Neurological Manifestations of Arsenic Intoxication Follow-up

Updated: Jul 24, 2018
  • Author: Frances M Dyro, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Follow-up

Further Outpatient Care

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  • The patient should be monitored regularly to observe the improvement in neuropathic features and also to assess the need for physical or occupational therapy.

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Inpatient & Outpatient Medications

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  • Chelating agents are used during hospitalization and may be continued on an outpatient basis if the patient is discharged before the course is completed.

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Transfer

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  • Transfer to an extended care facility or rehabilitation center may be necessary in a patient with severe neurological involvement.

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Deterrence/Prevention

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  • The source of the arsenic poisoning should be investigated. People with chronic poisoning by well water often are reassured when testing labels their water "safe." Unfortunately, this usually means simply that the water harbors no pathogenic bacteria. [6]

  • Testing of other family members should be considered; installation of filters or even switching to bottled water may be necessary.

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Complications

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  • Treatment with BAL sometimes produces sterile abscesses that require drainage and may necessitate home nursing care for dressing.

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Prognosis

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  • After removal from exposure, patients generally improve over the course of time. The neuropathy and accompanying weakness may take months or years to resolve. Little is known about the effect on cognition in regularly exposed children. Lead in relatively low levels is known to sometimes produce learning delays and cognitive problems in children. Evaluation of the Japanese children exposed in 1955 found a 10-fold incidence of mental retardation in babies exposed to arsenic contamination of powdered milk.

  • Inorganic arsenic has been suspected as a carcinogen since 1879 when the high rates of lung cancer in German miners were thought to be caused by exposure to inhaled arsenic. Careful surveillance of patients exposed to occupational arsenic on a regular, long-term basis should include screening for cancers of the lung, liver, GI tract, kidney, and hematopoietic system. [22, 23]

  • Arsenic exposure and smoking appear to have synergism; therefore, smoking cessation should be advised strongly.

  • Regular and long-term alcohol intake also appears to contribute to the development and severity of peripheral neuropathy associated with arsenic exposure. This is another factor that can be modified and should be discussed at follow-up visits.

  • The keratotic skin lesions of arsenic toxicity are considered premalignant and must be monitored. OSHA requires periodic chest x-rays and regular skin examinations in workers exposed to arsenic in a work setting.

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