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Arsine Poisoning

Arsine Toxicity


Presentation

  • The present manuscript describes a series of cases treated with HBPT. METHODS: Eleven SAAP subjects were enrolled. The study did not include a control group, because of ethical issues.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • At present the plant has stopped operations of all machines. More details remain for further investigation.(Editor: Minnie Mao)[en.kunming.cn]
Anemia
  • 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]
  • Arsine causes massive hemolysis and results in anemia, jaundice, and hemoglobinuric renal failure.[emergency.cdc.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]
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]
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]
  • All 8 sailors developed fever, headache, myalgia, epigastric pain, nausea, and vomiting between 1 and 12 hours of exposure.[emedicine.medscape.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]
  • 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]
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]
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]
  • 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]
  • Lack of appetite which may lead to weight loss (further aggravated by vomiting and diarrhea). Headaches with dizziness.[healthhype.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]
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]
  • He complained of weakness, nausea, dry mouth and backache and had developed orange colored diarrhea, red coloured urine and his urine output was decreased.[toxicology.imedpub.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
  • 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]
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
  • , 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]
  • 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]
Muscle Weakness
  • - Weakness, cramping Physical Physical signs and their severity depend on the concentration of arsine gas and the duration of the patient's exposure.[emedicine.medscape.com]
Costovertebral Angle Tenderness
  • 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 Causes See the list below: Arsine gas is used in[emedicine.medscape.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]
Kidney Failure
  • Kidney failure. Impaired immune functioning. Increased risk of cancer – liver, bladder, larynx and lymphoid system.[healthhype.com]
  • Renal Kidney failure due to acute tubular destruction is a significant sequela of arsine exposure. Urinalysis shows large amounts of protein and free hemoglobin usually without intact RBCs.[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]
Dark Urine
  • 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]
  • 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]
Oliguria
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]
  • […] syndrome, hypovolemic shock, tachycardia, dysrhythmias Neurologic - Headache; dizziness; sensorimotor peripheral neuropathy (usually 1-3 wk after exposure); neuropsychological symptoms (several days after exposure) including memory loss, restlessness, and confusion[emedicine.medscape.com]
  • 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]
  • People exposed to a low or moderate dose of arsine by inhalation may experience some or all of the following symptoms within 24 hours of exposure: Confusion Drowsiness Fatigue Headache Muscle cramps Nausea, vomiting, and/or abdominal pain Rapid breathing[emergency.cdc.gov]
  • 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]
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]
Paresthesia
  • […] 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]
  • The latter is characterized by paresthesias, motor palsies, and painful neuritis.[pathopedia-india.com]

Workup

Heinz Bodies
  • At 90 days, the concentration of methemoglobin was increased along with an increase in intracellular denatured proteins, or Heinz bodies.[emedicine.medscape.com]
  • 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]
Prolonged QT Interval
  • ECG changes including ST-segment changes, prolonged QT interval, ventricular tachycardia, torsades de pointes and ventricular fibrillation. Gangrene of extremities.[patient.info]
Ventricular Repolarization Abnormalities
  • Arsenic-induced carotid atherosclerosis, ventricular repolarization abnormalities, and ischemic heart disease / Chih-Hao Wang -- ch. 8. Arsenic exposure and cerebrovascular disease / Hung-Yi Chiou and Yi-Chen Hsieh -- ch. 9.[books.google.com]

Treatment

  • 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 advantage of HBPT is that it can integrate the characteristics of different blood purification technologies to maximize treatment efficacy.[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]
  • The Role of Chelation in the Treatment of Arsenic and Mercury Poisoning. J Med Toxicol . 2013 Nov 1. [Medline] . Anthonisen P, Nielsen B, Pedersen K, Raaschou F. 3. Clinical picture and treatment in arsine poisoning.[emedicine.medscape.com]

Prognosis

  • 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]

Etiology

  • 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]

Epidemiology

  • الصفحة 69 - Epidemiology is defined as the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems. ‏[books.google.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]
  • 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]
  • Epidemiology Mortality/Morbidity Arsine has been reported to cause immediate death at 150-250 ppm. In addition to absolute concentration, the duration of exposure is another factor that determines toxicity.[emedicine.medscape.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]
Sex distribution
Age distribution

Pathophysiology

  • 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]

Prevention

  • "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]
  • Centers for Disease Control and Prevention. Case Definition: Arsine or Stibine Poisoning. Emergency Preparedness and Response. Last updated March 4, 2005. Available at . Centers for Disease Control and Prevention.[emedicine.medscape.com]
  • The reducing of arsenic blood concentration did not prevent acute renal failure.[toxicology.imedpub.com]
  • Centers for Disease Control and Prevention. Case Definition: Arsine or Stibine Poisoning. Emergency Preparedness and Response. Available at . April 4, 2018; Accessed: February 16, 2019.[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]

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