Arsenic

Physical properties: Arsenic is present in more than 200 different minerals. The most common of
which is called arsenopyrite. Metallic arsenic in its pure form is a black - gray substance which is
said to be non poisonous, as it is insoluble in water. Therefore can not be absorbed from G.I.T. It is
continuously changing in to arsenious oxide or white arsenic which is colourless, odourless, tasteless
and is very poisonous.
Sources of arsenic:
1. Arsenious oxides - As2O3: The term arsenic refers to white arsenic or arsenious oxide or
arsenious acid also known as arsenic trioxide or sankhya. Arsenic is colorless, odorless and
tasteless. It is sparingly soluble in water. It floats on the surface of the water and adheres to the
side of the vessel. Therefore it is commonly given mixed with milk, tea, or coffee in homicidal
poisoning.
2. Sulphides of arsenic:
i. Arsenic disulphide (As2 S2) - Red regular.
ii. Arsenic trisulphide (As2 S3) - Yellow orpiment.
3. Copper compound of arsenic:
i. Copper Arsenate (Scheele's Green)
ii. Copper Acetoarsenate (Paris Green, Emerald Green)
4. Others: Lead arsenate, sodium arsenite and potassium arsenite.
5. Arsine is a colorless gas with garlic like odor.
6.Tobacco smoke, particularly cigars also contain arsenic.
7. Natural sources of arsenic are; rock, soil, water and some sea fish (prawns). Naturally human
exposure include; volcanic ash, surface water and shallow tube wells inserted for drinking water.
Uses
i. Arsenic is used for agriculture purpose in one form or an other as; germicide, vermicide, pesticide,
fungicide, insecticide, rodenticide and weed killers by spray on the crops and fruit trees.
ii. It is also used for the preservation of timber and lather against white ants – sheep dip.
iii. It is also used for coloring artificial flowers, wallpapers and printer’s inks.
iv. Various cosmetics preparations contain arsenic.- depilatories.
v. Small amount of arsenic (less then 2%) can be used in lead alloys for ammunition.
vi. In the past arsenic has been used by the quacks;
a. for the cure of various diseases ranging from common cold to cancer mainly in; syphilis, psoriasis,
joint pain (rheumatism) hemorrhoids, asthma, cough and itching.
b. As an abortificiant ;applied to the abortion stick in the form of paste to produce abortion.
c. As a tonic.
d. As an aphrodisiac(to increase the sexual desire).
Mode of action: Arsenic combines with sulphydryl group of enzymes, and thus interfering with the cell
metabolism.
Locally: Arsenic causes irritation of the mucous membranes of G.I.T.
Remotely: Arsenic damage the liver and kidneys, causes depression of the central nervous system.
Generally: Arsenic effect the multiple organs and tissues of the body.
Absorption : Arsenic is absorbed orally through the GIT, skin and lungs (arsine).
Distribution: Arsenic is present in almost all tissues and found in the greatest quantity in the liver,
followed by kidneys and spleen. In case where the patient survives it is found in the muscles (for months),
bones, hair, nails and skin (for years).
Excretion: Arsenic is excreted mainly by the kidneys but some part through feces, bile, sweat, milk, nails
and hair. After a single dose, it may be found in the urine within half an hour and continues to be
excreted for about 10 to 14 days or even longer.
Symptoms and Signs:
In Fulminant and Narcotic poisoning: When a large dose (>3g) of arsenic is taken, the
poison is quickly absorbed and the symptoms of G.I.T may be absent. Symptoms of
narcotic poisoning, such as; vertigo, headache, spasm, tenderness of muscles, delirium,
followed by sutuper, coma and death. The patient may die from narcotic effects, shock and
peripheral vascular collapse / failure with in 2-3 hours.
Collapse sets in; with cold clammy skin, rapid feeble pulse, sighing respirations, subnormal
temperature, pale anxious face, sunken eyes and dilated pupils.
