Arsenic poisoning

Almost everyday people all over the world had affected or died because of poison. Arsenic poisoning is one of them. It's a big issue of Bangladesh, India, China as well as many other countries of the world. In Bangladesh around 50 million people being at risk of exposure. Lots of initiative program were taken to combat this disease in Bangladesh and the good news is now the rate of poisoning is very low.

1. Arsenic Poisoning 1 Presented by: MD. MOHABBOT HOSSEN B.Pharm (Hon’s) Dhaka International University

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3. Poison Poison is anything that kills or injures through its chemical actions. Most poisons are swallowed (ingested ). But poisons can also enter the body in other ways : Through the skin By IV injection From exposure to radiation Venom from a snake bite or insect bite By breathing 3

4. Symptoms of Poisoning Signs and symptoms of poisoning are so wide and variable that there is no easy way to classify them. Some poisons enlarge the pupils , while others dwindle them. Some result in excessive drooling , while others dry the mouth and skin. Some speed the heart , while others slow the heart. Some increase the breathing rate , while others slow it. Some cause pain , while others are painless. 4

5. How Is Poisoning Diagnosed? A combination of history, physical examination, and laboratory studies will help reveal the cause of most poisonings. History :  As a family member or friend of a poisoned person, you can greatly assist the doctor and provide valuable clues by telling the doctor about these details: Everything the person ate or drank recently. Names of all prescription and over-the-counter medications the person is taking. Exposure to chemicals at home or at work. Whether others in the family or at work have been similarly ill or exposed. Whether the person has any psychiatric history to suggest an intentional ingestion (suicide attempt). 5

6. CONTD.. Testing:  Many poisons can be detected in the blood or urine . A specific blood test will give serum levels of some drugs, including  phenytoin,   theophylline,   digoxin,   lithium and acetaminophen. Some drugs affect the electrical activity of the heart . An  electrocardiogram (ECG ) may reveal toxicity. Sometimes a person is unconscious for no obvious reason. A  CT scan  of the brain will help tell if there has been a structural change in the brain, such as a  stroke. 6

7. Background on Arsenic(As) According to the U.S. Agency for Toxic Substances and Disease Registry, arsenic is the number one most hazardous substances. Taste less, color less, and odor less. The lethal dose for humans is 125 mg. As is mostly excreted through urine, skin hair. 7

8. Major Forms of Arsenic Intoxication Acute Inorganic Arsenic Poisoning Chronic Inorganic Arsenic Poisoning Arsine Gas Poisoning 8

9. Acute Inorganic Arsenic Poisoning Exposure to high doses ( tens to hundreds of milligrams ) of soluble inorganic arsenic compounds. Pancytopenia usually develops within 1 week 9

10. DIAGNOSIS 10

11. TREATMENT Gut decontamination Intensive supportive care chelation with- Unithiol , 3–5 mg/kg, intravenously every 4–6 hours. or Dimercaprol , 3–5 mg/kg. Intramuscularly every 4–6 hours. 11

12. Chronic Inorganic Arsenic Poisoning Chronic absorption of more than 0.01 mg/kg/d ( ∼ 500–1000 mcg/d in adults ). Symptoms: fatigue weight loss weakness Anemia 12

13. CONTD.. Cancer of the lung, skin, bladder , and possibly other sites, may appear years after exposure to doses of arsenic that are not high enough to elicit other acute or chronic effects . Skin changes—among the most characteristic effects—typically develop after years of exposure 13

14. Diagnosis of Chronic Inorganic Arsenic Poisoning The urine concentration of the sum of inorganic arsenic and its primary metabolites MMA and DMA is less than 20 mcg/L in the general population. All seafood should be avoided for at least 3 days before submission of a urine sample for diagnostic purposes. The arsenic content of hair and nails (normally less than 1 ppm) may sometimes reveal past elevated exposure. 14

15. Management 15

16. Arsine Gas Poisoning 2 hours to 24 hours post inhalation, massive intravascular hemolysis may occur. Malaise Headache Dyspnea Weakness Nausea Vomiting Abdominal pain Jaundice Hemoglobinuria . Initial symptoms may include: 16

17. Treatment of Arsine Gas Poisoning Intensive supportive care including – Exchange transfusion Vigorous hydration Hemodialysis Currently available chelating agents have not been demonstrated to be of clinical value in arsine poisoning. 17

18. Where can we find Arsenic? Arsenic can be found all over the world both from- Human activities In the earth crust 18

19. How has Arsenic entered into the water sources? Release of As is due to dropping water levels in the river, for agriculture uses, allows for oxidation of the As. Another source is from the water running over As rich rocks into the wells. 19

20. Effects of Arsenic Poisoning Melanosis (darkening of the skin) Keratosis (growth of keratin on the skin) Dark spots on the chest, back, limbs, and gums Enlargement of the liver, kidneys, and spleen Short term Cancers of the skin, lung, or bladder. Blood vessel diseases in the legs and feet. Nephropathy and hepatopathy . Gangrene (death of tissues in part of the body ). Long term 20

21. EPA and WHO Standards EPA standard for arsenic in drinking water is 10 ppb, which replaced the old standard of 50 ppb in 2001. WHO has the standards of 0.01mg/L in drinking water for Europe and North America. The WHO standard for Bangladesh still stands at 0.05mg/L 21

22. Ground water & Arsenic Poisoning The excess amount of arsenic in drinking water has been reported from various parts of the world , such as Argentina, Bangladesh, Chile, China, Hungary, India, Mexico, Nepal, Taiwan , and USA . In Bangladesh However , in some areas, the arsenic contamination is found in the tube wells that were installed in greater depths. 22

23. Arsenic mitigation program in Bangladesh a countrywide screening for arsenic contamination in tube well water was initiated in 1996. The initial screening that concluded in 1999 had tested 51,000 tube wells , which revealed that arsenic contamination was present in 211 out of 460 upazillas . Subsequently, in 2003, a nationwide blanket survey was conducted by Bangladesh Arsenic Mitigation Water Supply Project (BAMWSP), covering 57,482 villages located in 271 upazillas , where it was reported that out of 4.95 million tubewells for arsenic contamination, 1.44 million tubewells were contaminated. In 2004, the government formulated National Policy for Arsenic Mitigation (NPAM) to confront the “groundwater arsenic problem,” on the basis of which Arsenic Policy Support Unit (APSU) and Implementation Plan for Arsenic Mitigation (IPAM) guided by a national committee were formed. 23

24. Wish you have a healthy life with a safe water THANK YOU 24

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26. Pancytopenia  is a medical condition in which there is a reduction in the number of red and white blood cells, as well as platelets . Delirium  is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment.  Encephalopathy  is a term that means brain disease, damage, or malfunction.  Encephalopathy  can present a very broad spectrum of symptoms that range from mild, such as some memory loss or subtle personality changes, to severe, such as dementia, seizures, coma, or death . Anuria  is when the kidneys stop producing urine monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA ) United States Environmental Protection Agency 26

27. Hemoglobinuria  is a condition in which the oxygen transport protein hemoglobin is found in abnormally high concentrations in the urine Malaise  is a feeling of general discomfort, uneasiness, or pain, often the first sign of an infection or other disease.  27

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