Arsenic Toxicity
How Should Patients Overexposed to Arsenic Be Treated and Managed?
Course: WB 1576
CE Original Date: October 1, 2009
CE Renewal Date: October 1, 2011
CE Expiration Date: October 1, 2013
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Learning Objectives |
Upon completion of this section, you will be able to
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Introduction |
Patients presenting to their primary care providers with a history of arsenic exposure will vary widely in their clinical condition.
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Treatment and Management–Acute Over Exposure |
Gut decontamination and hemodynamic stabilization are key factors in the initial management of acute arsenic intoxication. Patients with suspected acute arsenic poisoning generally require rapid stabilization with fluid and electrolyte replacement in an intensive care setting.
Chelating agents administered within hours of arsenic absorption may successfully prevent the full effects of arsenic toxicity. Dimercaprol (2, 3 dimercaptopropanol, also known as British anti Lewisite or BAL), was previously the most frequently recommended chelating agent for arsenic. The currently recommended treatment is 2-3-dimercapto-1-propanesulfonate (DMPS) or meso 2, 3-dimer-captosuccinic acid (DMSA). These are more water soluble than BAL, and can be administered orally with lower toxicity [Mazumder et. al. 2001]. All known chelating agents have adverse side effects and should be used with caution.
Data supporting duration of treatment are limited, and regimens may warrant adjustment. If acute renal insufficiency develops, hemodialysis may be of value. If the source of arsenic exposure has not been determined, the patient may be at risk for further arsenic intoxication. |
Treatment and Management –Chronic Over Exposure |
Identification and removal of the toxic source and supportive measures are primary concerns for the treatment of chronically exposed patients.
Patients demonstrating excessive exposure on urine testing or clinical effects of arsenic exposure, and whose source of exposure is unclear, may require environmental testing (such as of drinking water), attention to exposure from malicious intent, or workplace investigation. |
Clinical Follow-up |
After an intervention has been made, follow-up urine testing may be necessary to confirm a reduction in exposure, and follow-up clinical testing may be necessary to verify a resolution of clinical and lab test abnormalities. |
Occupational Over ExposureâEnsuring a Healthy Workplace |
Patients whose excessive arsenic exposure occurred in the workplace can be medically removed from exposure while remediation of the workplace is undertaken.
OSHAâs standard for arsenic also requires that medical examinations be provided for all employees exposed to levels of inorganic arsenic above the action level of 5 micrograms per meter cubed for at least 30 days per year. For more information on the OSHA standard for arsenic, see http://www.osha.gov/SLTC/arsenic/index.html |
Nutrition in Prevention |
Nutritional status may play a role in preventing arsenic health effects. For example, arsenic and selenium may be mutually antagonistic [Zeng et al. 2005]. There have been recent reports that a diet rich in selenium and other antioxidants (such as vitamin E) helps promote methylation of arsenic which leads to increased excretion [Verret et al. 2005; Rossman 2007; Son et al. 2008]. Methyl donors such as folate may also be of help in arsenic metabolism and excretion in humans [Rossman 2007]. Arsenic-induced disease has been shown to increase in individuals who are mal- or under-nourished, possibly due to the decrease in arsenic methylation [Hsueh et al. 1995; Mitra et al. 2004; Steinmaus et al. 2005]. |
Arsine Gas Poisoning |
Arsine gas poisoning requires careful monitoring of hematocrit/hemoglobin and renal function.
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Key Points |
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Progress Check |
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