In Acute poisoning: Symptoms in acute poisoning usually manifest within 1h after
ingestion.
i. There is burning pain in the mouth, throat esophagus, stomach and epigastrium
followed by nausea vomiting and diarrhea. Severe, continuous and persistent vomiting.
Intense thirst and dryness of mouth.
ii. Vomit initially contains stomach contents finally mucus mixed with blood. The main
effect however is diarrhea. The stools are watery like rice – water resembling the
stools of cholera, tinged with blood, contain shreds of mucous membrane and
fragments of the poison.
iii. Na and K loss, painful cramps in the legs and muscular twitching.
iv. The body presents a dehydrated appearance with sunken eyes and wrinkled skin.
v. Convulsions, coma, collapse may proceed to death, with in 24 to 48 hours.
In Sub - acute poisoning In some cases if the patient survives the initial acute attack,
the poisoning becomes sub acute, The patient becomes progressively weak due to loss
of appetite and may die of heart failure and weakness within 7 to 10 days.
 Differential Diagnosis
Arsenic poisoning should be differentiated from cholera
and food poisoning.
Sr Symptoms Arsenic Poisoning Cholera
no
1 Pain in throat Before vomiting After vomiting
2 Vomiting Before diarrhoea After diarrhoea
3 Vomited matter (Vomit) Contains mucus mixed No mucus
with blood No blood
4 Stool i Like rice water in early Like rice water
stage throughout
5 Stool ii Tinged with blood, No blood.
Contains shreds of No mucous
mucous membrane and No Poison.
fragments of poison.
6 Voice Hoarse Not affected
 Fatal Dose: The fatal dose is usually stated as 120-200mg.
Tolerance: Certain individuals develop the habit of arsenic eating, either as a tonic
or as an aphrodisiac. They develop tolerance to bear arsenic more then toxic dose
up to 250mg – 300mg. Such people are known as arsenophagists. Chronic
poisoning may occur in due course.
Fatal Period:
In the narcotic form of poisoning; the average F.P is about 2 to 3 hours.
In the gastrointestinal form of poisoning, the average F.P is about 1 to 2 days.
In the sub acute form of poisoning; the average F.P is about 7-10 days.
In the chronic form of poisoning; The average F.P is about some weeks or some
months.
Treatment
i. Stomach should be repeatedly washed out with warm water and milk to remove
arsenic particles adherent.
ii. Demulcents – fatty, oily substances to prevent absorption
iii. Tannic acid (strong tea) to form insoluble compounds with arsenic.
iv. Chelating agents as specific antidote - BAL, EDTA, Penicillamine.
v. 0.9 % Saline for dehydration
vi. 0.5 % glucose to combat liver damage.
vii. Ringer for Na and K Loss.
viii. Sodium bicarbonate to regulate acid-base balance
 Postmortem Appearances
External Sings.
i. Blood tinged vomitus and fecal matter may be present on the body
and clothes
ii. The body presents a dehydrated appearance with sunken eyes and
wrinkled skin.
iii. Rigor mortis lasts longer than usual.
iv. Putrefaction is delayed due to the antibacterial action of arsenic.
Internal Sings.
I. Stomach, appearance is like red velvet. The mucosa appears red,
swollen and edematous.
II. Mucous membrane of the small intestine is congested, inflamed and
ulcerated with submucous hemorrhages along its hole length.
III. Rectum is most prone to inflammation.
IV. Liver may show fatty degenerative changes.
V. Kidneys – Tubular necrosis
VI. Hemorrhages may be found in the abdominal organs. There may be
wide spread hemorrhages in larynx, trachea and lungs.
VII. Petechial hemorrhages under the endocardium of the left ventricle are
common.
 Chronic arsenic poisoning:
Symptoms and Sings:
1. First stage of GIT disturbances.
The earliest sign is; nausea, intermittent attack of vomiting, diarrhea, loss of appetite and
gradual emaciation, are common.
