Symptoms are not listed in order of presentation or specificity. Also, partial presentations (an absence of some of the following signs/symptoms) do not necessarily imply less severe disease. [emergency.cdc.gov]

He is presently appointed as a member of the Joint FAO/WHO Expert Committee on Food Additives (JECFA) for the period 2016-2020. Dr. [books.google.com]

The results of the present study suggest that arsine is quickly metabolized to AsIII and then metabolized via MMA to DMA in humans. [ncbi.nlm.nih.gov]

At present the plant has stopped operations of all machines. More details remain for further investigation.(Editor: Minnie Mao) [en.kunming.cn]

• Anemia

  Arsine causes massive hemolysis and results in anemia, jaundice, and hemoglobinuric renal failure. [emergency.cdc.gov]

  On admission, anemia, hematuria, and renal and liver dysfunction were observed. His clinical condition had improved remarkably after 5-days of transfusion and 4 units of RBC transfusion. [ncbi.nlm.nih.gov]

  Three months later he again had aplastic anemia, and the urine once more contained considerable amounts of arsenic. Treatment with pencillamine and oxymetholone was reinstituted. [annals.org]

  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]

  Pre-existing cardiopulmonary or renal conditions, iron deficiency, and/or pre-existing anemia may result in more severe outcomes if hemolysis occurs. [sccgov.org]

• Fever

  General Weakness Malaise Fatigue Fever Gastrointestinal signs and symptoms Nausea Vomiting Abdominal pain Liver injury Central nervous system signs and symptoms Headache Lethargy Convulsions Coma Peripheral neuropathy (1–3 weeks after acute exposure) [emergency.cdc.gov]

  HPS and hemmorhagic fever inhalation of rodent urine hantanavirus is spread by: tiny bacteria that must live inside a host cell. associated with bloodsucking arthropods. causes typhus, spotted fevers and erhlichosis etiological agent lymes disease. characteristic [chegg.com]

  Its title, Bitten By Witch Fever, is a reference to something once said by the man at the center of all parts of this story: William Morris. [smithsonianmag.com]

  All 8 sailors developed fever, headache, myalgia, epigastric pain, nausea, and vomiting between 1 and 12 hours of exposure. [emedicine.medscape.com]

  Low grade fever. Hair loss. Conjunctivitis (‘pink eye’) or even red, bloodshot eyes. Corneal tissue death ( necrosis ) and/or ulcers. Skin discoloration – darkening (hyperpigmentation), pale ( pallor ), yellow (jaundice), blue (cyanosis). [healthhype.com]

• Fatigue

  General Weakness Malaise Fatigue Fever Gastrointestinal signs and symptoms Nausea Vomiting Abdominal pain Liver injury Central nervous system signs and symptoms Headache Lethargy Convulsions Coma Peripheral neuropathy (1–3 weeks after acute exposure) [emergency.cdc.gov]

  It can also result in decreased production of red and white blood cells which may cause fatigue, abnormal heart rhythm, blood-vessel damage resulting in bruising, and impaired nerve function. [environmentalhealth.ca]

  Chronic arsenic intoxication ( arsenicosis) is characterized initially by such nonspecific symptoms as malaise and fatigue. Eventually gastrointestinal disturbances develop, along with changes in the skin and a peripheral neuropathy. [pathopedia-india.com]

  Appl Pharmacol 2001;172:225 ) Clinical features Bone marrow depression: due to acute or more commonly chronic arsenic intoxication, may initially manifest as pancytopenia and be reversible; may have nonspecific clinical presentation of pancytopenia, fatigue [pathologyoutlines.com]

  These symptoms included fatigue, headache, numbness, and palpitations. A metallic taste may also be noted in the mouth, and a victim’s breath may also develop an odour resembling that of garlic. [compoundchem.com]

• Rigor

  The episode was instrumental in securing more rigorous legislation on food safety. [independent.co.uk]

  ◦ 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]

• 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]

• Dyspnea

  […] exposure) Neuropsychological symptoms (several days after exposure): memory loss, restlessness, confusion Cardiovascular signs Tachycardia Hypotension ECG changes (repolarization, S-T segment, and T-wave changes) Respiratory signs and symptoms Tachypnea Dyspnea [emergency.cdc.gov]

  Signs and symptoms include generalized weakness, dark urine, jaundice, and dyspnea. Oliguria and renal failure often occur 1-3 days after exposure. [emedicine.medscape.com]

  Pain may cause anxiety and fear with shortness of breath ( dyspnea ), insomnia and even nightmares have been reported. Lack of appetite which may lead to weight loss (further aggravated by vomiting and diarrhea). Headaches with dizziness. [healthhype.com]

  Dyspnea may be due to lack of oxygen secondary to hemolysis. Children may be more vulnerable because of increased minute ventilation per kg and failure to evacuate an area promptly when exposed. [sccgov.org]

  Bone marrow suppression, chronic respiratory syndromes including cough, dyspnea, and chest discomfort may result. Chest imaging may reveal a patchy infiltrative pattern. [calpoison.org]

• Cough

  When it does occur, respiratory tract symptoms - cough, chest pain, difficult breathing, giddiness, headache, and a general weakness of the body - occur. These symptoms may be followed by gastrointestinal or stomach pains. [ohsrep.org.au]

  Bone marrow suppression, chronic respiratory syndromes including cough, dyspnea, and chest discomfort may result. Chest imaging may reveal a patchy infiltrative pattern. [calpoison.org]

   Voice is hoarse and husky,  Runing nose,  Cough  Bronchial coryza.  Photophobia and conjunctivitis  Liver is enlarged and cirrhotic,  Chronic nephritis. 28. [slideshare.net]

• Tachypnea

  […] acute exposure) Neuropsychological symptoms (several days after exposure): memory loss, restlessness, confusion Cardiovascular signs Tachycardia Hypotension ECG changes (repolarization, S-T segment, and T-wave changes) Respiratory signs and symptoms Tachypnea [emergency.cdc.gov]

  Findings may include the following: Vital signs - Hyperthermia, tachypnea, tachycardia, hypotension Head, ears, eyes, nose, and throat (HEENT) - Discoloration of conjunctivae (red, orange, brown, or brassy; reportedly distinct from hyperbilirubinemia) [emedicine.medscape.com]

• Rales

  […] tachypnea, tachycardia, hypotension Head, ears, eyes, nose, and throat (HEENT) - Discoloration of conjunctivae (red, orange, brown, or brassy; reportedly distinct from hyperbilirubinemia), scleral icterus, garlic odor to breath (possible) Pulmonary - Rales [emedicine.medscape.com]

• Vomiting

  [Photo/Chen Yuzhou] A total of 8 workers from Jinhu Metallurgical Co Ltd within Sifangdi Industrial Park of Dongchuan District, Kunming have reported that they feel nausea and vomiting one after another on March 8. [en.kunming.cn]

  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]

  Lack of appetite which may lead to weight loss (further aggravated by vomiting and diarrhea). Headaches with dizziness. [healthhype.com]

  General Weakness Malaise Fatigue Fever Gastrointestinal signs and symptoms Nausea Vomiting Abdominal pain Liver injury Central nervous system signs and symptoms Headache Lethargy Convulsions Coma Peripheral neuropathy (1–3 weeks after acute exposure) [emergency.cdc.gov]

  All 8 sailors developed fever, headache, myalgia, epigastric pain, nausea, and vomiting between 1 and 12 hours of exposure. [emedicine.medscape.com]

• Nausea

  [Photo/Chen Yuzhou] A total of 8 workers from Jinhu Metallurgical Co Ltd within Sifangdi Industrial Park of Dongchuan District, Kunming have reported that they feel nausea and vomiting one after another on March 8. [en.kunming.cn]

  General Weakness Malaise Fatigue Fever Gastrointestinal signs and symptoms Nausea Vomiting Abdominal pain Liver injury Central nervous system signs and symptoms Headache Lethargy Convulsions Coma Peripheral neuropathy (1–3 weeks after acute exposure) [emergency.cdc.gov]

  All 8 sailors developed fever, headache, myalgia, epigastric pain, nausea, and vomiting between 1 and 12 hours of exposure. [emedicine.medscape.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]

  This condition is divided into three phases: The worker complains of weakness, loss of appetite, nausea, occasional vomiting, and some diarrhoea. [ohsrep.org.au]

• Abdominal Pain

  General Weakness Malaise Fatigue Fever Gastrointestinal signs and symptoms Nausea Vomiting Abdominal pain Liver injury Central nervous system signs and symptoms Headache Lethargy Convulsions Coma Peripheral neuropathy (1–3 weeks after acute exposure) [emergency.cdc.gov]

  The classic triad of symptoms in sublethal arsine exposures includes abdominal pain, hematuria, and jaundice. [emedicine.medscape.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]

  In the course of treatments for a variety of symptoms—swollen legs, abdominal pain, jaundice, vomiting, weakness—Napoleon was subjected to a smorgasbord of other toxic substances. [amnh.org]

• Abdominal Tenderness

  tenderness, hepatomegaly Genitourinary - Costovertebral angle tenderness, colored urine (red, brown, or green from hemoglobinuria and/or methemoglobinuria) Extremities - Possible paresthesias and Mees lines with chronic arsenic toxicity from arsine exposure [emedicine.medscape.com]

• Jaundice

  The classic triad of symptoms in sublethal arsine exposures includes abdominal pain, hematuria, and jaundice. [emedicine.medscape.com]

