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Arsenic Poisoning

Arsenic Poisoning is a topic covered in the 5-Minute Emergency Consult.

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  • Acute toxicity:
    • Caused by intentional ingestion, malicious poisoning, or medication error
  • Minimal lethal ingested dose ∼2 mg/kg
  • Chronic toxicity:
    • Resulting from occupational exposures, water or food contamination, or use of folk remedies containing arsenic
  • Ingestion is the primary route of exposure
  • Inhalational toxicity is possible from arsine gas exposure


  • Most cases seen in the ED result from intentional ingestion or malicious poisoning
  • Sodium arsenate, found in ant killer, is the most common acute exposure in the US
  • Contaminated food and water supplies are the most common cause worldwide
  • Inorganic arsenic trioxide has been recently approved as a chemotherapeutic agent for acute myelogenous leukemia (AML)
  • Melarsoprol, an organic arsenical, has been used to treat trypanosomiasis since 1949
  • Found in pesticides, certain folk remedies (herbal balls), industrial wood preservatives
  • May be released as arsine gas from combustion of zinc- and arsenic-containing compounds

  • Arsenic exists in several forms—gas (arsine, or lewisite), organic, elemental, and inorganic
  • Inorganic forms (pentavalent and trivalent arsenic) are most frequently involved in toxic exposures:
    • Pentavalent arsenic uncouples oxidative phosphorylation
    • Most pentavalent arsenic is converted to the more toxic trivalent arsenic in the body
    • Trivalent arsenic binds sulfhydryl groups and interferes in hemoglobin production
    • Some trivalent arsenic may be methylated into species of varying toxicity
    • The more reactive species are DNA damaging and genotoxic

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Rosen, Peter, et al., editors. "Arsenic Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307390/all/Arsenic_Poisoning.
Arsenic Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307390/all/Arsenic_Poisoning. Accessed April 24, 2019.
Arsenic Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307390/all/Arsenic_Poisoning
Arsenic Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307390/all/Arsenic_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Arsenic Poisoning ID - 307390 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307390/all/Arsenic_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -