Arsenic Toxicity Treatment & Management
- Author: Steven Marcus, MD; Chief Editor: Asim Tarabar, MD more...
Provide support to airway, breathing, and circulation.
Emergency Department Care
Hemodynamic stabilization is of primary importance, and large amounts of crystalloid solutions may be required because of significant GI losses (ie, vomiting, diarrhea). In the face of acute blood loss, consideration of the use of blood products may be critical in sustaining the life of the victim.
The use of gastrointestinal decontamination is controversial and may confuse the clinical picture. For acute arsenic ingestions, orogastric lavage is recommended if the patient presents rapidly or plain radiography indicates that arsenic is present in the stomach. Activated charcoal does not adsorb arsenic appreciably and is not recommended for patients in whom co-ingestants are not suspected. Whole bowel irrigation with polyethylene glycol may be effective to prevent GI tract absorption of arsenic. The use of invasive gastric-emptying procedures has been reported in dire cases, but these attempts do not seem to be fruitful.
Do not delay with definitive chelation therapy and hemodialysis.
Consult a hematologist and nephrologist in cases of arsine exposure.
Neurology and physiatry consultations are appropriate in cases of arsenic exposures induced neuropathy.
Consultation with a medical toxicologist conversant with the use of chelation therapy may be very useful.
Psychiatric consultation is necessary before discharge if the arsenic ingestion was intentional.
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