Arsenic acute

The "arsenic poison" referred to in true-crime dramas is actually the oxide of arsenic, As203, rather than the element itself. Less than 0.1 g of this white, slightly soluble powder can be fatal. The classic symptoms of acute arsenic poisoning involve various unpleasant gastroin-... 

Mathews, N.E. and W.F. Porter. 1989. Acute arsenic intoxication of a free-ranging white-tailed deer in New York. Jour. Wildl. Dis. 25 132-135. 

Nystrom, R.R. 1984. Cytological changes occurring in the liver of coturnix quail with an acute arsenic exposure. Drug Chem. Toxicol. 7 587-594. 

Some of the effects of acute arsenic intoxication are nausea, vomiting, diarrhea, and irritation inflammation and ulceration of the mucous membranes and skin and kidney damage. Among the effects of chronic arsenic poisoning are increased pigmentation and keratinization of the skin, dermatitis, and epidermoid carcinoma. Other effects seen after ingestion, but which are not common from industrial exposure, are muscular paralysis, visual dismrbances, and liver and kidney damage. ... 

The answer is A. This patient exhibits several signs of acute arsenic exposure, including the cholera-like gastrointestinal symptoms and probable dehydration. He may currently be in hypovolemic shock and beginning chelation therapy is the only recourse. Arsenic is a metabolic toxin because it inhibits enzymes that require lipoic acid as a coenzyme the PDH complex, the a-ketoglutarate dehydrogenase complex, and trans-ketolase of the pentose phosphate pathway. 

Succimer has also been effective in animal models and has a higher therapeutic index than dimercaprol. However, because it is available in the United States only for oral administration, its use may not be advisable in the initial treatment of acute arsenic poisoning, when severe gastroenteritis and splanchnic edema may limit absorption by this route. 

Treatment of acute arsenic poisoning includes removal from the exposure source, supportive measures for loss of fluids, and chelation therapy (Ibrahim et al., 2006). Chelators that can be used include dimercaprol or 2,3-dimercaptosuccinic acid. In cases of renal failure, hemodialysis should be considered. 

Arsenic has been implicated as a cause of arteriosclerosis. Blackfoot disease, a malady suffered in areas of Taiwan having high soil and water levels of arsenic, is a very severe form of arteriosclerosis. Dilation of arteries and capillaries is a symptom of acute arsenic poisoning. 

After initial contradictory reports it is now established that arsenic can cross the blood-brain barrier and produces alternations in whole rat brain biogenic amines levels in animals chronically exposed to arsenite (Tripathi et al, 1997). The neurological effects are many and varied. Usually, peripheral neuropathy, sensory neuropathy (Hafeman et al, 2005), and encephalopathy are the initial complaints associated with acute arsenic poisoning. Acute exposure to arsenic in humans has been shown to result in problems of memory, difficulties in concentration, mental confusion, and anxiety (Hall, 2002 Rodriguez et al, 2003). Other neurological symptoms arising due to arsenic are primarily those of a peripheral sensory neuritis, predominantly numbness, severe paresthesia of the distal portion of the extremities, diminished sense of touch, pain, heat and cold, and symmetrically reduced muscle power (Menkes, 1997). 

Liu, J., Kaduska, M., Liu, Y., Qu, W., Mason, R.P., Walker, M.P. (2000). Acute arsenic induced free radical production and oxidative stress related gene expression in mice. Toxicologists 54 280-1. 

Dimercaptopropane sulfonate is the treatment of choice for acute arsenic poisoning and has been used safely in high doses (15.25 g in 12 days, first intravenously and later orally) in a 21-year-old man who swallowed about 1000 mg or more of arsenic trioxide (1). There were no adverse effects. A modest transient increase in serum transaminases was thought to have been due to the arsenic. 

Hantson P, Haufroid V, Buchet JP, et al. Acute arsenic poisoning treated by intravenous dimercaptosuccinic acid (DMSA) and combined extrarenal epuration techniques. JTox/co/Clin Toxicol. 2003 41 1-6... 

Arsenic can cause acute and chronic poisoning. Acute arsenic poisoning may cause vomiting, dryness of the mouth and throat, muscle cramps, colicky abdominal pain, tingling of the hands and feet, circulatory disorders, and nervous weakness. Cold and clammy skin, hallucinations, delirium, and diarrhea appear. If death does not occur within 24 h, irreversible organ disorders oecur. 

Liu, J., Y. Liu, D.A. Powell, M.P. Waalkes and C.D. Klaassen. Multidrug-resistance mdrla/lb double knockout mice are more sensitive than wild type mice to acute arsenic toxicity, with higher arsenic accumulation in tissues. Toxicology 170 55-62, 2002. 

Moore DF, O Callaghan CA, Berlyne G et al. (1994). Acute arsenic poisoning after treatment with 2,3-dimercaptopropanesulphonate (DMOS). J Neurol Neurosurg Psychiat, 57, 1133-1135. 

Table 7-3 lists the psychiatric signs and symptoms attributed to arsenic poisoning. Acute arsenic poisoning may induce an encepha-... 

Arsenic poisoning is commonly an acute clinical syndrome, and death usually occurs rapidly. Clinical signs of acute arsenic toxicity include colicky pain, vomiting, diarrhea, marked depression, and der-... 

Heineich-Ramm R, Schaller KH, Horn J and Angeeee j (2003) Arsenic species excretion after dimercaptopropanesuffonic acid (DMPS) treatment of an acute arsenic trioxide poisoning. Arch Toxicol 77 63-68. 

Franzbiau, A., Lilis, R. (1989). Acute arsenic intoxication from environmenmtal arsenic exposure. Arch. Environ. Health 44, 385-390. 

Clinical use Dimercaprol is used in acute arsenic and mercury poisoning—and for lead poisoning when administered with edetate. It is an oily liquid that must be given parenterally. 

Acute arsenic poisoning Acute arsenic poisoning results in severe gastrointestinal discomfort, vomiting, ricewater stools, and capillary damage with dehydration and shock. A sweet, garlicky odor may be detected in the breath and the stools. Treatment consists of supportive therapy to replace water and electrolytes, and chelation therapy with dimercaprol. 

The treatment of choice in acute arsenic poisoning is intramuscular dimercaprol. While succimer is less toxic than dimercaprol, it is available only in an oral formulation and its absorption may be impaired due to the severe gastroenteritis that occurs in acute poisoning with arsenic. The answer is (B). 

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