Arsine Poisoning Workup

Updated: Feb 16, 2019
  • Author: Kermit D Huebner, MD, FACEP; Chief Editor: Duane C Caneva, MD, MSc  more...
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Workup

Laboratory Studies

No specific test is available for arsine exposure; however, arsine exposure may be confirmed by 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.

  • Methemoglobin

  • 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. [11]

    • 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. In patients with pulmonary symptoms, however, chest radiography is indicated to detect acute respiratory distress syndrome (ARDS).

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