Case Definition: Arsine or Stibine Poisoning

Clinical description

Inhalation of arsine gas causes no immediate symptoms. Signs and symptoms occur 2 to 24 hours after exposure and result from massive hemolysis. These signs and symptoms include generalized weakness, dark urine, jaundice, and dyspnea. Oliguria and renal failure often occur 1 to 3 days after exposure (1-3).

Laboratory criteria for diagnosis

• Biologic: No specific test is available for arsine exposure; however, exposure to arsine might be indicated by detection of elevated arsenic levels in urine (>50 µg/L for a spot or >50 µg for a 24-hour urine) and signs of hemolysis (e.g., hemoglobinuria, anemia, or low haptoglobin).
• Environmental: Detection of arsine in environmental samples, as determined by NIOSH.

Case classification

• Suspected: A case in which a potentially exposed person is being evaluated by health-care workers or public health officials for poisoning by a particular chemical agent, but no specific credible threat exists.
• Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for arsine exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
• Confirmed: A clinically compatible case in which laboratory tests have confirmed exposure.

The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or a 100% certainty of the etiology of the agent is known.

Additional resources

1. Fowler BA, Weissberg JB. Arsine poisoning. N Engl J Med 1974;291:1171-4.
2. Hatlelid KM, Brailsford C, Carter DE. Reactions of arsine with hemoglobin. J Toxicol Environ Health 1996;47:145-57.
3. Pinto SS. Arsine poisoning: evaluation of the acute phase. J Occup Med 1976;18: 633-5.