Arsenic toxicity: Difference between revisions
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==Background== | |||
*infamous historical poison | *infamous historical poison | ||
*heavy metal | *heavy metal | ||
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*ingestion fatal dose: 100-200mg | *ingestion fatal dose: 100-200mg | ||
==Clinical Features== | |||
#Acute ingestion | #Acute ingestion | ||
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*CNS depression | *CNS depression | ||
==Workup== | |||
*urine arsenic level (usual normal level is <50mcg/L); both urine spot test and 24h urine collection | *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) | *blood arsenic level not helpful (cleared within 2 hrs of exposure) | ||
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*CXR if respiratory symptoms | *CXR if respiratory symptoms | ||
==Treatment== | |||
*supportive care, ABCs, IV, O2, monitor | *supportive care, ABCs, IV, O2, monitor | ||
*removal from exposure | *removal from exposure | ||
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#Dimercaprol (BAL). 3-5 mg/kg IM Q4-6h | #Dimercaprol (BAL). 3-5 mg/kg IM Q4-6h | ||
==Disposition== | |||
*admit pt's with significant symptoms | *admit pt's with significant symptoms | ||
*ED observation and discharge with follow-up for mildly symptomatic pts | *ED observation and discharge with follow-up for mildly symptomatic pts | ||
==Sources== | |||
Harwood-Nuss, EMedicine | Harwood-Nuss, EMedicine | ||
[[Category:Tox]] | [[Category:Tox]] | ||
Revision as of 06:33, 3 December 2013
Background
- infamous historical poison
- 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
- pulmonary edema
- shock
- rhabdomyolysis
- sz
- coma
- death
- cardiovascular instability
- Arsine gas exposure: hemolysis causing abdominal pain, hematuria, jaundice
2. Subacute or chronic poisoning
- anemia
- sensory motor neuropathy
- skin changes
- ataxia
- CNS depression
Workup
- 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 pts
Sources
Harwood-Nuss, EMedicine