2. Second Stage of catarrhal Stage: Common cold, conjunctivitis, running of the eyes and
nose, coughing, hoarseness of voice and bronchial catarrh.
3. Third stage of skin and nails disturbances.
i. There is irritation of the skin and skin rashes resembling fading measles rash.
ii. Patchy brown pigmentation of the skin called “rain drop pigmentation”.
iii Hyperkeratosis of the palms and soles.
iv. Mee’s lines : white bands crossing the nails of the fingers and toes called ‘Mee’s Lines’.
They indicate arrested growth due to interference with normal metabolism.
v. Brittle nails and alopecia.
4. Fourth stage of nervous disturbances: There is tingling and numbness of the hands and
feet – Paresthesia and arsenical neuritis.
5. Other symptoms include; headache drowsiness and impairment of vision and mental
activity.
6. Arsenic is a carcinogenous substance since skin, lungs and bladder carcinoma has been
observed in population with multiple exposure.
Cause of death: In chronic arsenic poisoning the patient may die from general action of
poison effecting the multiple organs and tissues of the body.
Symptoms & Signs of chronic arsenic poisoning (Alphabetically)
A. Alopecia
B. Bronchial catarrh and brittleness off nails.
C. Conjunctivitis, common cold and convulsions.
D. Diarrhea, dehydration, drowsiness and dilated pupils
E. Evidence of liver damage, kidney damage and heart damage.
F. Falling out of the hair and fatty degeneration of liver.
G. Gut inflamed,
H. Headache, hoarseness of voice and hyperkeratosis of palms and soles
I. Itching, impaired vision and impaired mental activity.
J. Jaundice.
K. Keratosis (hyperkeratosis)
L. Loss of appetite.
M. Mee’s lines, white bands crossing the nails of fingers and toes showing arrested growth.
N. Numbness, neuritis and necrosis of the liver, heart muscles and renal tubules.
O. Oligurea.
P. Petechial heamorrhages.
R. Running nose and rain drop pigmentation.(patchy brown pigmentation of the skin).
S. Skin changes: Vesicular eruption and nettle rash - Stupor.
T. Tingling and tenderness of muscles.
U. Urticaria
V. Vomiting and vertigo.
W. Weakness and weight loss.
 Treatment of chronic arsenic poisoning.
i. Remove the patient from source.
ii. Chelating agents; BAL (Dimercaprol), EDTA and penicillamine
(cuprimine) are very helpful.
iii. Rest of the treatment is symptomatic.
iv. Complete recovery may require six months to one year.
Post -mortem appearance of chronic arsenic poisoning.
External sings.
i. Alopecia, brittle nails, progressive emaciation, jaundice, skin rashes,
patchy brown pigmentation, hyperkeratosis, and Mee’s lines,
ii. Rigor mortis lasts longer than usual.
iii.Putrefaction is delayed due to the antibacterial action of arsenic.
Internal sings
i Stomach, may show chronic gastritis and inflammatory redness.
ii Liver: Fatty degeneration or necrosis.
iii. Heart mussels: Myocardial necrosis may be seen.
iv. Kidneys: Tubular necrosis.
Samples for confirmation.
Hair must be complete with their bulb.
Nail – complete.
Lower end of femur. As arsenic is deposited at the end of long bones.
Medico -legal importance.
Accidental poisoning:
i. Chronic poisoning result from drinking surface water or shallow well water containing arsenic.
ii. In workers, working in ARSENIC foundry and mining.
iii. Accidental poisoning may occur from quack remedies.
Suicidal poisoning not seen.
Homicidal poisoning: Arsenic was a popular poison in the past, administered in paan (betel leaf) tobacco, coffee, tea,
food and drinking water of well or tank.
Advantages in the homicidal use of arsenic.
I. Arsenic is colorless, odorless and tasteless can be given in food, drink or paan.
II. Arsenic is easily available and cheap.
III. Lethal dose is small (120mg – 200mg)
IV.Symptoms appear about half an hour after administration thus providing sufficient time to the culprit to escape.
