Arsine renal failure

Arsine is extremely toxic and a potent hemolytic agent, ultimately causing death via renal failure. Numerous human case reports are available, but these reports lack definitive quantitative exposure data. The reports, however, affirm the extreme toxicity and latency period for the toxic effects of arsine in humans. 

Based upon the available data, derivation of AEGL-1 values was considered inappropriate. The continuum of arsine-induced toxicity does not appear to include effects consistent with the AEGL-1 definition. The available human and animal data affirm that there is a very narrow margin between exposures that result in little or no signs or symptoms of toxicity and those that result in lethality. The mechanism of arsine toxicity (hemolysis that results in renal failure and death), and the fact that toxicity in humans and animals has been reported at concentrations at or below odor detection levels (-0.5 parts per million (ppm)) also support such a conclusion. The use of analytical detection limits (0.01 to 0.05 ppm) was considered as a basis for AEGL-1 values but was considered to be inconsistent with the AEGL-1 definition. 

A case of oliguric renal failure following acute exposure to arsine was reported by Uldall et al. (1970). The concentration of arsine was not available,... 

Several reports identified nonlethal effects in humans acutely exposed to arsine. These reports, however, lacked definitive exposure data but verified hematologic disorders leading to renal failure as critical effects of arsine exposure. Bulmer et al. (1940) (as cited in Elkins 1959) reconstructed an exposure incident at a gold extraction facility and estimated that subchronic (up to 8 mon) exposure to 0.12 ppm arsine resulted in jaundice and anemia (see Section 2.2.1). The lack of definitive exposure data for humans necessitates the use of animal data for quantitative estimation of AEGL values. Derivation of AEGL-2 values based upon limited human data (Flury and Zernik 1931) was considered but rejected because the data were poorly documented and inconsistent with other data showing lethality at lower cumulative exposures. 

Reference The available human and animal data indicate that there is very little margin between seemingly inconsequential exposures and lethal exposures. The mechanism of arsine toxicity (hemolysis and subsequent renal failure) and the fact that toxicity has been demonstrated at or below the odor threshold justify the inappropriateness of AEGL-1 values for any exposure period. 

Arsine affects the ability of the blood system to carry oxygen by destroying red blood cells. The lack of oxygen rapidly affects all body tissues, especially the central nervous system. Arsine may also affect the kidneys, liver, and heart. Most deaths related to arsine exposure are believed to be secondary to acute renal failure. Arsine is carcinogenic. 

Highly toxic vapor. Symptoms, often latent for up to 2 days, include headache, vomiting, anorexia, numbness, abdominal cramping, chills, and nausea. Death results from renal failure and pulmonary edema (see Arsine).1,2 TLV-TWA 0.1 ppm (0.51 mg/m3).8... 

The symptoms of acute and chronic poisoning by arsenic have been described by Rentoul and Smith [10], Davidson and Henry [11] and Fowler [12]. Acute symptoms include gastrointestinal damage, convulsions and haemorrhage at autopsy, fatty degeneration of the liver and kidneys is frequently noted. Acute inhalation of arsine is followed by extensive haemolysis, haemoglobinuria and death from renal failure. 

Arsine poisoning can lead to acute renal tubular necrosis and ultimately to oliguric/anuric renal failure (Rogge et al, 1983). Renal failure can be attributed to (1) direct effect of arsine on renal tissue, (2) heme-pigment nephropathy, or... 

Effects of long-term exposure to low levels of arsine are not well documented however, most of the reported deaths are believed to be secondary to acute renal failure. Exposure to other arsenic compounds to which arsine is metabolized can induce lung, bladder, kidney, and skin cancer in humans (Kleinfeld, 1980 Lenza, 2006). 

Rogge, H., Fassbinder, W., Martin, H. (1983). Arsine (Ash3) poisoning - hemolysis and renal failure. Dtsch. Med. Wochenschr. 108 1720-5. 

Some agents such as arsine may trigger a severe hemolytic reaction, causing hemoglobinuria and subsequent acute renal failure. Others may lead to the destruction of striated muscle, and myoglobinuria... 

Renal Renal failure from hemolysis (arsine)... 

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). 

Arsine gas Arsine gas (AsH ) is formed during the refinement and processing of certain metals and is used in the semiconductor industry it is an occupational hazard. Arsine causes a unique form of toxicity characterized by massive hemolysis. Pigment overload from red cell breakdown may cause renal failure. Treatment is supportive. 

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