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Arsenic Poisoning - Causes, Symptoms, Diagnosis, Prevention, and Treatment

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Arsenic poisoning through environmental and occupational exposure is a global issue. This article explains it in detail.

Written by

Dr. Sameeha M S

Medically reviewed by

Neha Suryawanshi

Published At November 7, 2022
Reviewed AtMarch 15, 2023

Introduction

Arsenic is an element that combines with organic and inorganic substances present in the earth. Inorganic arsenic is very toxic and results in severe complications in humans. Arsenic poisoning occurs due to increased levels of arsenic in the body. Symptoms of arsenic poisoning include vomiting, abdominal pain, watery diarrhea, and skin rashes. Long-term exposure results in multisystem complications. Drinking contaminated water due to pesticides and industrial waste is the common reason for long-term arsenic exposure.

What Is Arsenic?

Arsenic is a chemical element in the natural earth's crust in three forms: black, yellow, and gray. It exists in organic and inorganic forms. Arsenic is used for manufacturing semiconductors as doping agents and for solid-state devices (gallium arsenide). In addition, arsenic compounds can be used to manufacture specialty glass, pesticides, herbicides, and wood preservatives. The inorganic form of arsenic is extremely hazardous. Arsenic poisoning from occupational exposure, contaminated drinking water, and eating can lead to cancer and skin diseases.

What Is Arsenic Poisoning?

Arsenic poisoning or arsenicosis occurs due to inhalation or ingestion of high levels of arsenic. Arsenic is naturally present in the earth in its organic form, but the inorganic (man-made) form of arsenic is highly poisonous. These are used in agriculture, mining, and industries. The common reason for arsenic poisoning is long-term exposure to contaminated drinking water (groundwater gets contaminated due to industrial waste, agriculture, and mining). Arsenic poisoning can result in health complications and death if not treated properly.

What Are the Causes of Arsenic Poisoning?

  • Drinking contaminated water containing arsenic.

  • Smoking tobacco products.

  • Breathing air that is contaminated with arsenic.

  • Pesticides,herbicides,and fungicides.

  • Occupational exposure from coal power plants, paints, glass, and fireworks.

  • Burning of fossil fuels.

  • Contact with wood containing arsenic as a preservative.

  • Eating arsenic-contaminated food.

What Are the Symptoms of Arsenic Poisoning?

1. Acute Poisoning - It occurs due to accidental ingestion of pesticides and insecticides or due to attempted suicide. In acute poisoning, the lethal dose ranges from 100 to 300 mg.

Immediate symptoms include:

  • Vomiting.

  • Nausea.

  • Abdominal pain.

  • Diarrhea.

  • Numbness and tingling of extremities.

  • Muscle cramping.

  • Abnormal heart rhythm.

  • Red or swollen skin.

2. Chronic Poisoning - Long-term exposure to high levels of arsenic through drinking water and food results in chronic poisoning and severe symptoms. Long-term exposure leads to multisystem disease and malignancies. The clinical features depend on geographic area, population group, and individual.

It includes:

  • Skin - Long-term exposure results in numerous skin changes like patchy skin, hyperpigmentation, palmar and solar keratosis. Keratosis may be uniform or discrete. Hyperpigmentation occurs as less discrete diffuse darkening of the skin, diffuse dark brown spots, and has a characteristic raindrop appearance. Chronic exposure to inorganic arsenic is associated with an increased risk of skin cancer. Skin cancer is usually presented as lesions over the entire body surface, mostly in unexposed areas of the body like the trunk, soles, and palms.

  • Cardiovascular System - Increased risk of cardiovascular disease is reported in exposure to arsenic. Arsenic causes direct myocardial injury, cardiac arrhythmias, and cardiomyopathy. In addition, arsenic poisoning may cause diffuse capillary leakage and cardiomyopathy, resulting in shock. Experimental studies have shown atherosclerosis due to inhibition of endothelial nitric oxide synthase, changes in coagulation, and inflammation. Gangrene of the extremities due to arteriosclerotic or thromboangiitis obliterans, known as Blackfoot disease, has been reported with drinking arsenic-contaminated well water. Arsenic ingestion affects the cardiovascular system by altering myocardial depolarization, resulting in cardiac arrhythmias and hypertension.

  • Gastrointestinal System - Chronic toxicity results in diarrhea with recurrent bouts and is associated with vomiting. Increased inflammation and necrosis of the submucosa mucosa and mucosa of the stomach and intestine results in perforation of the gut wall. In addition, hepatomegaly, cirrhotic portal fibrosis, incomplete septal cirrhosis, macronodular cirrhosis, and a high incidence of variceal bleeding are found in individuals exposed to higher levels of arsenic for an extended period of time.

  • Respiratory System - Increased deposition of arsenic in the lung results in irritation of the respiratory mucosa, bronchitis, and restrictive and obstructive lung disease. Chronic arsenic exposure leads to an increased incidence of lung cancer in pesticide workers and smelter workers.

  • Neurological System - Chronic exposure results in the destruction of axonal cylinders, leading to peripheral neuropathy. Changes in behavior, confusion, and memory loss are also seen. Cognitive impairment was also seen in workers exposed to arsenic. Increased incidence of cerebrovascular disease, especially cerebral infarction, was also seen.

