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Chronic Arsenic Poisoning


Presentation

  • A case is presented of repeated arsenic poisoning over two years misdiagnosed as Landry-Guillain-Barré syndrome.[ncbi.nlm.nih.gov]
  • Some patients might have experienced arsenic neuropathy to some degree in the past (before 1987) but they had recovered to some degree at the time of the present investigation (1996) as most of the patients with chronic arsenic poisoning in the present[ncbi.nlm.nih.gov]
  • The patient presented with bleeding esophageal varices. Splenomegaly and hyperkeratosis of palms and soles were later noted and led to the discovery of chronic arsenic poisoning.[ncbi.nlm.nih.gov]
  • Rehabilitation specialists have traditionally dealt with the debilitating consequences of the classic arsenic-induced sensorimotor peripheral neuropathy; however, a knowledge of the presentation of acute toxicity combined with the effects of chronic exposure[ncbi.nlm.nih.gov]
  • The present study was designed to reveal this question.[ncbi.nlm.nih.gov]
Anemia
  • Skin pigmentation changes, palmar and plantar hyperkeratoses, gastrointestinal symptoms, anemia, and liver disease are common. Noncirrhotic portal hypertension with bleeding esophageal varices, splenomegaly, and hypersplenism may occur.[ncbi.nlm.nih.gov]
  • ), 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]
  • […] 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 of fatty tissue; anemia[britannica.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]
  • This produces chronic and worsening anemia and extreme weakness with total lack of energy.[gurupoison.tripod.com]
Weight Loss
  • Symptoms include nausea, vomiting, weight loss, diarrhea, abdominal pain, headaches, irritability, insomnia, poor balance, numbness and tingling of the extremities, and a few other symptoms.[writersforensicsblog.wordpress.com]
  • Weight loss always accompanies stomach cancer in its advanced stage.[napoleon.org]
  • Patient had history of weight loss and was bed bound for 3 months. None of his brothers or sisters had such a disease. His parents were not alive and they were reported not to have had any such disorder.[jpma.org.pk]
  • GI: Anorexia, weight loss, abdominal pain, diarrhoea. Jaundice, hepatomegaly; development of portal fibrosis and cirrhosis. Cardiac/respiratory: [ 12 , 13 ] Coronary heart disease, increased further in those who also smoke.[patient.info]
  • A patient with chronic arsenic poisoning may present with fatigue, weight loss, gastrointestinal disturbances and respiratory irritation, as well as slowly progressive central vision loss and dyschromatopsia.[reviewofoptometry.com]
Fatigue
  • Overexposure may cause fatigue, headaches, nausea, vomiting, abdominal cramps, diarrhea, and fever.[rarediseases.org]
  • 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]
  • A patient with chronic arsenic poisoning may present with fatigue, weight loss, gastrointestinal disturbances and respiratory irritation, as well as slowly progressive central vision loss and dyschromatopsia.[reviewofoptometry.com]
Raynaud Phenomenon
  • 'Blackfoot disease' has been associated with arsenic-contaminated drinking water in Taiwan; Raynaud's phenomenon and acrocyanosis also may occur.[ncbi.nlm.nih.gov]
Chronic Cough
  • Other data recorded included subjective and objective symptoms, such as chronic cough (35.0%) and insomnia (37.5%).[ncbi.nlm.nih.gov]
Vomiting
  • His vomiting and diarrhea would be bloody and his abdominal pain severe. With an acute poisoning, death can take many hours and is not pleasant.[writersforensicsblog.wordpress.com]
  • 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]
  • THALLIUM POISONING Symptoms associated with thallium poisoning include extreme drowsiness (somnolence), nausea, vomiting, abdominal pain, and bloody vomiting (hematemesis).[rarediseases.org]
  • Acute arsenic poisoning, which may result in shock and death, is marked by skin eruptions, swelling of eyelids and limbs, vomiting, diarrhea, and cramps.[medical-dictionary.thefreedictionary.com]
  • Acute arsenic poisoning leads to nausea and vomiting, developing into massive intestinal tract inflammation with diarrhea two hours later.[dmsachelation.com]
Nausea
  • Symptoms include nausea, vomiting, weight loss, diarrhea, abdominal pain, headaches, irritability, insomnia, poor balance, numbness and tingling of the extremities, and a few other symptoms.[writersforensicsblog.wordpress.com]
  • A wide range of signs and symptoms may be seen in acute arsenic poisoning including headache, nausea, vomiting, diarrhea, abdominal pain, hypotension, fever, hemolysis, seizures, and mental status changes.[mayomedicallaboratories.com]
  • 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]
  • Overexposure may cause fatigue, headaches, nausea, vomiting, abdominal cramps, diarrhea, and fever.[rarediseases.org]
  • 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]
Abdominal Pain
  • His vomiting and diarrhea would be bloody and his abdominal pain severe. With an acute poisoning, death can take many hours and is not pleasant.[writersforensicsblog.wordpress.com]
  • A wide range of signs and symptoms may be seen in acute arsenic poisoning including headache, nausea, vomiting, diarrhea, abdominal pain, hypotension, fever, hemolysis, seizures, and mental status changes.[mayomedicallaboratories.com]
  • 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]
