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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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.


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).