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ARSENIC

SOURCE
Smelting and microelectronics
industries
wood preservatives
Pesticides
Herbicides
Fungicides
Fruit sprays
Contaminated ground water

FORMS
Arsenious oxide(AS2O3) or Arsenious or White
arsenic
MC form of arsenic used
Copper arsenite(Scheeles green)
Copper acetoarsenite(Paris green)
Arsenic trichloride(butter of arsenic)

Permissible limit in water(WHO)


10 micrograms arsenic per litre
FATAL DOSE
Adult 120-200mg
Children 2mg/kg

METABOLISM

Absorbtion
inorganic arsenic is readily
absorbed
(GI and LUNG)
sequesters in liver, spleen
kidneys,lungs
GI tract
Residues persist in skin, hair
nails

ACTION
1)Decrease ATP Synthesis
Inhibition of Pyruaate dehydrogenase
Uncoupling of oxidative phosphorylation
Production of ROS
Lactic acidosis
NECROSIS
2)Thiamine deficiency
Prevents use of thiamin
3)Disruption of cellular electrolytic function
interferes with voltage gated K channels
4)Targets vascular endothelium leading to increased
Permeaability,tissue edema & hemorrhage
specially in the GIT

ACUTE ARSENIC POISONING


1)GASTROINTESTINAL FORM
Common form
Resembles bacterial gastroenteritis(Cholera)
Garlic odour with hemorrhagic gastoenteritis &
Necrosis of mucosa
Fluid loss Hypotension
Acute tubular necrosis,and hemolysis

2)FULMINANT TYPE
Large dose of Asenic rapidly absoebed
without gi symptoms
Giddiness,Headache,Vertigo
Death within 2 to 3 hrs

TREATMENT OF ACUTE POISONING

Ipecac to induce vomiting


Gastric lavage(Freshly precipitated
ferric oxide
which forms ferric
arsenite,
a harmless salt)
Activated charcoal

POSTMORTEM FINDINGS
RED VALVETY MUCOSA of stomach &
submucous petechial hemorrahge
Subendocardial petechial
hemorrahge
Fatty degeneration of liver heart &
kidney

CHRONIC ARSENIC
POISONING
FIRST STAGE (Nutritional
and gi disturbances)
Earliest sign is gradual emaciation
Nausea,intermittent vomiting & diarrhea
SECOND STAGE(Catrrhal changes)
Resembles cold
Running nose,conjunctivitis,cough
THIRD STAGE(Skin rashes)
Rain drop pigmentation
Hyperkeratosis of palm and sole
Mee s line
Alopecia
FOURTH STAGE(Nervous disturbances)
Mixed polyneuropathy
Painful paraesthesia of hand and foot

Chronic arsenic exposure causes


Diabetes
Vasospasm,peripheral vascular
insufficiency and gangrene
Peripheral neuropathy
Cancer of skin, lung, liver
(angiosarcoma), bladder, and kidney.

RAIN DROP
PIGMENTATION

HYPERKERATOSIS

MEE S LINE

HYPERERATOSIS

INVESTIGATIONS
24-h urinary arsenic >67 mol/d or
50 g/d
ECGQRS broadening, QT
prolongation, ST depression, T-wave
flattening
Neutron Activation Analysis
MARSHS TEST
REINSCHS TEST
NOT
USED NOW

TREATMENT
Dimercaprol 35 mg/kg IM q4h 2
days
q6h 1
day
then
q12h 10 days
Alternative: oral succimer

POSTMORTEM APPEARANCE
Ar delays putrefaction
Ar delays rigor mortis which last longer
Can be detected in completely
decomposed bodies.
Can be found in bones, hairs and nails
for several years.
Can be detected in charred bones or
ashes