Arsenic poisoning

1. Dr. Badar Uddin Umar
MBBS, M.Phil (Pharmacology)
ARSENIC POISONING

2. PROPERTIES OF ARSENIC (AS)
It is a heavy metallic inorganic irritant poison
Inorganic arsenic compounds are poisonous:
Arsenic trioxide, sodium arsenite, arsenic sulphide,
copperarsenite, etc.
Metallic arsenic is non poisonous if ingested
because it is not absorbed

3. MECHANISM OF ACTION
Arsenic ion binds with sulphydryl group (-SH) of
enzymes in the liver, lungs, intestinal walls,
spleen
It replaces phosphorus in bones where it may
remain for years
It also gets deposited in the hairs

4. SIGNS & SYMPTOMS
Arsenic poisoning clinically manifests in three
forms -
1.ACUTE FULMINATING TYPE:
•Symptoms occur within half an hour when
heavy dose (3-5 gm) is taken
•Acts on sulphhydryl groups of enzymes and
capillaries inhibiting cellular metabolism and
causing marked dilation of capillaries and
myocardial failure resulting in shock and
death

5. Purging precedes vomiting
Stools are rice water
throughout and passed as
involuntary jet
No pain in the throat
Voice rough & whistling
Conjunctiva is normal
Vomitus is watery
Vomiting precedes purging
Stools are rice water
initially and later turn
bloodstained
Pain in the throat
Voice remains unaffected
Conjunctiva is inflamed
Vomitus contains mucus,
bile and streaks of blood
2.SUB ACUTE TYPE( GASTROENTERITIS TYPE):
Arsenic poisoning Cholera
•When small doses of arsenic are given at repeated intervals
•Resembles case of cholera or food poisoning

6. 3. CHRONIC TYPE:
Gastrointestinal: presents with gradual weight loss,
malnutrition, fatigue, loss of appetite
Catarrhal changes: presents with running nose,
headache, conjunctivitis, bronchial catarrh
Raindrop pigmentation: known to produce milk & roses
complexion initially, followed by patchy brown
pigmentation of the skin (especially forehead, neck,
shoulders)
Presents with a sequence of 5 different set of manifestations

7. It might also show hyperkeratosis of the skin of
palms and soles
Mees lines: whitish lines 1-2 mm breadth across the
nails of fingers and toes
Arsenical neuritis: polyneuritis, optic neuritis,
paresthesias, atrophy of extensors resulting in wrist
and foot drop
Diagnosis: urinary As level of > 100 mg/24 hrs.
Blood levels are not reliable
3. CHRONIC TYPE:

8. TREATMENT
Butter and greasy substances act as demulcents
Gastric lavage with warm water or freshly prepared
hydrated ferric oxide solution
Hemodialysis is the line of choice in massive arsenic
poisoning
BAL is the specific antidote. (3 – 5 mg/kg 4 hourly deep
IM for 2 days followed by 2 – 3 mg/kg 6 hourly for 2
days and then every 12 hours for 7 days)
DMSA, Penicillamine can also be used
Symptomatic therapy
Inj. Vitamin B
1
helps in peripheral neuritis

9. POSTMORTEM FINDINGS
Stomach: velvety red or brownish, patchy areas
with ulceration. Gastric contents emit garlicky odor
Heart: subendocardial haemorrhage
Other viscera: fatty degeneration of liver, kidney &
heart
Brain may show inflammation with haemorrhagic
spots

10. MEDICOLEGAL IMPORTANCE
It was considered as an ideal homicidal poison as it
was-
Cheap
Easy to obtain
Could be easily mixed and given
Symptoms were similar to cholera
Accidental poisoning with those who consume for its
aphrodisiac effects
Accidental poisoning with contaminated tube well
water is common in Asia