eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Arsenic: Follow-up

Author: Steven Marcus, MD, Professor, Department of Preventive Medicine and Community Health, Associate Professor, Department of Pediatrics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey; Executive and Medical Director, New Jersey Poison Information and Education System; Consulting Staff, Departments of Pediatrics and Internal Medicine, University Hospital, University of Medicine and Dentistry of New Jersey; Consulting Staff, Department of Pediatrics, Newark Beth Israel Medical Center
Contributor Information and Disclosures

Updated: Apr 21, 2009

Follow-up

Further Inpatient Care

  • Many patients will develop profound peripheral motor palsies requiring extensive rehabilitation. Rehabilitation should be started as promptly as the clinical picture allows.

Further Outpatient Care

  • Perform a careful neurological evaluation in follow-up of all patients because the peripheral neuropathy, which may develop after an acute exposure, may not appear for 2-3 weeks.

Complications

  • Sterile abscesses after the use of dimercaprol (BAL in Oil) are not unusual. They initially may appear like erythematous macules, which spread or coalesce and may continue to drain for some time.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to immediately report all suspicious cases to an appropriate law enforcement agency (If someone presents with arsenic toxicity and the cause is not obvious, a malicious etiology may be involved.)

Special Concerns

  • Checking the patient's family members for exposure is important because a good chance exists that they may also have been exposed to arsenic toxicity.
 


More on Toxicity, Arsenic

Overview: Toxicity, Arsenic
Differential Diagnoses & Workup: Toxicity, Arsenic
Treatment & Medication: Toxicity, Arsenic
Follow-up: Toxicity, Arsenic
Multimedia: Toxicity, Arsenic
References
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References

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  3. Ng JC, Moore MR. Arsenic in drinking water: a natural killer in Bangladesh and beyond. An urgent alternative watershed management strategy is needed. Med J Aust. Dec 5-19 2005;183(11-12):562-3. [Medline]. [Full Text].

  4. Zablotska LB, Chen Y, Graziano JH, Parvez F, van Geen A, Howe GR, et al. Protective effects of B vitamins and antioxidants on the risk of arsenic-related skin lesions in Bangladesh. Environ Health Perspect. Aug 2008;116(8):1056-62. [Medline].

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  14. Muckter H, Liebl B, Reichl FX, et al. Are we ready to replace dimercaprol (BAL) as an arsenic antidote?. Hum Exp Toxicol. Aug 1997;16(8):460-5. [Medline].

  15. Navarro B, Sayas MJ, Atienza A, Leon P. An unhappily married man with thick soles. Lancet. Jun 8 1996;347(9015):1596. [Medline].

  16. Severo R. Albany consumer unit calls sealant a health peril. NY Times Mag. Dec 30 1976;42.

  17. Stenehjem AE, Vahter M, Nermell B, Aasen J, Lierhagen S, Morland J. Slow recovery from severe inorganic arsenic poisoning despite treatment with DMSA (2.3-dimercaptosuccinic acid). Clin Toxicol (Phila). May 2007;45(4):424-8. [Medline].

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Further Reading

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Keywords

arsenic toxicity, arsenic poisoning, element 33, poison, As, arsenic exposure, trivalent arsenic, pentavalent inorganic arsenic, arsine, arsine exposure, arsenic gas, arsenic trioxide, heavy metal exposure, heavy metal toxicity

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Contributor Information and Disclosures

Author

Steven Marcus, MD, Professor, Department of Preventive Medicine and Community Health, Associate Professor, Department of Pediatrics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey; Executive and Medical Director, New Jersey Poison Information and Education System; Consulting Staff, Departments of Pediatrics and Internal Medicine, University Hospital, University of Medicine and Dentistry of New Jersey; Consulting Staff, Department of Pediatrics, Newark Beth Israel Medical Center
Steven Marcus, MD is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Clinical Toxicology, American Academy of Pediatrics, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, and Medical Society of New Jersey
Disclosure: Nothing to disclose.

Medical Editor

David C Lee, MD, Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School
David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Michael J Burns, MD, Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center
Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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