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Arsenic exposure and poisoning

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 peripheral sensorimotor neuropathy, skin eruptions, and hepatotoxicity. 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. In the office setting, clinicians also need to consider chronic arsenic exposure when determining causes of peripheral neuropathy or addressing patient concerns about arsenic found in drinking water and other environmental settings. Exposure to weaponized arsine gas is discussed separately. (See "Chemical terrorism: Diagnosis and treatment of exposure to chemical weapons", section on 'Toxic asphyxiants'.)

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.

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. Some fish and crustaceans contain large amounts of organic arsenic called "fish arsenic," consisting mostly of arsenobetaine (a trimethylated arsenic compound) and arsenocholine, which are thought to be of negligible toxicity [1-3].

Human exposures can occur from natural sources, such as volcanic eruptions, and arsenic leaching from soil and rocks into drinking water.
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