  Arsine causes massive hemolysis and results in anemia, jaundice, and hemoglobinuric renal failure. [emergency.cdc.gov]

  Skin discoloration – darkening (hyperpigmentation), pale ( pallor ), yellow (jaundice), blue (cyanosis). Mee’s lines – white lines on fingernails and/or toenails. [healthhype.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]

  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]

• Hepatomegaly

  Enlarged liver (hepatomegaly) and/or spleen (splenomegaly). Aplastic anemia when the bone marrow fails to produce new cells. Kidney failure. Impaired immune functioning. Increased risk of cancer – liver, bladder, larynx and lymphoid system. [healthhype.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]

  Hepatic Right upper quadrant pain, hepatomegaly, elevated serum globulin, elevated liver enzymes and prolonged prothrombin time have been observed. Musculoskeletal Skeletal muscle injury or necrosis have been reported. [sccgov.org]

  orange, brown, or brassy; reportedly distinct from hyperbilirubinemia), scleral icterus, garlic odor to breath (possible) Pulmonary - Rales from acute respiratory distress syndrome (ARDS) in severe exposure Gastrointestinal - Abdominal tenderness, hepatomegaly [emedicine.medscape.com]

• Keratosis

  Thickening of the skin on the palms (palmar keratosis) or soles of the feet (plantar keratosis). [healthhype.com]

  Arsenical Keratosis – Medscape Reference Sengupta SR, Das NK, Datta PK. Pathogenesis, clinical features and pathology of chronic arsenicosis. Indian J Dermatol Venereol Leprol [serial online] 2008 [cited 2009 Jan 26];74:559-70. [dermnetnz.org]

  […] arsenic trioxide Sulfur containing substances in garlic may scavenge arsenic from tissue and blood Clinical images Images hosted on other servers : Pigment changes and palmoplantar hyperkeratoses are characteristic of chronic arsenic exposure Arsenic keratosis [pathologyoutlines.com]

   Epithelial hyperplasia, discrete multiple wart like keratosis on the palms and sole, head and trunk.  Hyperkeratosis then occurs with desquamation of the palm and soles 29. ◦ Nails are brittles with linear pigmentation, Aldrich Mee`s Line ( white [slideshare.net]

• Muscle Weakness

  Signs and symptoms include generalized weakness, dark urine, jaundice, and dyspnea. Oliguria and renal failure often occur 1-3 days after exposure. [emedicine.medscape.com]

• Dark Urine

  urine Shortness of breath Weakness Yellow skin and eyes (jaundice) Exposure to a large dose of arsine by any route may result in these additional health effects. [emergency.cdc.gov]

  Signs and symptoms include generalized weakness, dark urine, jaundice, and dyspnea. Oliguria and renal failure often occur 1-3 days after exposure. [emedicine.medscape.com]

  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]

• Kidney Failure

  Kidney failure. Impaired immune functioning. Increased risk of cancer – liver, bladder, larynx and lymphoid system. [healthhype.com]

  Children may be more vulnerable because of increased minute ventilation per kg and failure to evacuate an area promptly when exposed. Renal Kidney failure due to acute tubular destruction is a significant sequela of arsine exposure. [sccgov.org]

  If the victim perseveres through, they will likely eventually succumb over the subsequent days to either liver failure or kidney failure. [compoundchem.com]

• Hematuria

  On admission, anemia, hematuria, and renal and liver dysfunction were observed. His clinical condition had improved remarkably after 5-days of transfusion and 4 units of RBC transfusion. [ncbi.nlm.nih.gov]

  The classic triad of symptoms in sublethal arsine exposures includes abdominal pain, hematuria, and jaundice. [emedicine.medscape.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]

• Oliguria

  Oliguria and renal failure often occur 1-3 days after exposure. [emedicine.medscape.com]

  • With a smaller amount the patient will have severe headache, vertigo, periorbital edema, skeletal muscle cramping and evidence of renal damage manifested as oliguria, proteinuria, and haematuria. • If death does not occur in the first few hours from [assignmentpoint.com]

• Headache

  General Weakness Malaise Fatigue Fever Gastrointestinal signs and symptoms Nausea Vomiting Abdominal pain Liver injury Central nervous system signs and symptoms Headache Lethargy Convulsions Coma Peripheral neuropathy (1–3 weeks after acute exposure) [emergency.cdc.gov]

  All 8 sailors developed fever, headache, myalgia, epigastric pain, nausea, and vomiting between 1 and 12 hours of exposure. [emedicine.medscape.com]

  Arsenic can also cause a range of neurological effects, including headaches and vision problems. It can cause noticeable behavioral changes, most commonly aggression or depression. [environmentalhealth.ca]

  Headaches with dizziness. Arsenic Poisoning Signs The signs of arsenic poisoning may mimic many diseases and apart from the above symptoms that the patient will report, other signs are evident to the physician or concerned associates. [healthhype.com]

