There are two forms of arsenic (As): inorganic (toxic) and organic (health effects in humans are not clear)(3).

Clinical features of arsenic toxicity

Vary depending on level of exposure and age of the child. Clinical features can be nonspecific. Inorganic arsenic is a human carcinogen (associated with skin, liver, bladder, and lung cancer).

Investigations

• FBE
  • Acute exposure - may cause haemolysis
  • Chronic exposure - pancytopaenia, basophilic stippling, rouleaux
• Spot urinary arsenic concentrations - for confirming arsenic exposure within previous 48-72 hours.
  • UAL do not differentiate between inorganic and organic arsenic; seafood consumption within 48 hours of urine testing can lead to false positive results.
  • Testing is available through Dorevitch, Melbourne Pathology and Healthscope for a standard Medicare rebate of around $35. Results are available in 7-14 days
• Blood arsenic concentrations are of limited use - the half-life of inorganic arsenic in the blood is short (~ 2 hours)
• Hair samples are not recommended. They become positive 30 hours after exposure but may give falsely high results. They do not differentiate between ingestion and external exposure

Treatment

• Prevention of further arsenic exposure
• Supportive therapy
  • May require aggressive fluid resuscitation
  • Activated charcoal does not bind arsenic and is not indicated.
• Chelation therapy (to bind arsenic and facilitate excretion)
  • Chelating agents for As include: Dimercaprol (BAL in Oil) and Succimer (DMSA) 
• Patient/family education.
• Cases should be notified to local toxicology services

Further information

• Emedicine overview: Arsenic toxicity in emergency medicine
• Patient information (UK website). No translated information identified

References

• References

_{Immigrant health resources Authors: Dr Anthea Rhodes, Dr Vanessa Clifford, Dr Georgie Paxton. Initial April 2012, Last review Feb 2020. Contact: georgia.paxton@rch.org.au}