Immigrant Health Service

Arsenic - further information

  • 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).

     Low level exposure High level exposure

    Abdominal pain, nausea, anorexia, vomiting
    Skin and nail changes, including warty growths on palms, soles, torso
    Alopecia (hair loss)
    Anaemia
    Generalized weakness
    Polyneuritis

    Nausea, vomiting, abdominal pain and severe diarrhoea, may progress to severe dehydration and shock
    Garlic odour
    CNS - confusion, seizures, coma

    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)
    • Patient/family education.
    • Cases should be notified to local toxicology services

    Further information

    References

    Immigrant health resources Authors: Dr Anthea Rhodes, Dr Vanessa Clifford, Dr Georgie Paxton. Initial April 2012, Last review May 2015. Contact: georgia.paxton@rch.org.au