystemet, arsen, Arsenforgiftning |
