Arsenic toxicity: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
[[File:arsenicrash.png|thumb|Typical rash associated with chronic exposure]] | |||
===Acute ingestion=== | ===Acute ingestion=== | ||
*GI symptoms that can resemble [[cholera]] | *GI symptoms that can resemble [[cholera]] | ||
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*death | *death | ||
*cardiovascular instability | *cardiovascular instability | ||
[[File:Meeslines.png|thumb|"Mees lines"]] | |||
===Arsine gas exposure=== | ===Arsine gas exposure=== | ||
*hemolysis causing abdominal pain | *hemolysis causing abdominal pain | ||
*[[hematuria]] | *[[hematuria]] | ||
*[[jaundice]] | *[[jaundice]] | ||
===Subacute or chronic poisoning=== | ===Subacute or chronic poisoning=== | ||
*[[Anemia]] | *[[Anemia]] | ||
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**typically symmetric "glove and stocking" distribution | **typically symmetric "glove and stocking" distribution | ||
*skin changes | *skin changes | ||
*White lines on the finger nails known as "Mees lines" | *White lines on the finger nails known as "Mees lines" | ||
*[[ataxia]] | *[[ataxia]] | ||
*[[CNS Depression]] | *[[CNS Depression]] | ||
Revision as of 19:48, 20 October 2015
Background
- Heavy metal
- sources of exposure: poisoning, contaminated drinking water, eruptions, metal and semiconductor industry, wood preservatives
- seafood arsenic felt to be organic form which is NONTOXIC and cleared from body in few days
- readily absorbed via GI tract and inhalation, poorly via skin
- organic trioxide form used as chemotherapeutic agent
- trivalent form, As3+, is toxic to over 200 intracellular enzymes
- known carcinogen: skin, lung, other
- ingestion fatal dose: 100-200mg
Clinical Features
Acute ingestion
- GI symptoms that can resemble cholera
- Vomiting may be bloody
- "rice water" like diarrhea
- dehydration
- Pulmonary Edema
- Shock
- Rhabdomyolysis
- altered mental status
- Seizure
- coma
- death
- cardiovascular instability
Arsine gas exposure
Subacute or chronic poisoning
- Anemia
- peripheral neuropathy
- typically symmetric "glove and stocking" distribution
- skin changes
- White lines on the finger nails known as "Mees lines"
- ataxia
- CNS Depression
Differential Diagnosis
Diagnosis
- urine arsenic level (usual normal level is <50mcg/L); both urine spot test and 24h urine collection
- blood arsenic level not helpful (cleared within 2 hrs of exposure)
- ECG to eval for QT Prolongation in acute exposure
- CBC to eval for hemolysis
- BMP, Mg, phos, Ca, LFTs, CK, type and screen
- CXR if respiratory symptoms
Treatment
- supportive care, ABCs, IV, O2, monitor
- removal from exposure
- NO Charcoal - adsorbs poorly to arsenic
- consider Whole Bowel Irrigation if large radiopaque material in GI tract on xray
- airway management and mechanical ventilation if acute inhalation of arsine gas and resp distress
- IV fluids
- CHELATION therapy: if severe symptoms present
- Dimercaprol (BAL). 3-5 mg/kg IM Q4-6h
Disposition
- admit pt's with significant symptoms
- ED observation and discharge with follow-up for mildly symptomatic