What is Arsenic Poisoning?

Arsenic poisoning is mainly caused by arsenic compounds. The toxicity of trivalent arsenic compounds is stronger than that of pentavalent arsenic. Among them, the more toxic arsenic trioxide (commonly known as arsenic) poisoning is more common. Poisoning can occur from 0.01 to 0.05 g orally. ~ 200mg (0.76 ~ 1.95mg / kg). Arsenic poisoning such as arsenic disulfide (realgar), diarsenic trisulfide (female yellow) and hydrogen arsenide is also common. Acute arsenic poisoning is mainly caused by oral arsenic, and long-term use of arsenic-containing drugs can also cause poisoning. Occupational arsenic poisoning is found in production workers who melt arsenic-containing ores, manufacture alloys, glass, ceramics, arsenic-containing medicines and pesticides, and print and dye. Arsenide can be absorbed through the skin or wounds. Long-term exposure to arsenide can cause chronic poisoning. Excessive arsenic in drinking water can cause endemic arsenic poisoning.

Basic Information

English name: arsenic poisoning
Visiting department: Emergency department, occupational disease department
Multiple groups: Those who take arsenic-containing drugs for a long time, and those who melt arsenic-containing ore to make alloys, glass and ceramics

Common causes: Mainly caused by arsenic compounds
Common symptoms: Acute gastroenteritis is the main evidence of acute arsenic poisoning; in addition to the symptoms of neurasthenia, chronic arsenic poisoning is manifested by diverse skin damage and polyneuritis

Causes of Arsenic Poisoning

Excessive dose of arsenic-containing drugs or long-term use, can also be caused by ingestion of arsenic-containing poisonous rats, snails, insecticides, and fruits and vegetables just sprayed by such insecticides, and poisoned birds , Livestock, meat, etc. Arsenic trioxide (also known as arsenic, red, white letter, etc.) is often used for seed dressing in rural areas in northern China. Its pure product looks similar to salt, sugar, flour, gypsum, etc. It can be poisoned by misuse, misuse, and also due to diet. Poisoning from well water and food contaminated with arsenic trioxide, maternal poisoning can cause fetal and infant poisoning. Occupational arsenic poisoning is found in production workers who melt arsenic-containing ores, manufacture alloys, glass, ceramics, arsenic-containing medicines and pesticides, and print and dye.

Clinical manifestations of arsenic poisoning

Acute arsenic poisoning

Mostly caused by swallowing or suicide by swallowing soluble arsenic compounds. Poisoning symptoms can occur 10 minutes to 1.5 hours after oral administration.

(1) Acute gastroenteritis manifests esophageal burning sensation, metal odor in the mouth, nausea, vomiting, abdominal pain, diarrhea, rice-like stool (sometimes with blood), which can cause dehydration, electrolyte disturbance, prerenal renal insufficiency and even Circulatory failure and so on.

(2) Nervous system manifestations include headache, dizziness, fatigue, numbness around the mouth, general soreness, severe patient irritability, delirium, delusion, muscle cramps in the limbs, blurred consciousness, coma, and death from respiratory paralysis. Peripheral neuritis and radiculitis can occur from 3 to 3 weeks after acute poisoning, manifested by muscle pain, numbness of the limbs, acupuncture-like sensation, weakness of the upper and lower limbs, and symptoms of symmetrical development of distal to proximal limbs Features, feeling reduced or disappeared later. Severe patients have drop feet, wrists, muscle atrophy, and Achilles tendon reflexes disappear.

(3) Other organ damage includes toxic hepatitis (hepatomegaly, abnormal liver function or jaundice, etc.), myocardial damage, renal damage, anemia, etc.

Acute inhaled arsenic poisoning mainly manifests eye and respiratory tract irritation and nervous system symptoms, including eye tingling, tearing, conjunctival congestion, cough, sneezing, chest pain, dyspnea, headache, dizziness, etc. In severe cases, throat and throat swelling, Asphyxia, or coma, shock. Gastrointestinal symptoms occur relatively late and are mild.

There may be local pruritus and rash on the skin contact area, and after a week, pityriasis-like desquamation occurs, followed by local pigmentation and hyperkeratosis. For 40 to 60 days of acute poisoning, almost all patients had white horizontal stripes (Mess lines) on their fingernails and toenails, which moved to the tip of the toe with growth and disappeared after about 5 months.