• Confusion

  Vomiting Abdominal pain Liver injury Central nervous system signs and symptoms Headache Lethargy Convulsions Coma Peripheral neuropathy (1–3 weeks after acute exposure) Neuropsychological symptoms (several days after exposure): memory loss, restlessness, confusion [emergency.cdc.gov]

  With chronic exposure, the more common effects include gradual loss of strength; diarrhea or constipation; pigmentation and scaling of the skin, which may undergo malignant changes; nervous manifestations marked by paralysis and confusion; degeneration [britannica.com]

  The most commonly used toxin in Greece was the water hemlock, a plant in the carrot family not to be confused with the evergreen conifer common in New England. [dartmouth.edu]

  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]

• Paresthesia

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

  […] distress syndrome (ARDS) in severe exposure Gastrointestinal - Abdominal tenderness, hepatomegaly Genitourinary - Costovertebral angle tenderness, colored urine (red, brown, or green from hemoglobinuria and/or methemoglobinuria) Extremities - Possible paresthesias [emedicine.medscape.com]

• Heinz Bodies

  Anemia develops; the peripheral smear shows variation in the size of the red blood cells, irregularly shaped blood cells, red-cell fragments, components that have an affinity for basic dyes, Heinz bodies, and ghost cells. [sccgov.org]

  At 90 days, the concentration of methemoglobin was increased along with an increase in intracellular denatured proteins, or Heinz bodies. [emedicine.medscape.com]

• Prolonged QT Interval

  The levels of magnesium, K and Ca should be examined carefully since they may cause prolongation of the QT interval. In the case of acute intoxication, gastrointestinal decontamination should be considered. [omicsonline.org]

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

  • Cardiac manifestations include acute cardiomyopathy, subendocardial hemorrhages, and ECG changes of prolonged QT interval and non-specific ST and T wave changes. [assignmentpoint.com]

This retrospective study evaluated the clinical and effects and arsenic clearance from the use of plasma exchange treatment of patients with acute arsine poisoning. [ncbi.nlm.nih.gov]

The effectiveness of this compound in the treatment of arsine poisoning falls off rapidly as the time interval between exposure and treatment is increased. 6. [jpet.aspetjournals.org]

Konstantin M Brusin * Regional Poisoning Treatment Centre, Clinical Psychiatric Hospital, Yekaterinburg, Russia Corresponding Author: Konstantin M Brusin Regional Poisoning Treatment Centre Clinical Psychiatric Hospital, Yekaterinburg, Russia Tel: 79122872491 [toxicology.imedpub.com]

Naturopaths may be able to help with diagnosis and treatment with other methods. [environmentalhealth.ca]

The limited efficacy of conventional drug therapy prompted us to investigate the application of hybrid blood purification treatment (HBPT) to improve the prognosis in critically ill patients. [ncbi.nlm.nih.gov]

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]

Disorders of consciousness, cardiac arrhythmia, renal failure and hypotension are the conditions that determine the prognosis of patients [ 8 ]. Mortality occurs due to sudden emergence of a systole that develops following bradycardia [ 7, 9 ]. [omicsonline.org]

[…] contaminated blood and water hep. associated with contaminated food and water hep. associated with blood etiological agent of gonorrhea Is gonorrhea treatable and how etiological agent of syphilis 1. yes, pCN 2. fetus from mother 3. fluorescent antibodies [chegg.com]

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]

Medical/Legal Pitfalls • Failure to immediately report all suspicious cases to an appropriate law enforcement agency (If someone presents with arsenic toxicity and the cause is not obvious, a malicious etiology may be involved.) • Special Concerns • Checking [assignmentpoint.com]

He has coordinated EU- projects on Environmental Epidemiology and Toxicology of Metals and participated as an active scientist in several such projects. [books.google.com]

[…] 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]

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. [emedicine.medscape.com]

Pathophysiology Inhaled arsine gas is distributed rapidly and causes massive red blood cell hemolysis that can potentially lead to global cellular hypoxia. [emedicine.medscape.com]

[…] 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]

"Fat soluble" mono and dithiols have been found to prevent the lysis of erythrocytes by arsine in vitro when they are added five minutes after the cells have been exposed to arsine. 2. [jpet.aspetjournals.org]

According to the Centers for Disease Control and Prevention (CDC), signs and symptoms generally occur 2-24 hours after exposure and are a result of massive hemolysis. [emedicine.medscape.com]

Abstract Arsine gas exposure is a rare occupational event and can be completely prevented with the use of appropriate protective gear. [ncbi.nlm.nih.gov]

At the time, treatments were limited, so being poisoned by arsenic compounds usually meant certain death, with little that doctors could do to prevent it. [compoundchem.com]