Sx:
Acute: nausea, vomiting and diarrhea with esophageal and epigastric pain; immediate "rice water," then bloody stool; CHF (myocardiopathy) immediate with increased QT and torsades de pointes Vtach, rx with pacer or MgSO4 (Hypertension)
Chronic: vague malaise
Si:
Acute:
Chronic: Mees' lines in nails after 4-6 wk of chronic exposure (r/o INH, thallium); hematuria especially in children; increased skin pigmentation with spared spots = "rain drops on a dusty table"; keratosis
After several days mucous membrane inflammation, rashes, hematologic, ATN, encephalopathy, painful peripheral, sensory, and motor neuropathy after 7-14 d
Lung cancer incid increased (Jama 2004;292:2984)
r/o similar toxicity from arsine gas from industrial exposure in semiconductor industry
Lab: Chem:in acute, spot urine level in chronic, arsenic (As) tissue levels in bone, nails, hair (pubic best since fast-growing and sweat adds As); normal levels = 3-13 µgm/100 gm; 24-h urine arsenic level, fewer false positives than blood levels but will be back to normal when presents with neuropathy but can bring it out with dimercaprol
Xray:KUB shows radiodense cast of stomach or gi tract acutely
Rx:
Dimercaprol (BAL, British anti-Lewisite) 3-5 mg/kg im q 4 h × several days; within first 24-36 h to chelate As and reverse sx's. Few cmplc's at these doses in adults or children
Succimer (DMSA) may be an alternative po rx