Arsenic Poisoning: Not very Common But Treatable

Arsenic, a heavy metal, has been used for many years in agriculture, industry, and medicine.In some countries (e. g., Iran) arsenic compounds is used as an alternative for mechanical hair trimming. However, it acts as a poison in the settings of acute overdosage and chronic (usually occupational) exposure. They have been used as suicidal and homicidal poisons since the middle Ages. It also induces caustic injury because of its alkaline contents. Acute arsenic poisoning leads to usually pronounced gastrointestinal symptoms due to dilatation of splanchnic vessels resulting in submucosal vesicle formation. The patient develops nausea, vomiting, diarrhea (which may be bloody), and abdominal pain. A garlicky breath odor may be detectable. Delayed cardiomyopathy, acute tubular necrosis and hemolysis may develop; fatal rhabdomyolysis is reported after acute arsenic ingestion. Arsine gas causes severe hemolysis within 3 to 4 hours and can lead to acute tubular necrosis and renal failure. In chronic arsenic poisoning, the onset of symptoms comes at 2 to 8 weeks, typical findings are skin and nail changes, such as hyperkeratosis, hyperpigmentation, exfoliative dermatitis, and mee''s lines (transverse white striaes of fingernailbeds which become evident after 2-3 weeks of exposure), sensory and motor polyneuritis manifesting as numbness and tingling in a "stocking-glove" distribution, distal weakness, and quadriplegia, and inflammation of the respiratory mucosa. When acute arsenic poisoning is suspected, an x-ray film of the abdomen may reveal ingested arsenic. Serum (or blood) levels are detectable only during the first 2 to 4 hours after ingestion, after which arsenic (in any form) is not readily detectable in blood or serum. Urinary arsenic levels should be measured in 24-h specimens collected after 48 hours of abstinence from seafood ingestion. Treatment of acute arsenic poisoning is consisted of vomiting induction, gastric lavage, hydration with control of electrolyte balance, administration of Dimercaprol (BAL), and finally hemodialysis. For chronic intoxication, avoiding further exposure is only approved treatment.