Medical Care
The patient who presents with acute exposure is usually in severe distress. Hydration is vital in managing dehydration that can rapidly lead to hypovolemic shock because of the severity of the vomiting and diarrhea. If the patient is not actively vomiting, consider lavage with warm water or (some suggest) 1% solution of sodium thiosulfate. Whole bowel irrigation with polyethylene glycol may reduce or prevent continued absorption of arsenic that has passed the stomach. Chelation therapy should be started immediately.
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In the patient with acute arsine exposure and hemolytic anemia, the renal complications must be managed promptly. Chelation and hemodialysis should be initiated as soon as possible.
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The abdominal pain associated with acute toxic ingestion is severe enough to warrant the use of morphine.
Consultations
See the list below:
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Nephrology and hematology consultation should be requested urgently in cases of arsine exposure even if the hemolytic anemia has not manifested itself.
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Pulmonary consultation may be necessary in cases of arsine inhalation.
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A neurologist should be consulted for management of seizures and neuropathy.
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If the arsenic was ingested as a suicidal act, a psychiatrist must be consulted.
Diet
During the acute phase, when the patient is vomiting and having diarrhea, parenteral fluids are indicated. After the patient's condition stabilizes, oral intake may be allowed as tolerated. If circumstances are suspect, the patient should not be served any food or drink from home.
Activity
Activity is dependent on the patient's level of alertness and intactness of the peripheral nervous system.
