Acute arsenic poisoning (AAP) can present with a number of features. Exposure to non-lethal amounts, less than 5 milligrams, leads to vomiting and diarrhea, which spontaneously resolve after a few hours [1]. The lethal dose is exposure to more than 100 milligrams.

Poisoning can occur through accidental ingestion of contaminated water, alcohol, produce that has been treated with certain pesticides, and herbal medicines. Occupational exposure in industries that handle metals, paint, glass, and ceramics can also result in arsenic poisoning [2] [3]. Arsenic can be ingested, inhaled or absorbed through the skin.

More severe gastrointestinal (GI) manifestations of AAP include abdominal pain, which is usually colicky, but may also appear as an acute abdomen, and passage of large volumes of watery diarrhea with blood. This may lead to severe dehydration, hypovolemia, and death. It is often described as bloody rice water as it is similar to cholera rice water stools. Hyper-salivation may be the only GI symptom in some cases [4]. Systematic examination may show inflammation of the esophagus and stomach [5].

Neurological symptoms include acute psychosis and seizures, encephalopathy, and peripheral neuropathy [4]. The latter has been reported to last up to 2 years after the poisoning episode.

The cardiovascular effects of AAP are cardiomyopathy, arrhythmias and ECG changes. Pulmonary system effects may manifest as adult respiratory distress syndrome, pulmonary edema, or respiratory failure.

AAP can lead to several hematological ailments that are exemplified by bone marrow suppression leading to normocytic anemia or pancytopenia, disseminated intravascular coagulation (DIC), and leukocyte abnormalities. Hemoglobinuria, hematuria as well as the excretion of arsenic in urine, are both features of AAP. Other systemic signs of AAP are the presence of a garlic odor, caustic burns, dysphagia, gangrene, rash, acute renal failure, liver failure, and metabolic acidosis [5] [6].

• Anemia

  Results may show microcytic or hemolytic anemia. Blood arsenic levels: This may show elevated levels of arsenic, however, patients are often already started on treatment by the time results are available. [symptoma.com]

  frequent infections (leukopenia) and easy bruising / petechia (thrombocytopenia) Anemia and leukopenia are common in chronic arsenic toxicity, are often accompanied by thrombocytopenia and mild eosinophilia Chronic arsenic exposure may be associated [pathologyoutlines.com]

  Other symptoms include breakdown of the hemoglobin of red blood cells (hemolysis), a low level of iron in the red blood cells (anemia), and low blood pressure (hypotension). [rarediseases.org]

  Acute lung injury (ALI), acute respiratory distress syndrome (ARDS), frank respiratory failure, hepatitis, hemolytic anemia, and renal failure have all been reported. [calpoison.org]

  Non-specific features: Loss of appetite, nausea, vomiting, jaundice, weight loss and anemia Specific features: Hyperkeratosis of palms and soles Rain drop pigmentation of general skin surface with patches of leukoplakia Loss of hair Transverse white “ [medchrome.com]

• Fever

  Overexposure may cause fatigue, headaches, nausea, vomiting, abdominal cramps, diarrhea, and fever. [rarediseases.org]

  You can find the following article here, referring to the new book ‘ Bitten by Witch Fever ‘ by Lucinda Hawksley. Slightly over a century ago, poison was a common part of everyday life. [mmoedlinger.eu]

  Morris dismissed the concerns of the medical profession and the press, saying, “the doctors were being bitten by witch fever.” [triggered.edina.clockss.org]

  He developed jaundice, fever (38.6°C), diarrhoea and mental confusion. [casesjournal.biomedcentral.com]

  Hata returned to Japan to become a renowned laboratory bacteriologist who continued his work in using arsphenamine against syphilis, rat bite fever and other diseases. [jmvh.org]

• Gastric Lavage

  Treatment for acute arsenic poisoning 34 1 Remove ingested arsenic by gastric lavage or emesis and follow with a saline cathartic. 2 Antidote: give Dimercaprol for two days then Penicillamine. [ihcworld.com]

  Lavage 1% sodium thiosulphate in water is helpful  Demulcent such as ghee and barley water are given.  Purgatives like Castor oil and magnesium sulphate is administered to diminish intestinal absorption of arsenic 20.  British anti lewisite (B.A.L [slideshare.net]

  Gastric lavage: consider if a significant amount has been ingested Whole bowel irrigation with polyethylene glycol may be used to prevent arsenic absorption. [patient.info]

