Arsenic Toxicity in Emergency Medicine Medication

  • Author: Steven Marcus, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: May 11, 2012
 

Medication Summary

Treatment of acute arsenic toxicity is supportive. Chelation therapy is imperative in all symptomatic patients; however, the use of chelators in patients exposed to arsine gas is controversial. The efficacy of chelation therapy in providing either laboratory or clinical improvement in intoxicated patients is lacking.

The physician is reminded to look carefully at laboratory tests. Generally, organic arsenical compounds found in the urine are not an indication of arsenic toxicity and do not warrant therapeutical intervention.

Hemodialysis, in the absence of renal failure, has not been shown to alter medical outcome. The use of extracorporeal membrane oxygenation in an infant who developed cardiovascular collapse did not result in survival.

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Chelating agents

Class Summary

Bind heavy metals and to hasten excretion. By binding in plasma, they render heavy metals nontoxic.

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Dimercaprol (BAL in Oil)

 

First-line agent available in the US for treating arsenic poisoning. Often in short supply, is one of the antidotes considered essential to be stocked by every ED.

Administered IM q4h, mixed in a peanut oil base. Excreted in urine and bile. May be administered to patients with renal failure.

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Succimer (DMSA)

 

Licensed by the FDA for use only in childhood lead poisoning. Has been used worldwide as a heavy metal chelator and has been efficacious in treating arsenic intoxications. In the US, is only available in a bead-filled oral capsule of 100 mg.

Dimerval (DMPS)

 

Internationally accepted DOC for treating most heavy metal poisonings. Not licensed for use in the US and must be obtained from Helytex in Houston. Available as either a parenteral or oral form.

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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.

Specialty Editor Board

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.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and 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.

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.

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, Director, Medical Toxicology, Department 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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Black water urine from a patient with massive hemolysis secondary to arsine exposure at a gas tank cleaning operation.
 
 
 
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