Arsine Poisoning Workup

Updated: Apr 22, 2015
  • Author: Kermit D Huebner, MD, FACEP; Chief Editor: Robert G Darling, MD, FACEP  more...
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Workup

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

See the list below:

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