• Acutely Ill Patient

  Haematology, biochemistry and arterial blood gases - as for any acutely ill patient. Urinalysis. ECG. Arsenic levels in blood and urine (see box below for normal levels). CXR and plain abdominal X-ray (inorganic arsenic compounds are radio-opaque). [patient.info]

• Rigor

  ◦ Emaciated body d/t dehydration ◦ Rigor mortis lasts longer ◦ Blood tinged vomitus and faecal matter ◦ Mucus membrane of small intestine are inflamed ◦ Stomach red velvety appearance ◦ Liver, heart and kidney: congested, enlarged, swelling and fatty [slideshare.net]

• Vomiting

  Exposure to non-lethal amounts, less than 5 milligrams, leads to vomiting and diarrhea, which spontaneously resolve after a few hours. The lethal dose is exposure to more than 100 milligrams. [symptoma.com]

  Trait Arsenic poisoning Cholera 1.Pain in throat Before vomiting After vomiting 2.Purging Follows vomiting Precedes vomiting 3.StoolsLike Bloody later rice-water in early stage, Rice-watery and pass in continuous involuntary jet 4.Tenesmus Present Absent [slideshare.net]

  THALLIUM POISONING Symptoms associated with thallium poisoning include extreme drowsiness (somnolence), nausea, vomiting, abdominal pain, and bloody vomiting (hematemesis). [rarediseases.org]

  Course of the disease Severe abdominal pain, cramps, blood circulation, severe diarrhea and vomiting begin after the adoption of a human poison. Water-salt balance is disrupted; the body loses a lot of protein. [medical-enc.com]

  Exposure to arsine causes burning and stinging of the face and after 3-4 hours tightness of the chest, dysphagia, nausea, vomiting, diarrhoea and ventricular arrhythmia's. [ihcworld.com]

• Diarrhea

  Exposure to non-lethal amounts, less than 5 milligrams, leads to vomiting and diarrhea, which spontaneously resolve after a few hours. The lethal dose is exposure to more than 100 milligrams. [symptoma.com]

  Acute arsenic poisoning leads to nausea and vomiting, developing into massive intestinal tract inflammation with diarrhea two hours later. [dmsachelation.com]

  Acute poisoning is manifested by abdominal pain, diarrhea and dehydration. [medical-dictionary.thefreedictionary.com]

  Overexposure may cause fatigue, headaches, nausea, vomiting, abdominal cramps, diarrhea, and fever. [rarediseases.org]

  Course of the disease Severe abdominal pain, cramps, blood circulation, severe diarrhea and vomiting begin after the adoption of a human poison. Water-salt balance is disrupted; the body loses a lot of protein. [medical-enc.com]

• Nausea

  Exposure to arsine causes burning and stinging of the face and after 3-4 hours tightness of the chest, dysphagia, nausea, vomiting, diarrhoea and ventricular arrhythmia's. [ihcworld.com]

  Overexposure may cause fatigue, headaches, nausea, vomiting, abdominal cramps, diarrhea, and fever. [rarediseases.org]

  Acute arsenic poisoning is associated initially with nausea, vomiting, abdominal pain, and severe diarrhoea. Encephalopathy and peripheral neuropathy are reported. Chronic arsenic toxicity results in multisystem disease. [ncbi.nlm.nih.gov]

  Small amounts absorbed over a period of time may result in chronic poisoning, producing nausea, headache, coloration and scaling of the skin, hyperkeratoses, anorexia, and white lines across the fingernails. [medical-dictionary.thefreedictionary.com]

  Symptoms of acute poisoning from swallowing arsenic include nausea, vomiting, burning of the mouth and throat, and severe abdominal pains. Circulatory collapse may occur and be followed by death within a few hours. [britannica.com]

• Abdominal Pain

  More severe gastrointestinal (GI) manifestations of AAP include abdominal pain, which is usually colicky, but may also appear as an acute abdomen, and passage of large volumes of watery diarrhea with blood. [symptoma.com]

  Additional symptoms may include fever, headaches, fatigue, sluggishness (letheragy), vomiting, loss of appetite (anorexia), abdominal pain, constipation, joint pain, loss of recently acquired skills, incoordination, listlessness, difficulty sleeping [rarediseases.org]

