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Key Features

  • Found in some pesticides and industrial chemicals

Clinical Findings

  • Symptoms usually appear within 1 h after ingestion but may be delayed as long as 12 h

  • Abdominal pain, vomiting, watery diarrhea, and skeletal muscle cramps

  • Profound dehydration and shock may occur

  • In chronic poisoning, symptoms can be vague but often include

    • Pancytopenia

    • Painful peripheral sensory neuropathy

    • Skin changes (eg, melanosis, keratosis, and desquamating rash)

  • Cancers of the lung, bladder and skin have been reported

Diagnosis

  • Urinary arsenic levels may be falsely elevated after certain meals (eg, seafood) that contain large quantities of relatively nontoxic organic arsenic

Treatment

Emergency measures

  • Perform gastric lavage

  • Activated charcoal is of uncertain benefit because it binds arsenic poorly

  • Administer intravenous fluids to replace losses due to vomiting and diarrhea

Antidote

  • For severe acute intoxication

    • 2,3-dimercaptopropanesulfonic acid (DMPS, Unithiol) is the preferred parenteral chelator

    • Dosage: 3–5 mg/kg intravenously every 4 hours

    • Although there is no FDA-approved commercial formulation of DMPS in the United States, it can be obtained from some compounding pharmacies

  • An alternative parenteral chelator is dimercaprol

    • It comes as a 10% solution in peanut oil

    • Dosage: 3–5 mg/kg intramuscularly every 4–6 hours for 2 days

    • Side effects include nausea, vomiting, headache, and hypertension

  • If GI symptoms allow, switch to the oral chelator succimer (dimercaptosuccinic acid, DMSA), 10 mg/kg every 8 hours, for 1 week

  • Consult a medical toxicologist or regional poison control center (1-800-222-1222) for advice regarding chelation

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