Management overview for acute arsenic poisoning

Acute arsenic poisoning causes severe toxicity. Acute arsenic poisoning can result from:

• inhalation of arsine gas that is used in the production of semiconductors and in metal refining
• ingestion of inorganic arsenic compounds that are used in older pesticides and insecticides (for termites or ants), wood treatment and metal refining.

Organic arsenic is found in seafood, shellfish and organic rice, but is relatively nontoxic. Arsenic trioxide is used to treat acute promyelocytic leukaemia, and can cause acute toxicity if administered in high doses.

If acute arsenic poisoning is suspected, urgently contact a clinical toxicologist or poisons information centre (13 11 26). The mainstays of management of acute arsenic poisoning are resuscitation, haemodynamic support and chelation therapy.

Chronic arsenic poisoning commonly results from long-term exposure to environmental arsenic, such as ingestion of contaminated water from a well. It can cause peripheral and central nervous system toxicity as well as cardiomyopathy, liver and kidney dysfunction, various forms of malignancy and skin problems (hyperkeratosis and skin cancers). The management of chronic arsenic poisoning is beyond the scope of this guideline—consult a clinical toxicologist.