  Acute arsenic poisoning is associated initially with nausea, vomiting, abdominal pain, and severe diarrhoea. Encephalopathy and peripheral neuropathy are reported. Chronic arsenic toxicity results in multisystem disease. [ncbi.nlm.nih.gov]

  Acute poisoning is manifested by abdominal pain, diarrhea and dehydration. [medical-dictionary.thefreedictionary.com]

  Symptoms of acute poisoning from swallowing arsenic include nausea, vomiting, burning of the mouth and throat, and severe abdominal pains. Circulatory collapse may occur and be followed by death within a few hours. [britannica.com]

• Dysphagia

  Other systemic signs of AAP are the presence of a garlic odor, caustic burns, dysphagia, gangrene, rash, acute renal failure, liver failure, and metabolic acidosis. [symptoma.com]

  Exposure to arsine causes burning and stinging of the face and after 3-4 hours tightness of the chest, dysphagia, nausea, vomiting, diarrhoea and ventricular arrhythmia's. [ihcworld.com]

  Clinical findings Vague gastrointestinal (nausea, vomiting) and neurologic (apprehension and shortness of breath) symptoms, and a classic sign—“garlic” breath—followed by dysphagia, tachycardia, severe abdominal pain and bloody diarrhoea, then by renal [medical-dictionary.thefreedictionary.com]

   Patient experience a  Metallic taste,  Garlicky odour in the breath  Xerostomia  Dysphagia.  Increased salivation  Excessive thirst.  Severe nausea  Vomiting.  Colicky abdominal pain and  Profuse diarrhoea.  The stool are dark coloured [slideshare.net]

  Trivalent arsenic is corrosive - may cause oral burns, dysphagia and GI bleeding. Cardiovascular: Myocardial depression. Dehydration, hypovolaemia or shock. [patient.info]

• Jaundice

   The other symptoms produced as a result of poisoning are  Jaundice,  Dark red urine,  Renal failure,  Heart failure,  Delirium and  Coma.  Death usually instantaneous. 17.  Urine: proteinuria, cast and albuminuria are there.  Arsenic poisoning [slideshare.net]

  Manifestations are suggestive of a general toxic state with alterations of consciousness, from confusion until delirium, crash, hematuria, jaundice and renal insufficiency. [pathopedia-india.com]

  Jaundice, hepatomegaly; development of portal fibrosis and cirrhosis. Cardiac/respiratory: [ 12, 13 ] Coronary heart disease, increased further in those who also smoke. Myocarditis, pericarditis. Hypertension. Peripheral arterial disease. [patient.info]

  […] breakdown of the hemoglobin of red blood cells (hemolysis); irregular heart rhythms (ventricular arrhythmias); coma; seizures; bleeding within the intestines (intestinal hemorrhage); and yellowing of the skin, mucous membranes, and whites of the eyes (jaundice [rarediseases.org]

  Non-specific features: Loss of appetite, nausea, vomiting, jaundice, weight loss and anemia Specific features: Hyperkeratosis of palms and soles Rain drop pigmentation of general skin surface with patches of leukoplakia Loss of hair Transverse white “ [medchrome.com]

• Tachycardia

  In the cardiovascular system there may emerge clinical situations ranging from sinus tachycardia to orthostatic hypotension and even to shock. [omicsonline.org]

  Clinical findings Vague gastrointestinal (nausea, vomiting) and neurologic (apprehension and shortness of breath) symptoms, and a classic sign—“garlic” breath—followed by dysphagia, tachycardia, severe abdominal pain and bloody diarrhoea, then by renal [medical-dictionary.thefreedictionary.com]

  […] raise urinary arsenic): >50mg/day Arsenic in hair and nails Abnormal LFTs Hematology: Anemia, Leukocytosis Urine: Hematuria, Proteinuria ECG: QRS complex broadening, QT prolongation, ST-segment depression, T wave flattening and multifocal ventricular tachycardia [medchrome.com]

  ECG changes including ST-segment changes, prolonged QT interval, ventricular tachycardia, torsades de pointes and ventricular fibrillation. Gangrene of extremities. [patient.info]

  In some cases, affected individuals may exhibit increased salivation; yellowing of the teeth; an unusually rapid heart beat (tachycardia); low levels of iron within the red blood cells (anemia); bluish discoloration (cyanosis) of the skin and mucous membranes [rarediseases.org]

• Hypotension

  The majority of patients suffer from gastroenteritis together with medium-level hypotension resistant to antiemetic and fluid therapy. [omicsonline.org]

