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Neurological Manifestations of Arsenic Intoxication Treatment & Management

  • Author: Frances M Dyro, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
 
Updated: Nov 02, 2015
 

Medical Care

The patient who presents with acute exposure is usually in severe distress. Hydration is vital in managing dehydration that can rapidly lead to hypovolemic shock because of the severity of the vomiting and diarrhea. If the patient is not actively vomiting, consider lavage with warm water or (some suggest) 1% solution of sodium thiosulfate. Whole bowel irrigation with polyethylene glycol may reduce or prevent continued absorption of arsenic that has passed the stomach. Chelation therapy should be started immediately.

  • In the patient with acute arsine exposure and hemolytic anemia, the renal complications must be managed promptly. Chelation and hemodialysis should be initiated as soon as possible.
  • The abdominal pain associated with acute toxic ingestion is severe enough to warrant the use of morphine.
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Consultations

See the list below:

  • Nephrology and hematology consultation should be requested urgently in cases of arsine exposure even if the hemolytic anemia has not manifested itself.
  • Pulmonary consultation may be necessary in cases of arsine inhalation.
  • A neurologist should be consulted for management of seizures and neuropathy.
  • If the arsenic was ingested as a suicidal act, a psychiatrist must be consulted.
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Diet

During the acute phase, when the patient is vomiting and having diarrhea, parenteral fluids are indicated. After the patient's condition stabilizes, oral intake may be allowed as tolerated. If circumstances are suspect, the patient should not be served any food or drink from home.

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Activity

Activity is dependent on the patient's level of alertness and intactness of the peripheral nervous system.

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Contributor Information and Disclosures
Author

Frances M Dyro, MD Associate Professor of Neurology, New York Medical College; Physician, 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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American College of International Physicians, American Heart Association, American Stroke Association, American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, National Association of Managed Care Physicians, American College of Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Jonathan S Rutchik, MD, MPH Associate Clinical Professor, Division of Occupational Medicine, Department of Medicine, University of California, San Francisco, School of Medicine; Neurology, Environmental and Occupational Medicine Associates (www.neoma.com)

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

Disclosure: Nothing to disclose.

References
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