Arsenic exposure/poisoning

Choprapawon, C. and A. Rodcline. 1997. Chronic arsenic poisoning in Ronpibool Nakhon Sri Thammarat, the southern province of Thailand. Pages 69-77 in C.O. Abernathy, R. Calderon, and W.R. Chappell (eds.). Arsenic. Exposure and Health Effects. Chapman Hall, London. 

The symptoms observed in the affected areas of southwest Guizhou Province (Zhou et al, 1993) have all the classic hallmarks of chronic arsenic exposure. The visible features start with an erythematous flush (Fig. 17.4A) which is quite noticeable in this cohort, as freckles are not a common feature in Asian populations. Various degrees of skin lesions, hyperpigmentation, keratosis, and hyperkeratosis (Fig. 17.4B), leading to some probable skin cancers (Fig. 17.4C) were observed. The most common feature observed is keratosis of the hands (Fig. 17.4D). Cancer and severe skin lesions have lessened dramatically in the last 20 years, due to the intervention by local public health officials and the recognition of the etiology of the arsenic poisoning disease. 

Bone marrow depression, anemia, leukopenia, and basophilic stippling are associated with chronic arsenic exposure. Arsine (AsHj) poisoning can produce widespread hemolysis. Cirrhosis, ascites, and destruction of renal tissues have been reported. Arsine exposure may also cause renal failure (Forth et al. 1996). 

AH Welch, DB Westjohn, DR Helsel, RB Wanty. Arsenic in groundwater of the United States Occurrence and geochemistry. Ground Water 38 589-604, 2000. C Choprapawon, A Rodchne. Chronic arsenic poisoning in Ronpibool Nakhon Sri Thammarat, the Southern Province of Thailand. In CO Abernathy, RL Calderon, WR Chappell, eds. Arsenic Exposure and Health Effects. London Chapman HaU, 1997, pp 69-77. 

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Blood arsenic levels are highly variable. Blood arsenic, normally less than Igg/dL, may be elevated on acute intoxication. It is probably the most important diagnostic test for detecting arsenic exposure. Arsenic metabolites (inorganic arsenic -I- MMA -i- DMA) in urine have also been used as biomarkers of recent arsenic exposure (Yamauchi et al., 1989). A recent study by Yoshimura et al. (2011) showed that acute arsenic poisoning can also be confirmed by speciation analysis of arsenic compoxmds in the plasma and urine by HPLC-ICP-MS. Multiple blood purification methods can also be used as a combined treatment for acute arsine poisoning (Wu et al., 2010). 

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