  Other symptoms include breakdown of the hemoglobin of red blood cells (hemolysis), a low level of iron in the red blood cells (anemia), and low blood pressure (hypotension). [rarediseases.org]

  Cardiovascular dysfunction including sinus tachycardia, hypotension, and shock has been reported. [calpoison.org]

  […] toxicity: gastrointestinal symptoms: abdominal pain, vomiting, diarrhea, and hemorrhagic gastroenteritis arising from transmural mucosal inflammation that may be accompanied by hepatic necrosis. vascular endothelial injury: capillary leak, pulmonary edema, hypotension [triggered.edina.clockss.org]

  It can be absorbed through the skin and forms M-1 oxide (chlorovinylarsineoxide or Lewisite oxide) which causes systemic poisoning with diarrhoea, nausea, vomiting, and hypotension (“Lewisite shock”). [jmvh.org]

• Orthostatic Hypotension

  In the cardiovascular system there may emerge clinical situations ranging from sinus tachycardia to orthostatic hypotension and even to shock. [omicsonline.org]

• Alopecia

  Also, exfoliative dermatitis, alopecia, conjunctivitis, corneal ulceration. GI: Anorexia, weight loss, abdominal pain, diarrhoea. Jaundice, hepatomegaly; development of portal fibrosis and cirrhosis. [patient.info]

  Overexposure to selenium may cause irritation of the respiratory system, gastrointestinal tract, and eyes; inflammation of the liver; loss of hair (alopecia); loss of skin color (depigmentation); and peripheral nerve damage. [rarediseases.org]

  ARDS, renal and hepatic failure Bone marrow suppression develops over 24 – 72 hours reaching a nadir in 2 – 3 weeks and alopecia. [lifeinthefastlane.com]

  ◦ Hair are dry patchy and diffuse alopecia. ◦ Painless perforation in the nasal septum. 30.  that look much like traumatic injuries are found on the fingernails. 31. ◦ Peripheral neuritis with glove and stocking type of anaesthesia resembling alcoholism [slideshare.net]

  Patchy alopecia, desquamation, herpetiform lesions and diaphoresis and edema of the face may similarly occur. Chronic arsenic poisoning is somewhat more insidious and occurs most frequently from environmental or occupational exposures. [calpoison.org]

• Hyperpigmentation

  Skin lesions : Hyperpigmentation, hyperkeratosis and cancer / Chien-Jen Chen -- ch. 4. Arsenics and urothelial carcinoma / Chung-Hsin Chen and Yeong-Shiau Pu -- ch. 5. Arsenic exposure and lung cancer / Chi-Ling Chen -- ch. 6. [books.google.com]

  Hyperpigmentation on pressure points and acral surfaces can also be seen in Addison’s disease. [clinicaladvisor.com]

  Mees' lines (transverse white lines on nails). [ 6 ] Hyperpigmentation (especially on the arms and upper chest) - diffuse dark areas or 'raindrop' pigmentation. Also, exfoliative dermatitis, alopecia, conjunctivitis, corneal ulceration. [patient.info]

  Skin and nail symptoms include hardened patches of skin (hyperkeratosis) with unusually deep creases on the palms of the hands and the soles of the feet, unusual darkening of certain areas of the skin (hyperpigmentation), transverse white bands on the [rarediseases.org]

  Hyperpigmentation and hyperkeratosis of the skin—particularly on the palms and soles of the feet—is common. 5,7 “Black foot disease” (gangrene of the feet), renal damage and cirrhosis of the liver have also been reported. 5,7 Long-term exposure can cause [reviewofoptometry.com]

• Cold, Clammy Skin

  Gastric sign are usually absent Cyanosis, cold clammy skin, Hypoxic encephalopathy, convulsion, Acute tubular necrosis and renal failure Hyperpyrexia and acute haemolysis Acute hepatic failure, cirrhosis, ascitis, Cardiomyopathy, subendocardial [slideshare.net]

• Hematuria

  Hemoglobinuria, hematuria as well as the excretion of arsenic in urine, are both features of AAP. [symptoma.com]

  Manifestations are suggestive of a general toxic state with alterations of consciousness, from confusion until delirium, crash, hematuria, jaundice and renal insufficiency. [pathopedia-india.com]

