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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:
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Complete blood cell count, hemoglobin, haptoglobin, Coombs test - Hemolytic anemia from arsine exposure may be severe and rapidly developing, with pink serum resulting from free hemoglobin, and decreased haptoglobin. Hemolytic anemia: Coombs test results are negative. In addition, an elevated white blood cell count may be seen early.
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Methemoglobin
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Urinalysis may show hemoglobinuria (possible methemoglobinuria) and proteinuria (with possible tubular casts).
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Serum chemistry panel in patients with hemolysis can show hyperkalemia, elevated lactate dehydrogenase level, and hyperbilirubinemia; acute kidney injury can cause elevated creatinine and blood urea nitrogen (BUN) levels [12] ; hepatic transaminase levels may be elevated.
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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.
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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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