(4) The clinical manifestations of arsenic poisoning are mainly acute hemolysis.

2. Chronic arsenic poisoning

In addition to neurasthenia symptoms, it is manifested by multiple skin lesions and polyneuritis. Dust of arsenic compounds can cause irritating dermatitis, which occurs in the back of the chest, skin wrinkles and wet areas, such as the corners of the mouth, axilla, scrotum, groin and so on. Papules, herpes, and pustules can be seen on dry and rough skin. A few people have exfoliative dermatitis, and the skin will be black or brown-black with scattered pigmentation spots in the future. Hair is shed, hands and soles are hyperkeratinized or moulting. The typical manifestation is the ulnar side of the palm, the roots of the fingers have many small, horn-like or grain-like keratinized bulges, commonly known as or arsenic , which can be Fusion into warts or necrosis, secondary infections, formation of persistent ulcers, can be transformed into skin carcinoma in situ. Mucosal irritation can cause nasopharyngeal dryness, rhinitis, epistaxis, and even perforation of the nasal septum. Can also cause conjunctivitis, gingivitis, stomatitis and colitis. At the same time, toxic hepatitis (rarely developed into cirrhosis), poor regeneration of bone marrow hematopoiesis, numbness of the limbs, and decreased feeling of peripheral nerves can occur.

Arsenic poisoning test

Determination of arsenic in urine

Urinary arsenic in patients with acute arsenic poisoning increased significantly from hours to 12 hours after the poisoning, and the degree was directly proportional to the severity of the poisoning. Urinary arsenic is excreted very quickly. If you stop contact for 2 days, you can reduce 19% to 42%. After one intake of arsenide, the arsenic in urine increased for about 7 days.

2. Determination of blood arsenic

Can be elevated during acute poisoning.

3. Arsenic

It can be used as an indicator of chronic arsenic exposure, and it is considered abnormal if it is higher than 1 g / g.

Arsenic poisoning diagnosis

The diagnosis of acute arsenic poisoning can be based on oral or exposure history. The clinical manifestations are acute gastroenteritis, disturbance of consciousness, liver and kidney damage. Chronic arsenic poisoning is mostly manifested as skin and mucosal lesions, polyneuritis, and liver damage. The appearance of Mie lines on the fingernails indicates absorption of arsenic. Urinary arsenic exceeding 2.66 mol / L (0.12 mg / L) indicates excessive arsenic absorption.

Arsenic Poisoning Treatment

Oral acute poisoning should induce vomiting as early as possible, or lavage the stomach with warm water, normal saline or 1% sodium bicarbonate solution, and then immediately take freshly prepared iron hydroxide (12% ferrous sulfate solution and 20% magnesium oxide suspension, Mix and prepare the same amount before use, shake when using), make it insoluble iron arsenate with arsenic, and then give sodium sulphate or magnesium sulphate to diarrhea. After gastric lavage, 30g of activated carbon, 20-40g of magnesium oxide or protein water (4 egg whites and about 200ml of water are mixed well).

There are specific antidote for acute arsenic poisoning. Dimercaptopropane sodium 5mg / kg, intramuscular or intravenous injection; the first 2 g of dimercaptobutane dissolve in 10 ~ 20ml saline, intravenously, the course of treatment is 3 ~ 5d. Penicillamine also has a certain arsenic-repellent effect, and should be applied as soon as possible (use dosage, method, etc. according to the doctor's order).

Symptomatic and supportive treatment: In patients with severe abdominal pain, intramuscular atropine or gatiperidine can be injected; for muscle spasm pain, calcium gluconate can be given intravenously. Supplement vitamin B, vitamin C, vitamin K, pay attention to prevention and correction of dehydration, electrolyte disorders and shock. Hemodialysis should be performed as soon as possible in severe patients, which can effectively remove arsenic in the blood and prevent acute renal failure.

Those suffering from arsenic poisoning inhale oxygen, hydrocortisone 400 600mg or methylprednisolone 10 20mg intravenously to inhibit hemolytic reaction. If hemoglobin is as low as 5g, blood transfusion should be given.

Chronic arsenic poisoning can be intravenously injected with 10% sodium thiosulfate to assist renal excretion. Skin or mucosal lesions can be overcoated with 2.5% dimercaprol ointment or dexamethasone ointment. When multiple peripheral neuropathy appears, treat it symptomatically.