Arsine Poisoning Medication

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

Medication Summary

Diuresis with intravenous mannitol and urinary alkalinization with sodium bicarbonate may be of benefit prior to the onset of renal failure.

Next

Diuretics

Class Summary

These agents promote urine flow.

View full drug information

Mannitol (Osmitrol, Resectisol)

 

Increases osmotic pressure of glomerular filtrate, inducing an osmotic gradient that inhibits tubular resorption of water and electrolytes, resulting in increased urinary output.

Previous
Next

Urinary alkalinization agents

Class Summary

These agents decrease risk of heme-pigment–induced renal injury from arsine-related hemolysis.

View full drug information

Sodium bicarbonate (Neut)

 

Dosing of sodium bicarbonate to induce urinary alkalinization not standardized; urinary alkalinization may prevent heme-pigment nephropathy by decreasing hemoglobin crystallization in renal tubules and/or by decreasing iron uptake by tubular epithelium.

Previous
Proceed to Follow-up
 
 
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

  1. Blair PC, Thompson MB, Bechtold M, Wilson RE, Moorman MP, Fowler BA. Evidence for oxidative damage to red blood cells in mice induced by arsine gas. Toxicology. Jul 1990;63(1):25-34. [Medline].

  2. Rael LT, Ayala-Fierro F, Carter DE. The effects of sulfur, thiol, and thiol inhibitor compounds on arsine-induced toxicity in the human erythrocyte membrane. Toxicol Sci. Jun 2000;55(2):468-77. [Medline].

  3. Chowdhury R, Chowdhury S, Roychoudhury P, Mandal C, Chaudhuri K. Arsenic induced apoptosis in malignant melanoma cells is enhanced by menadione through ROS generation, p38 signaling and p53 activation. Apoptosis. Jan 2009;14(1):108-23. [Medline].

  4. Dai CW, Zhang GS, Shen JK, Zheng WL, Pei MF, Xu YX, et al. Use of all-trans retinoic acid in combination with arsenic trioxide for remission induction in patients with newly diagnosed acute promyelocytic leukemia and for consolidation/maintenance in CR patients. Acta Haematol. 2009;121(1):1-8. [Medline].

  5. Pullen-James S, Woods SE. Occupational arsine gas exposure. J Natl Med Assoc. Dec 2006;98(12):1998-2001. [Medline].

  6. Wilkinson SP, McHugh P, Horsley S, Tubbs H, Lewis M, Thould A, et al. Arsine toxicity aboard the Asiafreighter. Br Med J. Sep 6 1975;3(5983):559-63. [Medline].

  7. Centers for Disease Control and Prevention. Case Definition: Arsine or Stibine Poisoning. Emergency Preparedness and Response. Last updated March 4, 2005. Available at http://emergency.cdc.gov/agent/arsine/casedef.asp.

  8. Centers for Disease Control and Prevention. Agency for Toxic Substances and Disease Registry. Medical Management Guidelines for Arsine. Last updated 9/24/07. Available at http://www.atsdr.cdc.gov/MHMI/mmg169.html. Accessed October 5, 2007.

  9. Hesdorffer CS, Milne FJ, Terblanche J, Meyers AM. Arsine gas poisoning: the importance of exchange transfusions in severe cases. Br J Ind Med. May 1986;43(5):353-5. [Medline].

  10. Teitelbaum DT, Kier LC. Arsine poisoning. Report of five cases in the petroleum industry and a discussion of the indications for exchange transfusion and hemodialysis. Arch Environ Health. Jul 1969;19(1):133-43. [Medline].

  11. Pullen-James S, Woods SE. Occupational arsine gas exposure. J Natl Med Assoc. Dec 2006;98(12):1998-2001. [Medline].

  12. Danielson C, Houseworth J, Skipworth E, Smith D, McCarthy L, Nanagas K. Arsine toxicity treated with red blood cell and plasma exchanges. Transfusion. Sep 2006;46(9):1576-9. [Medline].

  13. Song Y, Wang D, Li H, Hao F, Ma J, Xia Y. Severe acute arsine poisoning treated by plasma exchange. Clin Toxicol (Phila). Sep 2007;45(6):721-7. [Medline].

  14. Anthonisen P, Nielsen B, Pedersen K, Raaschou F. 3. Clinical picture and treatment in arsine poisoning. Acta Med Scand Suppl. 1968;496:14-22. [Medline].

  15. Caravati, Martin E. Arsenic and arsine gas. In: Dart RC. Medical Toxicology. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:1393-1401/chap 213.

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

  17. Huq MA, Parveen F, Choudhury SR. A cheap and convenient modification of arsine generator used for arsenic estimation. Mymensingh Med J. Jan 2003;12(1):30-2. [Medline].

  18. Klimecki WT, Carter DE. Arsine toxicity: chemical and mechanistic implications. J Toxicol Environ Health. Dec 1995;46(4):399-409. [Medline].

  19. Levinsky WJ, Smalley RV, Hillyer PN, Shindler RL. Arsine hemolysis. Arch Environ Health. Mar 1970;20(3):436-40. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.