Arsine Poisoning Workup

Updated: Feb 23, 2023
  • 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, 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.
  • Methemoglobin
  • Urinalysis may show hemoglobinuria (possible methemoglobinuria) and proteinuria (with possible tubular casts).
  • 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.
  • 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).