- 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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Schaider, Jeffrey J., 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: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307390/all/Arsenic_Poisoning. Accessed June 6, 2023.
Arsenic Poisoning. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307390/all/Arsenic_Poisoning
Arsenic Poisoning [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 June 06]. 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 - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Wolfe,Richard E, 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 -