Health effects

Arsenic occurs in inorganic and organic forms.

Inorganic arsenic is metallic or a metalloid element that forms a number of poisonous
compounds. In industry, it can be found in a gaseous form termed arsine gas that is very toxic
when inhaled. Inorganic arsenic is found in nature at low levels mostly compounded with
oxygen, chlorine, and sulfur.
Organic arsenic is any compound that is made from a chemical combination of the element
arsenic with any organic compound (compounds containing a large amount of carbon). These are
often termed arsenical organic compounds.

The organs of the body that are usually affected by arsenic poisoning are the lungs, skin, kidneys,
and liver. The final result of arsenic poisoning is coma and death.

Symptoms:

Symptoms of arsenic poisoning begin with headaches, confusion, severe diarrhea,

and drowsiness. As the poisoning develops, convulsions and changes in fingernail pigmentation
called leukonychia striata (Mees's lines, or Aldrich-Mees's lines) may occur. When the poisoning
becomes acute, symptoms may include diarrhea, vomiting, vomiting blood, blood in the
urine, cramping muscles, hair loss, stomach pain, and more convulsions.

Other Effects:
The first symptoms of long-term exposure to high levels of inorganic arsenic are usually
observed in the skin, and include pigmentation changes, skin lesions and hard patches on the
palms and soles of the feet (hyperkeratosis). These occur after a minimum exposure of
approximately five years and may be a precursor to skin cancer.
In addition to skin cancer, long-term exposure to arsenic may also cause cancers of the bladder
and lungs. Other adverse health effects that may be associated with long-term ingestion of
inorganic arsenic include developmental effects, neurotoxicity, diabetes, pulmonary disease and
cardiovascular disease. In China, arsenic exposure has been linked to blackfoot disease, which

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is a severe disease of blood vessels leading to gangrene. Arsenic is also associated with infant
mortality, with impacts on child health.
Treatment:
Acute toxic inorganic arsenic exposure and arsine gas exposure can rapidly result in death, and
there are only a few ways to possibly save the patient's life.

Hemodialysis can remove arsenic from the bloodstream, but only before it binds to the tissues so
there is only a short time window for this treatment to work. Similarly, arsine binds to and causes
rapid destruction of red blood cells, so blood transfusions and exchange transfusions may help
the patient. In addition, if the arsenic was ingested, stomach or bowel irrigation may be
attempted, but there is no good data to indicate these will be successful. Consultation with a
nephrologist and a toxicologist as soon as possible is recommended.

Chelation therapy (the use of drugs that selectively bind and effectively inactivate substances) is
usually begun quickly through an intravenous line. The drug and the bound arsenic is then
excreted through the urine. The chelation drug of choice is Dimercaprol (also termed BAL in
oil); Succimer (DMSA) has also been used successfully, and Dimerval (DMPS) may also work
as a chelator.

Management:

Management of acute arsenic poisoning

Remove the patient from the source of arsenic; if there is skin contamination, wash with
copious water; seal contaminated clothing.

Gastric lavage: consider if a significant amount has been ingested <1 hour previously and
the patient has not vomited, or if plain X-ray indicates arsenic present in the stomach.
Arsenic is absorbed primarily from the small and large intestine and rarely from the
stomach. (Activated charcoal is unlikely to be of benefit - it does not absorb arsenic.)

Whole bowel irrigation with polyethylene glycol may be used to prevent arsenic
absorption.

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 Surgical and endoscopic removal of arsenic has been used successfully.

Supportive treatment:

Oxygen; bronchodilators if there is bronchospasm; positive end-expiratory

pressure (PEEP) for pulmonary oedema.

Intravenous fluids for hypovolaemia; blood transfusion for GI haemorrhage.

Inotropes for myocardial depression.

Treat seizures (diazepam, lorazepam +/- phenytoin).

Analgesia.

Bone marrow suppression: red cell and/or platelet transfusions.

Burns (from skin contamination) are treated conventionally.

Eye contact: treat as for a chemical eye burn.

Chelation Therapy

Management of chronic arsenic poisoning

Provide arsenic-free drinking water, to reduce the risk of further disease developing.
Anecdotal evidence suggests that mild-moderate keratoses may improve with cessation of
exposure.

Chelation therapy may have a role but its effectiveness is uncertain. Also, it is of no use if
exposure to arsenic continues.

Micronutrients and antioxidants may be beneficial, especially in undernourished

populations. It is recommended that all patients with skin lesions be given multivitamins.

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 Certain plant compounds may help to remove arsenic from tissues.

Skin care for keratoses and any associated bacterial or fungal infections.

Screen and treat for complications - eg, diabetes, hypertension.

Other household members:

Check other members of the family, as they may also have been exposed.

http://patient.info/doctor/arsenic-poisoning

https://en.wikipedia.org/wiki/Arsenic_poisoning

http://www.medicinenet.com/arsenic_poisoning/page5.htm

http://www.medicinenet.com/arsenic_poisoning/page3.htm#what_is_inorganic_arsenic

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