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Arsenic exposure and poisoning

Author
Rose H Goldman, MD, MPH
Section Editor
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

Arsenic is a metalloid element. Acute high-dose exposure to arsenic can cause severe systemic toxicity and death. Lower dose chronic arsenic exposure can result in subacute toxicity that can include skin changes and skin cancer, peripheral sensorimotor neuropathy, diabetes mellitus, cardiovascular effects, peripheral vascular disease, hepatotoxicity and other conditions [1]. Latent, or long-term effects of arsenic exposure include an increased risk of cancers, even after exposure has ceased.

Clinicians may need to consider arsenic exposure in the emergency care setting when treating those suspected of acute poisoning or those who present with prolonged or intermittent gastrointestinal symptoms that are atypical for most viral and bacterial enteric illnesses [2]. In the office setting, clinicians may need to consider questions concerning chronic arsenic exposure in patients whose source of water is well water, exposure from food (particularly rice products), and in other environmental settings.

SOURCES OF EXPOSURE

Overview — Arsenic is a naturally occurring element found in the earth's crust and within numerous ores. It is classed as a metalloid because it complexes with metals; it also reacts with other elements such as oxygen, hydrogen, chlorine, carbon, and sulfur. Elemental arsenic is rare, and the element exists more commonly as organic or inorganic compounds [2].

Arsenical compounds can be grouped as inorganic, organic, and arsine gas (AsH3), and they are further classified according to their valence states: elemental (0), arsenite (trivalent, +3), and arsenate (pentavalent, +5). Trivalent arsenic or arsenite compounds, both inorganic and organic, are considered the most toxic. However, other organic forms of arsenic, found in some fish and crustaceans, as well as other foods, consisting mostly of arsenobetaine (a trimethylated arsenic compound sometime called "fish arsenic") and arsenocholine, are excreted rapidly and are thought to be of negligible toxicity [2-4].

Human exposures can occur from natural sources, such as volcanic eruptions, and arsenic leaching from soil and rocks into drinking water. Exposure can also through inhalation, usually when workers are exposed to arsenic dusts as in smelting and refining [5].

                                  

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