  • Genitourinary System - Increased mortality from nephritis and prostate cancer has been reported due to long-term exposure. In addition, drinking water from wells containing high levels of arsenic was associated with transitional cell carcinomas of the bladder, kidney, ureters, and urethral cancers in both males and females and adenocarcinomas of the bladder in males.

  • Endocrine and Hematological System - Exposure to high concentrations of arsenic is associated with an increased risk of diabetes mellitus and neutropenia.

How Can We Diagnose Arsenic Poisoning?

Diagnosis depends on both clinical and laboratory findings. Therefore, monitoring the level of arsenic in drinking water in areas with a risk of arsenic poisoning is essential. This can be obtained by examining urine, hair, and fingernail samples.

How Can We Prevent Arsenic Poisoning?

  • Testing water sources for the presence of arsenic.

  • Installing arsenic removal systems in the home.

  • Use of deep well water containing less amount of arsenic.

How to Treat Arsenic Poisoning?

Management of Acute Arsenic Poisoning.

  • Remove the source of arsenic from the patient.

  • If a significant amount has been ingested in less than an hour and the patient has not vomited, or if a plain X-ray indicates arsenic in the stomach, gastric lavage is done. Arsenic is absorbed primarily from the small and large intestines and rarely from the stomach.

  • Surgical and endoscopic removal of arsenic.

  • Intravenous fluids and blood transfusion.

  • Chelation therapy should be done in symptomatic patients with urine concentrations greater than 200 micrograms per liter (mcg/L).

Management of Chronic Arsenic Poisoning.

  • Use of arsenic-free drinking water.

  • Chelation therapy.

  • Micronutrients and antioxidants.

  • Treatment of systemic complications.

Conclusion

Arsenic is widely used in the industrial production of pesticides, herbicides, wood preservatives, and semiconductors. It is heavily dangerous and toxic in its inorganic form. Arsenic poisoning can occur through ingestion, inhalation, and dermal absorption through contaminated water, air, soil, and food. Arsenic poisoning results in serious health conditions. Arsenic levels in drinking water should be monitored regularly to avoid complications. Safety measures should be taken to prevent occupational exposure.

Frequently Asked Questions

1.

What Is the Treatment for Arsenic Poisoning?

Arsenic poisoning occurs by ingesting, absorbing, or inhaling toxic amounts of arsenic, a naturally occurring semi-metallic compound. Acute arsenic acute poisoning is treated with supportive measures. In symptomatic patients, chelation therapy should be considered. Dimercaprol and dimercaptosuccinic acid are chelating compounds used to treat acute arsenic poisoning.

2.

Which Test Is Used To Identify Arsenic Poisoning?

A urine test is the most reliable approach to detecting recent arsenic exposure. A 24-hour urine collection sample is taken to identify the presence of arsenic in the body. Urinary levels of arsenic may reduce quickly in the first 24 to 48 hours following acute exposure; thus, it is important to collect a urine sample for arsenic analysis quickly.

3.

What Are the Sources of Arsenic?

Arsenic can exist in both organic and inorganic forms. Inorganic arsenic compounds can be found in groundwater, sediment, and soil. This arsenic can be found naturally or may also occur due to industrial purposes, mining, and ore smelting. The primary sources of organic arsenic compounds are fish and shellfish.

4.

How Does Arsenic Poisoning Affect Humans?

Vomiting, stomach pain, and diarrhea are the immediate symptoms of arsenic poisoning. In severe cases, these are followed by numbness and tingling in the extremities, muscle cramps, and death. Long-term arsenic exposure causes multisystem illness and an increased risk of cancer. Chronic exposure results in skin irritations, cardiac arrhythmias, bronchitis, and gastric irritations.

5.

Which Disease Is Related to Arsenic Pollution?

Long-term arsenic exposure can lead to skin, bladder, lung, and kidney cancer. It can also induce skin lesions of hypopigmentation, hyperpigmentation, and basal and squamous cell malignancies. Arsenic and arsenic compounds have been categorized as carcinogenic to humans by the IARC (International Agency for Research on Cancer).

6.

Can a Blood Test Detect Arsenic Poisoning?

An arsenic blood test is performed to assess if someone has recently been exposed to high levels of arsenic. Blood arsenic levels in healthy people vary greatly depending on their exposure to arsenic in their diet and environment. A 24-hour urine arsenic test is beneficial for detecting chronic arsenic exposure.

7.

Is Arsenic Poisoning a Common Condition?

More than 200 million people worldwide are exposed to more than safe arsenic levels through drinking water. Long-term exposure to inorganic arsenic, primarily through drinking water and food, can result in chronic arsenic poisoning. Acute poisoning, on the other hand, is uncommon.

8.

What Is the Treatment for Arsenic Poisoning?

Immediate management of acute arsenic poisoning is eliminating the patient's source of arsenic. Treatment for arsenic poisoning involves gastric lavage, whole bowel irrigation, and supportive treatment. Alternative therapies such as selenium and vitamin E supplements have been used to reduce the side effects of arsenic exposure.

9.

How Does Arsenic Affect the Brain?

Chronic arsenic exposure causes axonal damage, which leads to peripheral neuropathy. Other central nervous symptoms like behavioral changes, confusion, and memory loss are also seen in arsenic poisoning. Workers exposed to arsenic showed cognitive impairment as well. There was also an increase in cerebrovascular illness, particularly cerebral infarction, due to arsenic poisoning.
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Neha Suryawanshi
Neha Suryawanshi

Nutritionist

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