Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 38-22: Arsenic Poisoning + Key Features Download Section PDF Listen +++ ++ Found in some pesticides and industrial chemicals + Clinical Findings Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ Urinary arsenic levels may be falsely elevated after certain meals (eg, seafood) that contain large quantities of relatively nontoxic organic arsenic + Treatment Download Section PDF Listen +++ +++ 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