  Symptoms of acute arsenic poisoning include- ► Diarrhea ► Vomiting ► Cramping muscles ► Blood in the urine (hematuria) ► Stomach pain ► Hair loss ► Breath that smells like garlic ► Convulsions If arsenic poisoning is not treated properly, the patient [medindia.net]

  (only detectable during 1st 2-4 hrs of exposure): may be >7mg/dl 24 hr urinary arsenic (after 48 hrs abstinence from sea food which can raise urinary arsenic): >50mg/day Arsenic in hair and nails Abnormal LFTs Hematology: Anemia, Leukocytosis Urine: Hematuria [medchrome.com]

• Anuria

  This can be discontinued when the urine arsenic falls below 50 mg in 24 hours. 3 In addition treatment for dehydration, shock, pulmonary oedema, anuria and liver damage may be required In very severe cases haemodialysis may be necessary after Dimercaprol [ihcworld.com]

  Furthermore, prolonged administration of arsenic leads to renal failure and anuria (that is, failure to produce urine). [napoleon.org]

• Oliguria

  This leads to thirst, oliguria, collapse, cramps, convulsions, heart failure and death. [medchrome.com]

• Headache

  Overexposure may cause headaches, drowsiness, confusion, seizures, and life-threatening complications. [rarediseases.org]

  The symptoms of chronic arsenic poisoning includes headaches, confusion and drowsiness. As the poisoning develops, convulsions and changes in the fingernail pigmentation may occur and heart and breathing difficulties follow. [arsenictests.com]

  Death is from circulatory failure with convulsions and coma being the terminal signs. 34 Large doses of arsenic insufficient to cause death will induce restlessness, nausea, vomiting, headaches, dizziness, chills, cramps, irritability and variable paralysis [ihcworld.com]

  Headaches, confusion, drowsiness, convulsions, and changes in fingernail coloring may occur with chronic arsenic poisoning. [blog.imwithoutstress.com]

  Severe headache, vertigo, periorbtal odema, skeletal muscles cramps. Renal damage manifested as Oligurea, Proteinurea, and Haematuria. Fatty infilteration of liver Delayed loss of hair, skin eruptions 13. [slideshare.net]

• Peripheral Neuropathy

  Features of Textbook of Peripheral Neuropathy Include : ̈ Practical yet comprehensiveóan accessible ìgo-toî reference for clinicians ̈ Covers all clinically relevant peripheral neuropathies ̈ Clinical Pearls and Key Points are set off from the text for [books.google.com]

  Peripheral neuropathy can develop later Chronic toxicity Insidious multi-system symptoms. [lifeinthefastlane.com]

  Neurological symptoms include acute psychosis and seizures, encephalopathy, and peripheral neuropathy. The latter has been reported to last up to 2 years after the poisoning episode. [symptoma.com]

  Encephalopathy and peripheral neuropathy are reported. Chronic arsenic toxicity results in multisystem disease. Arsenic is a well documented human carcinogen affecting numerous organs. [ncbi.nlm.nih.gov]

  Lower dose chronic arsenic exposure can result in subacute toxicity that can include peripheral sensorimotor neuropathy, skin eruptions, and hepatotoxicity. [pathopedia-india.com]

• Seizure

  Overexposure may cause headaches, drowsiness, confusion, seizures, and life-threatening complications. [rarediseases.org]

  Neurological symptoms include acute psychosis and seizures, encephalopathy, and peripheral neuropathy. The latter has been reported to last up to 2 years after the poisoning episode. [symptoma.com]

  GI haemorrhage may occur Encephalopathy and seizures Cardiovascular collapse within hours and acute myopathy as indicated by ECG changes and dysrhythmias. [lifeinthefastlane.com]

  Seizures. Haematological: Acute haemolysis. Bone marrow suppression. Basophilic stippling and rouleaux formation may be seen on a blood film. Skin: rashes. [patient.info]

  […] contaminated clothes and washing and rinsing skin thoroughly ► Bowel irrigation - Passing large quantities of polyethylene solution through the GI tract to flush out arsenic ► Blood transfusions ► Supportive treatment for complications like heart failure and seizures [medindia.net]

• Vertigo

  Severe headache, vertigo, periorbtal odema, skeletal muscles cramps. Renal damage manifested as Oligurea, Proteinurea, and Haematuria. Fatty infilteration of liver Delayed loss of hair, skin eruptions 13. [slideshare.net]

