This document outlines the sources, modes of exposure, toxicokinetics, mechanisms and symptoms of both acute and chronic arsenic toxicity. It discusses diagnosis and treatment approaches including chelation therapy and removal techniques. Notable cases discussed include a strain of bacteria able to use arsenic instead of phosphorus.

1. ARSENIC TOXICITY
toxicology

2. OUTLINES
 Sources
Moods of exposure
Toxicokinetics
Mechanisms of toxicity
 Symptoms of acute and chronic toxicity
Diagnosis
Treatment
Notable cases of arsenic poisoning
References

3. SOURCES

6. MOODS OF
EXPOSURE

8. 1- INGESTION:

9. ARSENIC CONTAINING
FOODS:

10. 2- INHALATION:

11. 3- SKIN:

12. TOXICOKINETICS

13. .
ABSORPTION

15. DISTRIBUTION

16. METABOLISM

18. EXCRETION

20. MECHANISMS OF
TOXICITY

22. ARSENIC-INDUCED
CARDIOVASCULAR DYSFUNCTION

25. ARSENIC-INDUCED DIABETES
MELLITUS
.

27. ARSENITE-INDUCED NEUROTOXICITY

30. ARSENIC-INDUCED NEPHROTOXICITY
AND HEPATOTOXICITY

32. ARSENIC-INDUCED
CARCINOGENICITY

34. SYMPTOMS OF ACUTE
AND CHRONIC
TOXICITY

35. SYMPTOMS OF CHRONIC ARSENIC
POISONING
Affected organ Features
Skin  Excessive darkening of skin
(hyperpigmentation) in areas that are not
exposed to sunlight
 Excessive formation of scaly skin on the
palms and soles (arsenical keratosis)
 Exfoliative dermatitis
 Arsenic-induced skin cancers (especially
Bowen disease , Squamous cell carcinoma)
Nails  Transverse white bands of arsenic deposits
across the bed of the fingernails (Mee's
lines)

37. Hair  Arsenic deposits in hair
Nervous system  Sensory changes, numbness and
tingling in a “stocking-glove”
distribution (sensory peripheral
neuropathy)
 Headache, drowsiness, confusion
 Distal weakness of small muscles
e.g. hands and feet
Blood and urine  Haemolytic anaemia (moderate)
 Leukopaenia (low white cell count)
 Proteinuria (protein in urine)

38. Other  Inflammation of respiratory mucosa
 Peripheral vascular insufficiency
 Increased risk of cancer of lung, liver,
bladder, kidney and colon

39. Features of acute arsenic poisoning
Symptoms usually start within 30 minutes to 2 hours.
 Acute arsenic ingestion is typically followed by a severe
gastroenteritis, garlic odour and hypersalivation.
 There is a characteristic sequence of multi-organ failure,
with: neurological symptoms (within hours) and cardiac
features, succeeded by adult respiratory distress
syndrome and renal/liver dysfunction.
 Marrow suppression develops after a few days to weeks in
survivors, as does alopecia and an ascending motor
neuropathy.

40. often present in breath and body
tissues
Hypersalivation, abdominal pain, vomiting,
diarrhoea leading to hypovolaemic shock.
Trivalent arsenic is corrosive - may cause oral
burns, dysphagia and GI bleeding.
Myocardial depression.
Dehydration, hypovolaemia or shock.
ECG changes including ST segment
changes, prolonged QT interval, ventricular
tachycardia, torsades de pointes and ventricular
fibrillation.
Gangrene of extremities.

41. Pulmonary oedema, adult respiratory distress
syndrome and acute respiratory failure.
Inhaled arsenic causes irritation, bronchospasm
and pulmonary oedema
Haematuria or haemoglobinuria (from acute
haemolysis), proteinuria, acute tubular
necrosis with acute renal failure.
Jaundice, hepatomegaly, pancreatitis
CNS depression, encephalopathy and coma.
Seizures.

