Presentation: Can be acute or chronic. Acute poisoning presents with GI symptoms including nausea, vomiting and abdominal pain. This is followed closely thereafter by cardiac instability, ARDS, and encephalopathy. In patients that survive the accute insult, neuropathy, hepatitis, and pancytopenia often develop. In chronic expsure, neuropathy and skin lesions (alopecia, pruritic macular rash, mouth ulcers) are the usual presentation.
Sources of exposure: arsenic-containing pesticides and herbicides, semiconductors, metal refining, decorative glass-making, contaminated well water (ie. India, Bangladesh)
Diagnostic tests: Urine arsenic level. Of note, organic, non-toxic, arsenic found in fish and shellfish may elevate this level.
Treatment: Chelation. Consider activated charcoal for acute ingestion.
Sources
Olsen, Kent. Poisoning and Drug Overdose. McGraw-Hill, 2004. Goldman, Rose. "Arsenic exposure and poisoning." Up to date. 2 Feb 2008. <http://www.uptodate.com>
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