  Acute or immediate symptoms of a toxic level of exposure to arsenic may include the following: Vomiting Abdominal pain Diarrhea Dark urine (termed black water urine) Dehydration Cardiac problems Hemolysis (destruction of red blood cells) Vertigo Delirium [medicinenet.com]

  These symptoms of exposure to small-to-moderate exposure to arsine may appear immediately or only after several hours include headaches, vertigo and nausea. [chemsee.com]

• Paresthesia

  The latter is characterized by paresthesias, motor palsies, and painful neuritis. [pathopedia-india.com]

  […] loss and anemia Specific features: Hyperkeratosis of palms and soles Rain drop pigmentation of general skin surface with patches of leukoplakia Loss of hair Transverse white “Aldrich-Mees” line on nails Peripheral neuritis with itching, tingling and paresthesia [medchrome.com]

  […] acute poisoning Chronic inorganic arsenic poisoning has an insidious presentation, as follows: May manifest as a classic dermatitis (hyperkeratosis with a "dew drops on a dusty road" appearance) or peripheral neuropathy (usually a painful, symmetrical paresthesia [emedicine.medscape.com]

Acute arsenic poisoning may be diagnosed if arsenic is detected in blood, hair or urine samples [7]. Care should be taken to differentiate between organic and inorganic forms of arsenic, as the former is abundant in seafood, and is harmless. Severely ill patients may need close monitoring of their vital signs, as well as urine output.

Laboratory tests that may be requested are:

• Full blood count: This should be ordered with a reticulocyte count. Results may show microcytic or hemolytic anemia.
• Blood arsenic levels: This may show elevated levels of arsenic, however, patients are often already started on treatment by the time results are available.
• Urine arsenic levels: This includes both a spot test and 24 hour urine collection. The recent consumption of seafood may yield a false positive result.
• Urinalysis.
• Arterial blood gases.
• Full metabolic panel: There may be electrolyte derangements due to vomiting and diarrhea.
• Group and screen, and crossmatch: Blood transfusion may be needed in patients who have inhaled arsine, a gaseous form of arsenic.

Imaging techniques that may be carried out are abdominal and chest X-rays, electrocardiography, and nerve conduction studies [7].

• Torsades De Pointes

  ECG changes including ST-segment changes, prolonged QT interval, ventricular tachycardia, torsades de pointes and ventricular fibrillation. Gangrene of extremities. [patient.info]

  One report described an early manifestation of torsade de pointes after acute arsenic poisoning [ 18 ]. [casesjournal.biomedcentral.com]

  In four days to five weeks following the oral intake, the ECG may show uncharacteristic T-wave abnormalities, prolonged QT interval, conduction disorders, ventricular tachycardia and mortal arrhythmia such as torsades de pointes [ 5 ]. [omicsonline.org]

  des pointes, ventricular fibrillation, and sudden death. [triggered.edina.clockss.org]

TDMPS is useful for the treatment of massive acute arsenic poisoning. [ncbi.nlm.nih.gov]

Side effects associated with these treatments are inflammation, oozing, ulceration, crusting, pain, hypo/hyperpigmentation, and treatment failure. Surgical excision can be performed for arsenical keratoses. [clinicaladvisor.com]

Treatment for chronic poisoning Remove from further exposure and give Dimercaprol or Penicillamine. Signs of arsenic intoxication disappear slowly. [ihcworld.com]

Units (Check the arsenic boxes under Drinking Water Treatment Units, Reverse Osmosis, and Distillation, and then click the "Search" button.) [dep.pa.gov]

Treatment The treatment depends on the type and stage of the arsenic poisoning. Some methods remove arsenic from the human body before it causes any damage. Others repair or minimize the damage that has already occurred. [medicalnewstoday.com]

Prognosis In acute arsenic poisoning survival for more than one week is usually followed by complete recovery. With chronic arsenic poisoning recovery may require 6 months to 1 year. [ihcworld.com]

Tamra Carlson - 2019-01-07 15:18 Disease Topic Myeloproliferative Neoplasms- MPN implications for classification, diagnosis, and prognosis. [arupconsult.com]

Pregnancy and breast-feeding: arsenic is probably transferred to the baby via the placenta and breast milk. [ 2 ] Prognosis [ 2 ] The prognosis varies with the amount and rate of arsenic ingestion. [patient.info]

Besides skin and lung cancer, industrial and agricultural exposure to arsenic has been implicated in the etiology of cancers of the urinary bladder, kidney, and liver in exposed populations. [pathopedia-india.com]

