Acute toxic inorganic arsenic exposure
and arsine gas exposure can rapidly result in death, and there are only a
few ways to possibly save the patient's life. Hemodialysis can remove
arsenic from the bloodstream, but only before it binds to the tissues so
there is only a short time window for this treatment to work.
Similarly, arsine binds to and causes rapid destruction of red blood
cells, so blood transfusions and exchange transfusions may help the
patient. In addition, if the arsenic was ingested, stomach or bowel
irrigation may be attempted, but there is no good data to indicate these
will be successful. Consultation with a nephrologist and a toxicologist
as soon as possible is recommended; other consultants may need to be
called (hematologist, psychiatrist, or others).
Chelation
therapy (the use of drugs that selectively bind and effectively
inactivate substances) is usually begun quickly through an intravenous
line. The drug and the bound arsenic is then excreted through the urine.
The chelation drug of choice is Dimercaprol (also termed BAL in oil);
Succimer (DMSA) has also been used successfully, and Dimerval (DMPS) may
also work as a chelator, but it is not readily available in the US.
What is the prognosis (outcome) of arsenic poisoning?
If
the patient survives an acute toxic exposure, most will develop some
degree of nerve damage to the peripheral nerves (sensory and motor
disturbances); many survivors may have cardiac, liver, renal, and skin
problems; the prognosis is fair to poor. Chronic poisoning and organic
arsenic exposure have better outcomes with fewer and less severe
problems.
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