TOXICOLOGY■ Acute poisoning
■ GI symptoms predominate: Violent gastroenteritis
■ Confusion, coma, seizures
■ Hypotension, tachycardia, prolonged QT interval, dysrhythmias
■ ARDS-like syndrome
■ Arsine gas poisoning
■ Findings consistent with acute hemolysis: Hematuria, jaundice, renal
failure
■ Abdominal pain, N/V
■ Hypotension, tachycardia, pulmonary edema
DIAGNOSIS
■ Suspect based on clinical presentation and possible exposure.
■ Blood or 24-hour urine arsenic levels
■ Levels may be elevated following consumption of seafood because of
the presence of nontoxic, organic arsenic compounds.
■ Ingested arsenic-containing material is usually visible on X-ray.
TREATMENT
■ In chronic poisoning cases, identify and remove the source of arsenic
exposure.
■ Whole-bowel irrigation: If radiopaque objects visible on X-ray
■ Antidote=BAL (British anti-lewisite, dimercaprol)
■ In cases of severe, acute toxicity
■ DMSA(2,3-dimercaptosuccinic acid, succimer)
■ In cases of chronic poisoning
■ Arsine gas toxicity does not usually require chelation.
Mercury
Mercury is pervasive in industrial processes and commercial products. It is
encountered in three forms:
■ Elemental mercury (quicksilver): Mercury-containing devices in workplace
or home
■ Inorganic mercury salts: Disk batteries
■ Organic mercury: Occupational/agricultural exposure
Each form of mercury has differing toxicity. Elemental mercury primarily
causes toxicity when inhaled, while the principal route of exposure for mercury
salts and organic mercury is through GI absorption.
MECHANISM/TOXICITY
■ Inhibition of multiple cellular enzyme systems
■ Inhalation of elemental mercury may lead to severe pneumonitis.
SYMPTOMS/EXAM
■ Elemental mercury (quicksilver) inhalation: Rapid onset of shortness of
breath, cough, chills, fever, respiratory distress
■ Acute ingestion of inorganic mercury: Corrosive gastroenteritis with shock
(from massive fluid loss), renal failure, grayish discoloration of mucous
membranes, metallic taste
Acute arsenic exposure is
characterized by violent
gastroenteritis.