Arsenic Poisoning

WHAT IS IT?

Arsenic poisoning is a self descriptive condition. Arsenic is a toxin that is odorless, tasteless, and easily absorbed after ingestion/inhalation. 

WHAT CAUSES IT?

Ingestion/inhalation of a arsenic is responsible for this condition. There are various sources of arsenic to be aware of:

• Pesticides/insecticides 
• Contaminated water (such as wells)
• Pressure-treated wood
• Metallurgy (metal working)
• Mining 
• Glass making 

WHY IS IT CONCERNING MEDICALLY?

Arsenic imparts cellular respiration by inhibiting pyruvate dehydrogenase. It will also disrupt gluconeogensis and glutathione metabolism. 

Arsenic also causes QTc prolongation that can also progress to life-threatening torsades de points. 

WHAT IS THE INTIAL PRESENTATION?

Patient Chief Complaints:

• Vomiting: can occur acutely 
• Watery diarrhea: can occur acutely 

Detected Medical Problems:

• QTC prolognation 

WHAT ARE IMPORTANT ELEMENTS OF THE MEDICAL HISTORY?

Risk Factors:

Medical History:

WHAT ARE IMPORTANT FEATURES OF THE PHYSICAL EXAM?

Vital Signs:

General:

• Garlic breath may be noticed in the patient

CLINICAL WORKUP: SERUM STUDIES

CLINICAL WORKUP: IMAGING

CLINICAL WORKUP: OTHER

HOW DO WE NARROW THE DIFFERENTIAL?

Conditions that present similarly and how to exclude them:

WHAT IS OUR THRESHOLD FOR DIAGNOSING THIS CONDITION?

PATIENT MANAGEMENT: DISEASE TREATMENT

Chelation of arsenic is a priority:

• Dimercaprol is a first-line chelating agent used for this condition. It increases urinary excretion of heavy metals by forming stable, nontoxic, soluble chelates. 

PATIENT MANAGEMENT: PROPHYLACTIC MEASURES

COULD THIS HAVE BEEN PREVENTED?

ARCHIVE OF STANDARDIZED EXAM QUESTIONS 

This archive compiles standardized exam questions that relate to this topic.

Page Updated: 04.06.2017