  • Gastrointestinal symptoms include a flu-like illness (gastroenteritis) that is characterized by vomiting; abdominal pain; fever; and diarrhea, which, in some cases, may be bloody.[rarediseases.org]
  • Acute poisoning is manifested by abdominal pain, diarrhea and dehydration.[medical-dictionary.thefreedictionary.com]
Diarrhea
  • His vomiting and diarrhea would be bloody and his abdominal pain severe. With an acute poisoning, death can take many hours and is not pleasant.[writersforensicsblog.wordpress.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]
  • 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]
  • A wide range of signs and symptoms may be seen in acute arsenic poisoning including headache, nausea, vomiting, diarrhea, abdominal pain, hypotension, fever, hemolysis, seizures, and mental status changes.[mayomedicallaboratories.com]
Loss of Appetite
  • SYMPTOM REVIEW: Gastrointestinal: In sub-acute and chronic arsenic poisoning, the onset of gastrintestinal symptoms is so insidious, or gradual and subtle, that they may appear as ordinary loss of appetite and indigestion.[gurupoison.tripod.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]
Acrocyanosis
  • 'Blackfoot disease' has been associated with arsenic-contaminated drinking water in Taiwan; Raynaud's phenomenon and acrocyanosis also may occur.[ncbi.nlm.nih.gov]
Muscle Weakness
  • Muscular: Evidence of sudden muscle weakness or collapse in the legs due to the early effects of arsenic poisoning were seen in January and in February 1977 when Srila Prabhupada "suddenly collapsed" on two occasions.[gurupoison.tripod.com]
Hyperpigmentation
  • RESULTS: Among the 116 residents screened, 81 (70%) had clinically confirmed arsenic keratoses and hyperpigmentation. Among them, 52 were males and 29 were females with age range of 4-82 years.[ncbi.nlm.nih.gov]
  • In all of the studied patients, 22% had typical hyperkeratosis on the palms or soles and some had raindrop-like hyperpigmentation and depigmentation on the trunk.[ncbi.nlm.nih.gov]
  • 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]
  • Skin features of chronic arsenic poisoning Typical findings include: Affected organ Features Skin Excessive darkening of the skin ( hyperpigmentation ) in areas that are not exposed to sunlight Excessive formation of scaly skin on the palms and soles[dermnetnz.org]
  • The spirulina plus zinc patients had a statistically significant reduction of hyperpigmentation (melanosis) of the upper chest and arms and cracks and fissures (keratosis) of the palms and soles starting at 8-12 weeks of treatment.[rainbow.coop]
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]
Desquamating Rash
  • Over the next 2 weeks he developed profound distal weakness, desquamating rash over trunk and limbs, rain drop pigmentation ( Figure 1A ) and Mees’ lines ( Figure 1B ). 24-h urine arsenic levels were 405.2 μ g/l.[academic.oup.com]
Hematuria
  • 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]
Peripheral Neuropathy
  • Rehabilitation specialists have traditionally dealt with the debilitating consequences of the classic arsenic-induced sensorimotor peripheral neuropathy; however, a knowledge of the presentation of acute toxicity combined with the effects of chronic exposure[ncbi.nlm.nih.gov]
  • Peripheral neuropathy may also occur. Workplace exposure or chronic ingestion of arsenic-contaminated water or arsenical medications is associated with development of skin, lung, and other cancers.[ncbi.nlm.nih.gov]
  • neuropathy ) A headache, drowsiness, confusion The distal weakness of small muscles of the. hands and feet Blood and urine Haemolytic anaemia (moderate) leukopenia (low white cell count) Proteinuria (protein in the urine) Other Inflammation of respiratory[dermnetnz.org]
  • 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]
  • Peripheral neuropathy is the most frequent manifestation after the initial phase.[jpma.org.pk]
Headache
  • Symptoms include nausea, vomiting, weight loss, diarrhea, abdominal pain, headaches, irritability, insomnia, poor balance, numbness and tingling of the extremities, and a few other symptoms.[writersforensicsblog.wordpress.com]
  • Nails Transverse white bands of arsenic deposits across the bed of the fingernails (Mee's lines) Hair Arsenic deposits in hair Nervous system Sensory changes, numbness and tingling in a “stocking-glove” distribution (sensory peripheral neuropathy ) A headache[dermnetnz.org]
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
  • Overexposure may cause headaches, drowsiness, confusion, seizures, and life-threatening complications.[rarediseases.org]
  • A wide range of signs and symptoms may be seen in acute arsenic poisoning including headache, nausea, vomiting, diarrhea, abdominal pain, hypotension, fever, hemolysis, seizures, and mental status changes.[mayomedicallaboratories.com]
Paresthesia
  • Nausea, epigastric pain, colic (abdominal pain), diarrhea, and paresthesias of the hands and feet can occur. Reference Values Describes reference intervals and additional information for interpretation of test results.[mayomedicallaboratories.com]
  • The latter is characterized by paresthesias, motor palsies, and painful neuritis.[pathopedia-india.com]
Dizziness
  • Seizures, dizziness, fainting, languor, listlessness, and lethargy were definitely observed in the health biography, as was stomatitis, or sores and ulcers in the mouth. Srila Prabhupada was at many times noticeably restless or irritable.[gurupoison.tripod.com]
Dysesthesia