V. Acute arsenic poisoning may be confused with cholera or bacterial food poisoning.
Disadvantages in the homicidal use of arsenic.
i. Arsenic is not destroyed in the body therefore can be detected in the hair, nails, and bones even after years.
ii. Arsenic is resistant to heat so it can be detected in charged remains, If the body is burnt.
iii. Arsenic delay putrefaction.
Postmortem imbibitions of arsenic:
i. Certain samples of earth contain small traces of arsenic probably derived from the use of arsenical weed killers or
on account of drainage of water contaminated by arsenic.
ii. It is known that when a dead body is buried in such earth, small quantities of arsenic may enter the dead body.
iii. Where the soil contains arsenic and arsenic poisoning is suspected, samples of earth from around the dead body
should be collected for chemical analysis at the time of exhumation.
iv. In arsenical poisoning, the concentration of arsenic in various organs should be more than that in the earth.
 Q:1. Arsenic causes toxicity by interfering with cell metabolism by combining with which of the following enzymes:
a. Acetylcholinesterase
b. Cytochrome oxidase
c. Dehydrogenase
d. Lecithinase
e. Sulfhydryl enzymes
1- e - Parikh: 9.8
Q:2. In arsenic poisoning after its absorption greatest quantity of poison is found in which of the following tissues:
f. Bones
g.Brain
h.Kidneys
i.Liver
j.Muscles
2- d - Parikh: 9.13
Q:3. Which of the drug of choice for treatment of arsenic poisoning:
k. British Anti Lewisite
l.Calcium disodium versanate
m.Desferrioxamine
n.Penicillamine
o.Physostigmine
3- a - Parikh: 9.10
Q:4. Shaft of long bones of about 6 inches is required to be preserved in which of the following:
p. Aconite poisoning
q.Arsenic poisoning
r.Barbiturate poisoning
s.Dhatura poisoning
t.Smack poisoning
4- b - Parikh: 9.12
 Q:5. Diagnosis of chronic arsenic poisoning is best carried out by chemical examination of :
a. Blood
b. Hair
c. Liver
d. Muscle
e. Spleen
5- b - Parikh: 9.12
Q:6. Hair and nails are preserved for chemical analysis in suspected case of poisoning due to which of the following
poisoning:
f. Arsenic
g.Barbiturates
h.Cyanide
i.Opium
j.Strychnine
6- a - Parikh: 9.12
Q:7. ‘Red Velvety’ stomach mucosa and fatty liver is seen in poisoning with:
k. Arsenic
l.Aconite
m.Lead
n.Mercury
7- a - Parikh: 9.12 Biswas 436
Q:8. A middle aged man presented with paraesthesia of hands and feet. Examination revealed presence of ‘Mees’ lines
in the nails and raindrop pigmentation in the hand The most likely diagnosis is:
o. Lead Poisoning
p.Arsenic Poisoning
q.Thallium Poisoning
r.Mercury Poisoning
8- b - Parikh: 9.11 Biswas 436
Metallic arsenic in pure form
Volcano: Natural source of arsenic
NATURAL SOURCES OF ARSENIC POISONING
ARSENIC AND ARSENOUS ACID IN
BOTTLES
SOURCES OF
ARSENIC
POISONING
EMACIATION DUE TO ARSENIC
POISONING
SKIN RASHES: ARSENIC POISONING
HYPERKERATOSIS OF HANDS AND
FEET DUE TO ARSENIC POISONING
RAIN DROP APPEARANCE
HYPERPIGMENTATION
AND
HYPERKERATOSIS OF
SKIN
MEE’S LINES
THANK YOU
The number of persons from a colony of a city were admitted in hospital emergency. All persons have
sudden, frequent vomiting, watery-rice stools and shock. This incident of poisoning is due to:
a. Arsenic.
b. Ergots.
c. Lead.
d. Phosphorus.
1- a - Parikh: 9.9
THANK YOU