The history of the patient is very
important as exposures are most often from industrial accidents so other
people (coworkers, rescue personnel) may be exposed and not realize
they may have some risk also. People exposed to toxic levels of arsenic
may have breath and urine that smells like garlic as a clue to their
diagnosis. Most doctors that suspect arsenic (or other metal or
metalloid poisonings) will request lab studies such as blood cell counts and serum electrolytes
such as calcium and magnesium; if there is evidence of hemolysis (blood
cell destruction), a type and screening for a potential blood transfusion is done.
There
are rapid urine "spot" tests available to diagnose elevated levels of
arsenic, but they usually don't distinguish between organic and
inorganic arsenic. The patient's blood and urine will be sent for
analysis for arsenic; a result of > 50 micrograms/L is considered
elevated, but acute toxic exposures may result in levels 5 to 100 times
or more than those which are considered "elevated." A speciation test
(determines levels of inorganic versus organic arsenic) is required in
all cases in which total urine arsenic is elevated since inorganic
arsenic is so toxic. Electrocardiograms (ECG, EKG) and nerve conduction tests are often done in any type of suspected arsenic exposure. Tests for other toxins or toxic overdoses (for example, Tylenol ingestion) may also be done.
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