Podcast 573:  Arsenic Toxicity

<p><strong>Contributor: Nick Tsipis, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Arsenic is a heavy metal that binds to multiple cellular enzymes and inhibits aerobic metabolism</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;"> It is primarily absorbed through the skin, respiratory and GI tract.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">The classic symptoms of heavy metal exposure are GI irritation (watery diarrhea, vomiting and abdominal pain) with multisystem organ failure. </span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Neuropathy can present insidiously</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;"> </span><span style= "font-weight: 400;">Initial work up includes EKG, and basic lab work (expect a delayed rise in liver function tests). </span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Acute arsenic ingestions can sometimes show up on imaging as it is radioapaque</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Diagnosis is usually made with the history and evidence of multisystem organ failure.</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Treatment should be coordinated with your local Poison Control or toxicologist and involves predominantly supportive care along with chelating agents succimer (oral) or dimercaprol (intramuscular)</span></li> </ul> <p><strong>References</strong></p> <p><a href="https://litfl.com/arsenic-toxicity/"><span style= "font-weight: 400;">L</span></a><span style="font-weight: 400;">ong N. Arsenic toxicity • LITFL • Toxicology Library Toxicant. Life in the Fast Lane • LITFL • Medical Blog. https://litfl.com/arsenic-toxicity/. Published August 25, 2019.</span></p> <p><span style="font-weight: 400;">Kuivenhoven M, Mason K. Arsenic (Arsine) Toxicity. [Updated 2019 Apr 29]. In: StatPearls [Internet]. Treasure Islan