[…] c-Jun / AP1 transcription complex High doses of inorganic arsenicals induce release of TNF alpha Arsenic can induce cross tolerance to cytotoxicity, genotoxicity and apoptosis induced by nickel and other metals ( Toxicol Appl Pharmacol 2001;176:127 ) Etiology [pathologyoutlines.com]

Discussion of case questions The patient does demonstrate some findings suggestive of arsenic poisoning, however these symptoms are also nonspecific and may reflect other etiologies. [calpoison.org]

Tentative Diagnosis and Follow-Up The tentative assessment at this visit was optic atrophy of an unknown etiology. [reviewofoptometry.com]

(This article gives a thorough review of the literature regarding the etiology, epidemiology, and most common clinical presentations of chronic arsenic exposure. [clinicaladvisor.com]

Presumably this is the same mechanism as is responsible for the arsenic pollution in the mountains of Argentine and Chile where so much epidemiological studies have been made. [users.physics.harvard.edu]

[…] table Free element of arsenic appears in two allotropic forms: grey and yellow (crystalline) Can also exist in various oxidation states, inorganic and organic forms, exposure to inorganic arsenic is associated with most cases of arsenic induced toxicity Epidemiology [pathologyoutlines.com]

Arsenic poisoning caused by intentional contamination of coffee at a church gathering--an epidemiological approach to a forensic investigation. J Forensic Sci. 2010 Jul. 55(4):1116-9. [Medline]. [Full Text]. Mandal BK, Suzuki KT. [emedicine.medscape.com]

In other areas, where arsenic concentrations in water are elevated (10–50 μg/L), JECFA concluded that while there is a possibility of adverse effects, these would be at a low incidence that would be difficult to detect in epidemiological studies. [who.int]

Epidemiology In Victorian times arsenic was famous as a homicidal or suicidal poison; it is now thankfully much harder to obtain. Health and safety at work have also improved so that, in the UK, both acute and chronic arsenic poisoning are rare. [patient.info]

[…] is present in air, usually due to volcanic eruption and purposeful human activities Arsenic also found as sulphuric compound in lead, copper, nickel and ferrous ores; also in soil in small quantities Also a medicinal used by physicians for 2000 years Pathophysiology [pathologyoutlines.com]

Pathophysiology The exact mechanism for chromosomal damage has yet to be fully elucidated. [clinicaladvisor.com]

Pathophysiology Inorganic forms of arsenic are more toxic than organic forms. The trivalent forms are more toxic and react with thiol groups, while the pentavalent forms are less toxic but uncouple oxidative phosphorylation. [emedicine.medscape.com]

Systemic Implications and Complications It’s important to treat squamous cell carcinomas early on to prevent the risk of metastasis. [clinicaladvisor.com]

The Centers for Disease Control and Prevention (CDC) can assist with concerns about arsenic and other toxins. [medicalnewstoday.com]

Treatment and Prevention of Arsenic Poisoning Arsenic poisoning is capable of causing life- threatening health issues and can even prove fatal if not treated on time. [medindia.net]

One of the most effective preventive measures against arsenic poisoning is to make sure you drink clean, filtered water. You can also make sure that all foods are prepared in clean water. [healthline.com]

Ways to reduce or prevent exposure can include using personal protective equipment and using safer work practices. [cancer.org]

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2. Lai MW, Boyer EW, Kleinman ME, Rodig NM, Ewald MB. Acute arsenic poisoning in two siblings. Pediatrics. 2005;116(1):249-257.
3. Correia N, Carvalho C, Friões F, Araújo JP, Almeida J, Azevedo A. Haemolytic anaemia secondary to arsenic poisoning: a case report. Cases J. 2009;2:7768.
4. Campbell JP, Alvarez JA. Acute arsenic intoxication. Am Fam Physician. 1989;40(6):93–97.
5. Ghariani M, Adrien ML, Raucoules M, Bayle J, Jacomet Y, Grimaud D. Subacute arsenic poisoning. Ann Fr Anesth Reanim. 1991;10(3):304-307.
6. Lerman BB, Ali N, Green D. Megaloblastic, dyserythropoietic anaemia following arsenic ingestion. Ann Clin Lab Sci. 1980;10(6):515-517.
7. Ratnaike RN. Acute and chronic arsenic toxicity. Postgrad Med J. 2003;79(933):391-396.