Clinical presentation

Immediate effects of acute arsenic poisoning include:

• gastrointestinal effects—severe nausea, vomiting, diarrhoea, dehydration, abdominal pain
• cardiovascular effects—hypotension (due to arsenic-induced peripheral vasodilation), QT-interval prolongation, ventricular arrhythmias, acute heart failure (due to arsenic-induced myocardial depression), cardiovascular collapse
• severe haemolysis due to arsine gas inhalation
• metabolic acidosis
• multiorgan failure.

Delayed effects in survivors of acute arsenic poisoning can occur days to weeks after exposure and include:

• bone marrow suppression
• hepatitis
• neurological toxicity—encephalopathy and/or ascending sensorimotor peripheral polyneuropathy
• pigmented skin lesions.