Arsenic Poisoning, what to know?

Medical Aspects of Arsenic Poisoning

Introduction

Arsenic is a naturally occurring element found in the earth's crust, water, air, and soil. It exists in both organic and inorganic forms, with the latter being significantly more toxic. Arsenic poisoning, either acute or chronic, poses a serious public health concern worldwide, particularly in regions with contaminated drinking water or occupational exposure. Understanding the medical aspects of arsenic poisoning is essential for timely diagnosis, treatment, and prevention.

Types of Arsenic Exposure

Arsenic poisoning can be classified into two major types:

Acute Arsenic Poisoning: Occurs due to sudden ingestion or inhalation of large amounts of arsenic, often seen in suicide attempts, accidental poisoning, or occupational hazards.
Chronic Arsenic Poisoning (Arsenicosis): Results from prolonged exposure, commonly through contaminated drinking water, especially in countries like Bangladesh, India (West Bengal), and parts of South America.

Pathophysiology

Inorganic arsenic interferes with cellular respiration by inhibiting enzymes involved in oxidative phosphorylation, such as pyruvate dehydrogenase. It binds to sulfhydryl groups in proteins, disrupting cellular function and leading to multi-organ toxicity. Chronic exposure results in oxidative stress, DNA damage, and carcinogenesis.

Clinical Features

1. Acute Arsenic Poisoning

Gastrointestinal Symptoms: Severe abdominal pain, vomiting, diarrhea (often rice-water-like), and dehydration.
Cardiovascular Symptoms: Hypotension, arrhythmias, and circulatory collapse.
Neurological Symptoms: Headache, confusion, seizures, and peripheral neuropathy.
Renal and Hepatic Dysfunction: Acute tubular necrosis, jaundice.

2. Chronic Arsenic Poisoning

Dermatological Signs:
- Hyperpigmentation ("rain drop" pattern).
- Hyperkeratosis of palms and soles.
- Mees’ lines (transverse white lines on nails).
Neurological: Symmetrical sensorimotor polyneuropathy.
Hematological: Anemia, leukopenia.
Cancer Risk: Increased risk of skin, bladder, lung, and liver cancers.
Other: Hepatomegaly, peripheral vascular disease (e.g., Blackfoot disease).

Diagnosis

Diagnosis is based on clinical features, history of exposure, and laboratory confirmation:

Urinary arsenic levels: Best indicator for recent exposure.
Hair and nail analysis: Useful for chronic exposure.
Blood tests: Electrolyte imbalance, renal and liver function tests.
ECG: May reveal QT prolongation or arrhythmias.

Management

Acute Poisoning

Stabilization: Airway, breathing, circulation (ABCs), and IV fluids.
Decontamination: Gastric lavage (if early), activated charcoal.
Chelation Therapy:
- Dimercaprol (British Anti-Lewisite, BAL) for severe cases.
- DMSA (Succimer) or DMPS for less severe or oral treatment.
Supportive Care: Electrolyte correction, dialysis if needed.

Chronic Poisoning

Elimination of Exposure: Most critical step (e.g., switching to arsenic-free water).
Chelation: Limited role; may be used in symptomatic individuals.
Monitoring: Regular screening for cancers and organ damage.
Nutritional Support: Antioxidant therapy (e.g., vitamins C and E) may have adjunctive benefit.

Prevention

Water Testing: Regular testing of groundwater in endemic areas.
Use of Arsenic-Removal Technologies: Filters, alternative water sources.
Occupational Safety: Protective equipment, exposure limits.
Public Health Measures: Education and policy implementation.

Conclusion

Arsenic poisoning remains a significant health threat, especially in developing regions with contaminated water sources. Medical management requires a high index of suspicion, prompt diagnosis, and appropriate chelation therapy in acute cases. However, the cornerstone of managing chronic arsenicosis lies in prevention—through safe water practices and environmental regulations. An integrated approach involving healthcare providers, policymakers, and the community is essential to tackle the burden of arsenic toxicity.

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