ARSENIC POISONING

CLINICAL TOXICOLOGY

PRESENTED BY
ALBERT MATHEW
PHARMD 4TH YR
ARSENIC
 COMMON INSTANCES OF
ARSENIC POISONING

> Arsenic is more common in setting up

homicides
> It is occasionally used in deliberate self
poisoning.
> industrial exposure ,contaminated wines .
moonshine etc .
 Toxicity Levels
• Is available in two forms -
trivalent(ARSENITE ) and pentavalent
arsenic(ARSENATE). Acute poisoning will
occur at lower doses then the
pentavalent arsenic, because that
trivalent arsenic is 60 times more
poisonous than pentavalent arsenic.
• The pentavalent form of arsenic is less
toxic than trivalent arsenic because less
water solublity .
• arsine gas is the most toxic
form and the only one that causes
significant haemolysis. But does
not lead to long term toxic effect.

• Arsine gas (25 to 30ppm can be

lethal in 30 minutes.)

• 200 to 300 mg of arsenic trioxide

 DIAGNOSIS
• URNINE TEST : as arsenic ions will be
present very shortly after ingetion
• Urinary excretion of arsenic > 100mg /24
hours ---indicative of exposure to
potentially toxic amount of arsenic .
• Monomethyl arsine and dimethyl arsine
will be present in the urine . 24 hours after
ingestion – acute poisoning .
• Blood tests ,Liver function tests
,radiopaque tests.
MECHANISM OF ARSENIC POISONING
• arsenic bind to a a range of
sulphydryl containing proteins.
This proteins includes enzymes.
1) involved in oxidative metabolism -
leading to lactic acidosis, shock, multi
organ failure.
2) hemoglobin synthesis- leading to of
siderocytic anemia.
• 3) methionine synthetase - leading to
homocystenemia and atherosclerosis.
• Both clastogen and caricinogen .
CLINICAL PRESENTATIONS
• 1) acute Arsenic poisoning-
• symptoms will start in a few hours.
Local gastrointestinal effect including,

• Oropharyngeal Burns,
Dysphagia
Vomiting
Abdominal pain
Bloody diarrhoea
Multiple organ failure with shock acute renal
hepatic failure and encephalopathy may rapidly
lead to death .
 ARSINE GAS POISONING

• Along with this above symptoms.. seVERE

haemolysis leading to >hematuria.
> Facial skin burn.
> Hyperkalemia
> Dyspnea.
> Treatment is different from other Arsenic
poisoning utilising exchange transfusion
and dialysis.
 CHRONIC POISONING
• CHRONIC ARSENIC POISONING
Chronic exposure may lead to insidious
presentation, with
Peripheral sensorY motor neuropathy.
Dementia
Bone marrow depression
Myocarditis
Black foot disease
• lUNG and skin cancers

Skin changes include alopecia, pigmentation,

nail changes, hyperkeratosis
HYPERKERATOSIS
BLACK FOOT DISEASE
 TREATMENT
• 1) supportive measures.

• Gastric lavage with warm water or

freshlyprepared hydrated ferric oxide
solution.

• > intravenous fluids

> cardiac monitoring
 CHELATION THERAPY
• 2) chelation therapy:
This can be done with BAL - (britisH anti
lewisite ) or dimercaprol.(3-5mg /kg 4 hourly
deep IM for 2 days . Until urinary excretion
level dips below 50mcg in 24 hours . Duration
of therapy (7-10) days.
• DMSA (dimercaptosuccinic acid)
• ,DMPS (dimercaptopropanesulphonic acid)
oral penicillamines .-100mg /kg 6th hourly 5
days after initial 12-48 hr BAL Therapy .
Gastric lavage
• 3) antidotes :
chelating Agents are the antidote for
arsenic.
eg : SUCCIMER . Is an antidote that is a
choice for pAtients without life threatening
Arsenic poisoning. 10 mg/kg/dose (or 350
mg/m2/dose) every 8 hours for 5 days,
followed by 10 mg/kg/dose (or 350
mg/m2/dose) every 12 hours for 14 days;
Maximum: 500 mg/dose.
• BAL
D-penicillamine
DMPS
DMSA
• 4) hemodyalisis or exchange transfusions
.
 MOONSHINE
• Moonshine is any kind of alcohol, usually whisky or rum, that
is made in secret to avoid high taxes or outright bans on
alcoholic drinks. The term "moonshine" comes from Britain,
where it originally was a verb, "moo
• MOOnshining," that referred to any job or activity that was
done late at night. Because the operators of illegal whisky
stills had to conduct their business out of the sight of legal
authorities, these backwoods brewmasters became known
as moonshiners, and the term became exclusively theirs.
BLOOD TESTS FOR
ARSENIC
• Arsenic is not likely to
be detected in blood specimens
drawn more than 2 days after
exposure because it has become
integrated into nonvascular tissues.
Consequently, blood is not a good
specimen to screen for arsenic,
although
periodic blood levels can be
determined to follow the
effectiveness of therapy.
THANK YOU