Contributor: Nick Tsipis, MD

Educational Pearls:

• Arsenic is a heavy metal that binds to multiple cellular enzymes and inhibits aerobic metabolism
• It is primarily absorbed through the skin, respiratory and GI tract.
• The classic symptoms of heavy metal exposure are GI irritation (watery diarrhea, vomiting and abdominal pain) with multisystem organ failure.
• Neuropathy can present insidiously
• Initial work up includes EKG, and basic lab work (expect a delayed rise in liver function tests).
• Acute arsenic ingestions can sometimes show up on imaging as it is radioapaque
• Diagnosis is usually made with the history and evidence of multisystem organ failure.
• 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)

References

Long N. Arsenic toxicity • LITFL • Toxicology Library Toxicant. Life in the Fast Lane • LITFL • Medical Blog. https://litfl.com/arsenic-toxicity/. Published August 25, 2019.

Kuivenhoven M, Mason K. Arsenic (Arsine) Toxicity. [Updated 2019 Apr 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541125/