42. Acute haemolysis.
Bone marrow suppression.
Basophilic stippling and
rouleaux formation may
be seen on a blood film
Rashes

43. DIAGNOSIS

48. TREATMENT

49. 1-TREATMENT OF ACUTE
ARSENIC:

51. 2-TREATMENT OF CHRONIC
ARSENIC

52. 1-Chelation 2-Nutrition 3-Removal
Chemical and synthetic
Supplemental
methods are used to treat
potassium decreases
arsenic poisoning.
the risk of
Dimercaprol and
experiencing a life-threatening
dimercaptosuccinic acid are
heart
chelating agents that
rhythm problem from
sequester the arsenic away
arsenic trioxide.
from blood proteins and are
used in treating acute
arsenic poisoning. The most
important side effect is
hypertension. Dimercaprol
is considerably more toxic
than succimer.[citation
needed]DMSA monoesters,
e.g. MiADMSA, are
promising antidotes for
arsenic poisoning. Calcium
sodium edetate is also
used.
Various techniques have been
evolved for arsenic removal, most
frequently using absorbents such
as activated carbon, aluminium
oxide, co-operative with iron oxide
to form sludges, adsorption onto
iron-oxide-coated polymeric
materials, and electrocoagulation
by nanoparticle. To remove the
stress of heavy and toxic metals,
an environment-friendly approach
must be applied and the use of
naturally occurring microbe must
be emphasized. Bacteria, yeast,
fungi, algae—all of them can be
used for remediation processes
and it is always recommended
that microbe used for
bioremediation must have natural
decontamination process and the
method should be cost-effective.

53. NOTABLE CASES OF
ARSENIC POISONING

55. http://www.youtube.com/watch?v=W3Hvexu5SqM

56. STRAIN GFAJ-1 OF THE
HALOMONADACEAE,
ISOLATED FROM MONO
LAKE, CALIFORNIA,
THAT IS ABLE TO
SUBSTITUTE ARSENIC
FOR PHOSPHORUS TO
SUSTAIN ITS GROWTH.

57. REFERENCE
 http://www.atsdr.cdc.gov/csem/arsenic/docs/arsenic.pdf
 http://toxsci.oxfordjournals.org/content/123/2/305.full
 Agency for Toxic Substances and Disease Registry (2007)ToxGuide for Arsenic, USA: Centers for Disease
Control and Prevention.
 Agency for Toxic Substances and Disease Registry (2009) Case Studies in Environmental Medicine; Arsenic
Toxicity, USA: Centers for Disease Control and Prevention.
 WHO (2000) Air Quality Guidelines, 2 edn., Copenhagen, Denmark: WHO Regional Office for Europe.
 American Conference of Governmental Industrial Hygienists (ACGIH). Documentation of the threshold limit
values and Biological Exposure Indics. 5th ed. ACGIH, Cincinnati, OH, 1986.
 Armstrong, C. W., Stroube, R. B., Rubio, T., and Beckett, W. S. Outbreaks of fatal arsenic poisoning caused by
contaminated drinking water. Arch. Environ. Health 39, pp 274-279, 1984.
 Axelson, O., Dahlgren, E., Jansson, C. D., and Rehnlund, S. O. Arsenic exposure and mortality. Acase reference
study from a Swedish copper smelter. Br. J. Ind. Med. 35, pp 8-15, 1978.
 Dr. D.n. Guha Mazumder, Chapter 4 : Diagnosis and treatment of chronic arsenic poisoning By. In editor.
Diagnosis and treatment of chronic arsenic poisoning, : Institute of Post Graduate Medical; 2000. p.20
 Steven Marcus. Medscape. Arsenic Toxicity treatment [serial on the Internet]. 2012 [cited 2014 Nov 23].
Available from: Copyright © 1994-2014 by WebMD LLC, MEDLINE database Web site:
http://http://emedicine.medscape.com/article/812953-overview
 Dr. D.n. Guha Mazumder, Chapter 4 : Diagnosis and treatment of chronic arsenic poisoning By. In editor.
Diagnosis and treatment of chronic arsenic poisoning, : Institute of Post Graduate Medical; 2000. p.20
 Steven Marcus. Medscape. Arsenic Toxicity treatment [serial on the Internet]. 2012 [cited 2014 Nov 23].
Available from: Copyright © 1994-2014 by WebMD LLC, MEDLINE database Web site:
http://http://emedicine.medscape.com/article/812953-overview