Arsenic Poisoning

Arsenic Poisoning is characterized by projectile vomiting (bloody), burning pain in the stomach, watery diarrhea, dehydration, convulsions, uremia, and skin eruption.

Arsenic occurs in four forms:

Metalic (As), Trivalent compounds (As_2O3), Pentavalent compounds (As₂O₅) and Arsenic gas (AsH₃).

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Mechanism of Toxicity

Arsenic combines with the -SH group of enzymes of the body and inhibits them. Thus leaving them non-functional. It also inhibits the oxidative decarboxylation of pyruvate to acetyl CoA and binds to the SH group forming a chelate and therefore, resulting in accumulation of pyruvic acid in the blood. Accumulated pyruvic acid interferes with the normal enzymatic activities in the body and disturbing cell metabolisms.

Signs & Symptoms (Acute Case)

• Projectile vomiting (bloody)
• Burning pain in the stomach
• Watery diarrhea
• Dehydration
• Convulsions
• Uremia
• Skin eruption

Treatment

Gastric lavage (Charcoal, ferric oxide), Administration of antidote, BAL (Dimercaprol), Sodium thiosulphate, Purgatives, Morphine, Dialysis, I/V fluids & glucose

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Differential Diagnosis

Cholera, Food Poisoning can be the differential diagnosis.

ECG Abnormalities in Arsenic Poisoning

ST Segment & T wave abnormalities are very commonly seen in arsenic poisoning.

Delayed Manifestations

Delayed manifestations of arsenic poisoning include foot drop, wrist drop, abnormal gait, paraesthesia, alopecia and peripheral neuropathy.mia.

Postmortem Appearance

Externally:

Dehydrated, jaundice, cyanosis & wrinkled skin are seen externally during postmortem appearance.

Internally

The stomach is red velvet-like, corrosive of mucous membranes, particles of arsenic in the stomach, small acute ulcerations and petechial hemorrhages.

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