Blood arsenic

A case report of acute arsine poisoning in which a 27-y-old man was exposed to arsine during chemical manufacturing was reported by Pinto (1976). The subject was exposed to arsine as a result of arsine production via a reaction between a galvanized bucket and an arsenic-containing sulfuric acid solution. The exposure (duration not specified) produced toxic effects characterized by abdominal cramping, thoracic discomfort, and hematuria. Over the next week, the patient s hematocrit declined from 42.5 to 27.1 and hemoglobin dropped from 14.1 to 9.5 g/dL even with medical intervention (blood transfusions and mannitol diuresis). Nine hours after exposure, blood arsenic was 159 g/dL and urinary arsenic was 1862 ug/L. 

Blood arsenic levels are also routinely evaluated but also lack exposure correlates and vary as to post-exposure assessment 0.6 mg/L (2 d post-exposure Hesdorffer et al. 1986), 0.66 mg/L, 0.25 mg/L, and 2.2 mg/L (1 d post-exposure, De Palma 1969). 

Hall, M Gamble, M Slavkovich, V. et al. (2007) Determinants of arsenic metabolism Blood arsenic metabolites, plasma folate, cobalamin, and homocysteine concentrations in maternal-newborn pairs. Environmental Health Perspectives, 115 (10), 1503-9. 

Blackfoot disease 255, 313, 333 bladder cancer 260 blood arsenic 243, 258 Bowen s disease 259 brain 245... 

Routledge PA, Bialas MC, Babar I, et al. 1998. Blood arsenic and chromium concentrations after dermal exposure to tannalysing fluid and the use of DMPs. J Toxicol Clin Toxicol 36(5) 494-495. 

Blood arsenic levels are highly variable. Blood arsenic, normally less than 1 Hg/dl, may be elevated on acute intoxication. It is probably the most important diagnostic test for detecting arsenic exposure. Arsenic metabolites (inorganic arsenic + MMA + DMA) in urine have also been used as biomarkers of recent arsenic exposure (Yamauchi et al, 1989). 

In acute exposure prompt medical attention is critical. The victim should be immediately removed to fresh air and away from the source of exposure. Oxygen should be provided if there is a respiratory distress. Initial therapy should be directed at stopping the ongoing hemolysis by performing exchange transfusion. Currently there is no other treatment to decrease arsine hemolysis however, studies in vitro have shown that some dithiol chelators (meso-2,3-dimercaptosuccinic acid, DMSA 2,3-dimercapto-l-propanesulfonic acid, DMPS and 2,3-butanedithiol) are effective (see Further Reading). This should be followed by aims to restore renal function or compensate for lost renal function (hemodialysis). This process does not remove any formed arsenic from the exposed body. Administration of dimercaprol (British Anti-Lewisite, BAL) has no effect on arsine hemolysis, but it lowers blood arsenic levels resulting from arsine exposure. The use of chelators must be... 

The majority of arsenic in blood is cleared with a half-time of about 1 hr. Concentrations of total arsenic in blood of people with no excess exposure to arsenic range from 0.3-2 pg/L (86,91,109,110). In populations exposed to higher concentrations of arsenic in drinking water and seafood, higher blood arsenic concentrations have been reported (Table 2). In people exposed to arsenic in drinking water (200 pg As/L) in northern Argentina, average blood arsenic con-... 

A. Specific leveis. Urine and whole-blood arsenic levels may be elevated, but are rarely available in time to assist with prompt diagnosis and management. Whole-blood arsenic concentrations in patients with severe arsine poisoning have ranged from several hundred to several thousand micrograms per liter. 

Blood arsenic, whether given as As+ or As" ", rapidly clears from humans, mice, rabbits, dogs, and primates half-life is 6 h for the fast phase and about 60 h for the slow phase. In rat, however, blood arsenic is mostly retained in erythrocytes, and clears slowly half-life is 60-90 days. In rats, the excretion of arsenic into bile is 40 times slower than in rabbits and up to 800 times slower than in dogs. Most researchers now agree that the rat is unsatisfactory for use in arsenic research. 

A toxicologist is tasked with testing two blood samples in a case of possible chronic arsenic poisoning. The first sample was taken a week before the second. The toxicologist anal5Tzed each sample five times and obfedned the data shown in the table below. Is there a statistically significant increase in the blood arsenic concentration Use a 95% confidence level. 

The answer is 3 [III B 4 c IV E 3 a V F 3 VIIIC 3J. Of the choices presented, only arsenic toxicosis is not readily confirmed by detection of high concentrations In the blood. Arsenic in domestic animals has a high affinity for many epithelial tissues and is excreted rapidly in the urine. Copper accumulates in erythrocytes just prior to and during the acute hemolytic crisis. Iron is transported in the blood bound to transferrin, and both bound iron and total iron increase as dosage Increases. Selenium is present in both erythrocytes and serum or plasma and responds quickly to dietary or parenteral dosing. Lead is primarily associated with erythrocytes and is consistently elevated in lead poisoning. 

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). 

Measurement of blood arsenic levels may be useful to assess the severity of poisoning, although such testing may take a considerable time to perform. 

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