Neurological Manifestations of Arsenic Intoxication Treatment & Management

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

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

  • 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; 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

  1. Ford M. Arsenic. In: Goldfrank LR, Flomenbaum NE, et al, eds. Toxicologic Emergencies. 1994:1011-1029.

  2. Axelson O, Dahlgren E, Jansson CD, Rehnlund SO. Arsenic exposure and mortality: a case-referent study from a Swedish copper smelter. Br J Ind Med. Feb 1978;35(1):8-15. [Medline].

  3. Bae M, Watanabe C, Inaoka T, et al. Arsenic in cooked rice in Bangladesh. Lancet. Dec 7 2002;360(9348):1839-40. [Medline].

  4. Franzblau A, Lilis R. Acute arsenic intoxication from environmental arsenic exposure. Arch Environ Health. Nov-Dec 1989;44(6):385-90. [Medline].

  5. Heinrich-Ramm R, Mindt-Prufert S, Szadkowski D. Arsenic species excretion in a group of persons in northern Germany-- contribution to the evaluation of reference values. Int J Hyg Environ Health. Jul 2001;203(5-6):475-7. [Medline].

  6. Ball P. Arsenic-free water still a pipedream. Nature. Jul 21 2005;436(7049):313. [Medline].

  7. Fowler BA, Weissberg JB. Arsine poisoning. N Engl J Med. Nov 28 1974;291(22):1171-4. [Medline].

  8. Heyman A, Pfeiffer JB, Willett RW, Taylor HM. Peripheral neuropathy caused by arsenical intoxication; a study of 41 cases with observations on the effects of BAL (2, 3, dimercapto-propanol). N Engl J Med. Mar 1 1956;254(9):401-9. [Medline].

  9. Chen CJ, Wu MM, Lee SS, et al. Atherogenicity and carcinogenicity of high-arsenic artesian well water. Multiple risk factors and related malignant neoplasms of blackfoot disease. Arteriosclerosis. Sep-Oct 1988;8(5):452-60. [Medline].

  10. Watanabe C, Kawata A, Sudo N, et al. Water intake in an Asian population living in arsenic-contaminated area. Toxicol Appl Pharmacol. Aug 1 2004;198(3):272-82. [Medline].

  11. Donofrio PD, Wilbourn AJ, Albers JW, et al. Acute arsenic intoxication presenting as Guillain-Barre-like syndrome. Muscle Nerve. Feb 1987;10(2):114-20. [Medline].

  12. Bates MN, Smith AH, Hopenhayn-Rich C. Arsenic ingestion and internal cancers: a review. Am J Epidemiol. Mar 1 1992;135(5):462-76. [Medline].

  13. Enterline PE, Henderson VL, Marsh GM. Exposure to arsenic and respiratory cancer. A reanalysis. Am J Epidemiol. Jun 1987;125(6):929-38. [Medline].

  14. Karagas MR, Le CX, Morris S, et al. Markers of low level arsenic exposure for evaluating human cancer risks in a US population. Int J Occup Med Environ Health. 2001;14(2):171-5. [Medline].

  15. Argos M, Kalra T, Rathouz PJ, Chen Y, Pierce B, Parvez F, et al. Arsenic exposure from drinking water, and all-cause and chronic-disease mortalities in Bangladesh (HEALS): a prospective cohort study. Lancet. Jul 24 2010;376(9737):252-8. [Medline].

  16. Grandjean P, Landrigan PJ. Developmental neurotoxicity of industrial chemicals. Lancet. Dec 16 2006;368(9553):2167-78. [Medline].

  17. Kyle RA, Pease GL. Hematologic aspects of arsenic intoxication. N Engl J Med. Jul 1 1965;273:18-23. [Medline].

  18. Massey EW. Arsenic neuropathy. Neurology. Aug 1981;31(8):1057-8. [Medline].

  19. Moyer TP. Testing for arsenic. Mayo Clin Proc. Dec 1993;68(12):1210-1. [Medline].

  20. Lee AM, Fraumeni JF Jr. Arsenic and respiratory cancer in man: an occupational study. J Natl Cancer Inst. Jun 1969;42(6):1045-52. [Medline].

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

 
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