Workup

  • A thorough history and physical examination should be performed and further imaging and workup should be based on these findings.[clinicaladvisor.com]

Treatment

  • Abstract Although arsenic poisoning was a common cause of homicide in the past, it is seldom suspected today; thus there may be serious delays in diagnosis and treatment of arsenic ingestion.[ncbi.nlm.nih.gov]
  • There is no specific treatment. Some authors suggest the use of vitamins and minerals for more than 6 months.[ncbi.nlm.nih.gov]
  • The ayurvedic medication was discontinued and treatment with D-penicillamine started. At 6 months after treatment, blood arsenic levels returned to normal with clinical recovery in all of them.[ncbi.nlm.nih.gov]
  • In vitro studies revealed an induction of ERCC2 hypermethylation and decreased mRNA expression in response to NaAsO 2 treatment.[ncbi.nlm.nih.gov]
  • Treatment may incklude the use of chelating agents such as dimercaprol (BAL), dimercaptosuccinic acid (DMSA), and dimercaptopanesulfonic acid (DMPS).[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • Early diagnosis is the key for this condition and offers the best prognosis visually, as well as systemically, for the affected patient. Dr. Pate is a Clinical Associate Professor at the University of Houston College of Optometry.[reviewofoptometry.com]

Etiology

  • Bowen's disease was followed by four internal malignant tumors, even though the etiological relation between these cancers and arsenic is not clear.[ncbi.nlm.nih.gov]
  • Franklin M, Bean WB, Hardin RC: Fowler's solution as an etiologic agent in cirrhosis. Am J Med Sci 219:589–596, 1950 Google Scholar 19. Wade HJ, Frajer ES: Toxipathic hepatitis due to Fowler's solution. A case treated with dimercaprol.[springerlink.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]
  • Tentative Diagnosis and Follow-Up The tentative assessment at this visit was optic atrophy of an unknown etiology.[reviewofoptometry.com]

Epidemiology

  • Effects of prolonged exposure to high levels of As in drinking water have been observed and documented in various epidemiological studies from all over the world.[ncbi.nlm.nih.gov]
  • Clinical and epidemiological investigations were carried out on 13,021 people to ascertain the nature and degree of morbidity that occurred due to chronic arsenic toxicity.[ncbi.nlm.nih.gov]
  • His Scientific Publications are mainly on Toxicology and Epidemiology of environmental agents, particularly metals.[books.google.com]
  • Abstract An epidemiological, dietary, toxicological and clinical nutrition study, in an area with endemic chronic arsenic poisoning, was made.[ncbi.nlm.nih.gov]
  • "The results are consistent with modern epidemiological studies of arsenic poisoning by ingestion," Kakoulli said, adding that the technological approach used in the study could prove useful to forensic investigations and toxicity assessments in archaeology[livescience.com]
Sex distribution
Age distribution

Pathophysiology

  • This case report demonstrates the wide spectrum of medical complications associated with arsenic poisoning and briefly reviews its pathophysiology and treatment from both the medical and psychosocial perspective.[ncbi.nlm.nih.gov]
  • Useful For Suggests clinical disorders or settings where the test may be helpful Detection of acute or very recent arsenic exposure Monitoring the effectiveness of therapy Clinical Information Discusses physiology, pathophysiology, and general clinical[mayomedicallaboratories.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]
  • Pathophysiology The exact mechanism for chromosomal damage has yet to be fully elucidated.[clinicaladvisor.com]

Prevention

  • Xinghua Gao 3,* 1 Research Center of Environment and Non-Communicable Disease, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning 110122, China 2 Yunnan Institute of Endemic Disease Control and Prevention[mdpi.com]
  • It is a matter of international importance to be able to correctly diagnose chronic arsenic poisoning and to prevent the development of cancers and circulatory disturbances and to supply arsenic-free drinking water"--Preface.[searchworks.stanford.edu]
  • In his diaries this man writes about taking larger doses and feeling stronger and being in terrible pain and headaches, vomiting, and coldness or numbness in his hands and feet, when something prevents him from having his regular doses.[writersforensicsblog.wordpress.com]
  • The article reports treatment and preventative measures based on a review of the literature.)[clinicaladvisor.com]
  • There are no proven therapies for treating chronic arsenic toxicity or for preventing arsenical cancers. Selenium has been known to counter arsenic toxicity in a variety of animal models.[clinicaltrials.gov]

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