Arsine Poisoning Follow-up

  • Author: Kermit D Huebner, MD, FACEP; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Jun 3, 2011
 

Further Inpatient Care

  • All patients who have suspected arsine exposure should be carefully observed for 24 hours.
  • Monitor renal function; initiate hemodialysis as necessary for acute renal failure.
  • Monitor hemoglobin levels; perform transfusions to maintain oxygen-carrying capacity of the blood.
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Further Outpatient Care

  • Monitor the patient for signs of chronic arsenic toxicity.
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Inpatient & Outpatient Medications

  • Chelating agents (eg, BAL) may be used to treat chronic arsenic toxicity.
    • Chronic arsenic toxicity from arsine exposure is treated no differently than exposure from other sources.
    • See Toxicity, Arsenic for more information.
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Deterrence/Prevention

  • Train workers in high-risk industries to avoid toxic arsine exposures.
  • Screen workers in the same environment as those persons already exposed to acute arsine poison.
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Complications

  • Renal failure
  • Death
    • Overwhelming exposures cause rapid death from massive hemolysis.
    • In those who survive acute exposures, most deaths occur from renal failure.
  • Chronic arsenic toxicity: Patients who survive acute arsine exposure may develop chronic arsenic toxicity, including anemia and peripheral neuropathy.
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Prognosis

  • Patients who reach medical attention should survive with modern, supportive medical care.
  • Historically, patients who developed renal failure had 100% mortality. More recent (but still dated) studies report a mortality rate from arsine poisoning of approximately 25%.
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Patient Education

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Contributor Information and Disclosures
Author

Kermit D Huebner, MD, FACEP  Research Director, Carl R Darnall Army Medical Center

Kermit D Huebner, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, Association of Military Surgeons of the US, Society for Academic Emergency Medicine, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Ren M Kinoshita, DO  PGY-2 Resident Physician, Department of Emergency Medicine, Carl R Darnall Army Medical Center

Ren M Kinoshita, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Fred Henretig, MD  Director, Section of Clinical Toxicology, Professor, Medical Director, Delaware Valley Regional Poison Control Center, Departments of Emergency Medicine and Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital

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

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

References

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