Neurological Manifestations of Arsenic Intoxication Follow-up

  • Author: Frances M Dyro, MD; Chief Editor: Tarakad S Ramachandran, MBBS, FRCP(C), FACP   more...
 
Updated: May 17, 2012
 

Further Outpatient Care

  • The patient should be monitored regularly to observe the improvement in neuropathic features and also to assess the need for physical or occupational therapy.
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Inpatient & Outpatient Medications

  • Chelating agents are used during hospitalization and may be continued on an outpatient basis if the patient is discharged before the course is completed.
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Transfer

  • Transfer to an extended care facility or rehabilitation center may be necessary in a patient with severe neurological involvement.
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Deterrence/Prevention

  • The source of the arsenic poisoning should be investigated. People with chronic poisoning by well water often are reassured when testing labels their water "safe." Unfortunately, this usually means simply that the water harbors no pathogenic bacteria.[6]
  • Testing of other family members should be considered; installation of filters or even switching to bottled water may be necessary.
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Complications

  • Treatment with BAL sometimes produces sterile abscesses that require drainage and may necessitate home nursing care for dressing.
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Prognosis

  • After removal from exposure, patients generally improve over the course of time. The neuropathy and accompanying weakness may take months or years to resolve. Little is known about the effect on cognition in regularly exposed children. Lead in relatively low levels is known to sometimes produce learning delays and cognitive problems in children. Evaluation of the Japanese children exposed in 1955 found a 10-fold incidence of mental retardation in babies exposed to arsenic contamination of powdered milk.
  • Inorganic arsenic has been suspected as a carcinogen since 1879 when the high rates of lung cancer in German miners were thought to be caused by exposure to inhaled arsenic. Careful surveillance of patients exposed to occupational arsenic on a regular, long-term basis should include screening for cancers of the lung, liver, GI tract, kidney, and hematopoietic system.[20, 21]
  • Arsenic exposure and smoking appear to have synergism; therefore, smoking cessation should be advised strongly.
  • Regular and long-term alcohol intake also appears to contribute to the development and severity of peripheral neuropathy associated with arsenic exposure. This is another factor that can be modified and should be discussed at follow-up visits.
  • The keratotic skin lesions of arsenic toxicity are considered premalignant and must be monitored. OSHA requires periodic chest x-rays and regular skin examinations in workers exposed to arsenic in a work setting.
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Contributor Information and Disclosures
Author

Frances M Dyro, MD  Associate Professor of Neurology, New York Medical College; Neuromuscular Section, Department of Neurology, Westchester Medical Center

Frances M Dyro, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Muscular Dystrophy Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jonathan S Rutchik, MD, MPH  Clinical Professor, Division of Occupational Medicine, Department of Neurology, Environmental and Occupational Medicine, University of California, San Francisco, School of Medicine

Jonathan S Rutchik, MD, MPH is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Occupational and Environmental Medicine, and Society of Toxicology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Glenn Lopate, MD  Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Director of Neurology Clinic, St Louis ConnectCare; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa

Disclosure: Baxter Grant/research funds Other; Amgen Grant/research funds None

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP  Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine

Disclosure: Abbott Labs None None; Teva Marion None None; Boeringer-Ingelheim Honoraria Speaking and teaching

References

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  21. Neubauer O. Arsenical cancer. Br J Cancer. 1947;1:192-251.

 
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