Arsine Poisoning Workup

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

Laboratory Studies

No specific test is available for arsine exposure; however, arsine exposure may lead to detection of elevated arsenic levels in urine (>50 mcg/L for a spot test or >50 mcg for a 24-hour urine test) and signs of hemolysis (eg, hemoglobinuria, anemia, or low haptoglobin). In addition, arsine may be detected in environmental samples.

The following tests may aid in the diagnosis:

  • Complete blood cell count
    • Hemolytic anemia: Coombs test results are negative; this may be severe and rapidly developing, with pink serum resulting from free hemoglobin, and decreased haptoglobin.
    • Elevated white blood cell count: This may be seen early.
  • Methemoglobinemia
  • Urinalysis
    • Hemoglobinuria (possible methemoglobinuria)
    • Proteinuria (with possible tubular casts)
  • Serum chemistry panel
    • Hemolysis can cause hyperkalemia, elevated lactate dehydrogenase level, and hyperbilirubinemia.
    • Renal failure can cause elevated creatinine and BUN levels.
    • Hepatic transaminase levels may be elevated.
  • Arsenic levels
    • Blood and urine arsenic levels are elevated acutely, but these findings are not necessarily helpful in treatment decisions.
    • A 24-hour urine arsenic test may help in monitoring chronic, low-level arsine exposures.
  • Electrocardiography
    • Peaked T waves from hyperkalemia may be seen.
    • Nonspecific ST-segment and T-wave abnormalities have been reported.
    • QT-interval prolongation is possible from arsenic toxicity.
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Imaging Studies

  • No routine imaging studies are indicated.
  • Chest radiography is indicated to detect ARDS in patients with pulmonary symptoms.
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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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