Arsenic Poisoning Part-5

Arsenic Poisoning Part-5

How is arsenic poisoning treated?

Acute toxic inorganic arsenic exposure and arsine gas exposure can rapidly result in death, and there are only a few ways to possibly save the patient's life. Hemodialysis can remove arsenic from the bloodstream, but only before it binds to the tissues so there is only a short time window for this treatment to work. Similarly, arsine binds to and causes rapid destruction of red blood cells, so blood transfusions and exchange transfusions may help the patient. In addition, if the arsenic was ingested, stomach or bowel irrigation may be attempted, but there is no good data to indicate these will be successful. Consultation with a nephrologist and a toxicologist as soon as possible is recommended; other consultants may need to be called (hematologist, psychiatrist, or others).
Chelation therapy (the use of drugs that selectively bind and effectively inactivate substances) is usually begun quickly through an intravenous line. The drug and the bound arsenic is then excreted through the urine. The chelation drug of choice is Dimercaprol (also termed BAL in oil); Succimer (DMSA) has also been used successfully, and Dimerval (DMPS) may also work as a chelator, but it is not readily available in the US.

What is the prognosis (outcome) of arsenic poisoning?

If the patient survives an acute toxic exposure, most will develop some degree of nerve damage to the peripheral nerves (sensory and motor disturbances); many survivors may have cardiac, liver, renal, and skin problems; the prognosis is fair to poor. Chronic poisoning and organic arsenic exposure have better outcomes with fewer and less severe problems.