Arsenic poisoning

CLINICAL TOXICOLOGY ARSENIC POISONING

1. ARSENIC POISONING Clinical toxicology Pharm.D (IV/VI)

2. INTRODUCTION : It is a silver grey ,tin white shiny ;brittle crystalline and metallic looking element . TOXICITY LEVELS : Trivalent arsenate >>Pentavalent arsenate (Most toxic ) (less toxic ) less water soluble Arsenic gas ↔most toxic gas → hemolysis 200 -300 mg for ArO3 Most toxic form of arsine gas 25-30ppm lethal in 30 min .

3. MECHANISM OF ACTION : Ar binds sulphydryl containing proteins +enzyme in oxidative phosphoryaltion ↓leads to Lacto acidosis ,shock ,multiple organ failure Hb synthesis →siderocytic anemia Meth amine synthetase →chromocystei n anemia ,atherosclerosis Inhibition of metabolic pathways Ar also a clastogen ,human carcinogen .

4. CLINICAL(TOXIC) SYMPTOMS ACUTE POSINONING ARSINE GAS POSINONING CHRONIC Ar POSINONING ONSET OF SYMPTOMS BESIDES SYMPTOMS OBSERVED Dementia LOCAL GI EFFECTS +Severe hemolysis leads to Bone marrow depression Dysphasia haematuria Myelodysplasia Vomiting Abdominal pain Mycocarditis ARDS renal failure Black foot disease Acute renal failure Hyperkalemia Lung cancer Encephalopathy dysponea Alopecia

5. DIAGNOSIS : Hematology : CBC → early onset hemolysis . BIOCHEMISTRY : hepatic and renal toxicity lactic acidosis ECG : arrhythmias ,QT prolonged seen. Imaging abdominal x-ray : Identify Ar in GI tract. Hair level : Important diagnostic criterion .

6. MANAGEMENT : Supportive measures 1.gastric lavage 2.cardiac monitoring 3.IV fluids Chelation therapy: BAL /Dimercaprol Antidotes Haemodialysis/exchange transfusion