FEATURES OF NEUROLOGICAL DISORDERS CAUSED BY ARSENIC
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FEATURES OF NEUROLOGICAL DISORDERS CAUSED BY ARSENIC
- 1. FEATURES OF NEUROLOGICAL DISORDERS CAUSED BY ARSENIC WAN NUR INSYIRAH BINTI WAN RAMZAN KGJ 150040 NOR ILLIANI BINTI RAMZI KGJ 150050 MARINA BINTI MUHAMAD KQD 160022
- 2. ARSENIC NFPA 704 “fire diamond” Short exposure could cause serious, temporary or moderate residual injury Materials that require considerable preheating, under all ambient temperature conditions, before ignition and combustion can occur. Flash point at or above 93.9 °C Undergoes violent chemical change at elevated temperature and pressure, reacts violently with water, or may form explosive mixtures with water
- 3. KEY FACTS Naturally present at high levels in the groundwater of a number of countries Highly toxic in its inorganic form Contaminated water used for drinking, food preparation and irrigation of food crops poses the greatest threat to public health Route of absorption through inhalation and ingestion Long-term exposure from drinking water and food can cause cancer Associated with developmental effects, cardiovascular disease, neurotoxicity and diabetes
- 4. SOURCE OF EXPOSURE Drinking water and food •Contaminated groundwater •Crops irrigated with contaminated water •Food prepared with contaminated water Industrial process •Alloying agent in glass, pigments, textiles, paper, metal adhesives, wood preservatives and ammunition •Manufacture of semiconductors •Hide tanning process •Pesticides •Feed additives •Pharmaceuticals Tobacco •Smoker can be exposed as tobacco plant take up arsenic naturally present in soil
- 5. Renal Effects Cardio vascular Effects Neurologic Effects Gastro intestinal and Hepatic Effects Respiratory Effects Hemato poietic and Hematologic Effects Reproductive Effects Dermal Effects Skin Cancer Lung Cancer Other Health Effects Carcinogenic Effects
- 6. ACUTE GARLIC ODOR GASTROINTESTINAL CARDIOVASCULAR RESPIRATORY RENAL & HEPATIC NEUROLOGICAL HAEMATOLOGICAL SKIN CHRONIC SKIN LESIONS GASTROINTESTINAL CARDIAC/RESPIRATORY HAEMATOLOGICAL NEUROLOGICAL DIABETES CANCER USUALLY WITHIN 30 MINS TO 2 HOURS WEEKS/YEARS AFTER FIRST EXPOSURE
- 7. DETAIL FEATURES OF ARSENIC POISONING DIARRHEA (LEADING TO HYPO VOLAEMIC SHOCK) DYSPHAGIA GARLIC ODOR (BREATH & BODY TISSUES) COLICKY ABDOMINAL PAIN GANGRENEDEHYDRATION VENTRICULAR TACHYCARDIA PROTEINURIA ADULT RESPIRATORY DISTRESS SYNDROME IRRITATION HAEMATURIA RASHESJAUNDICE PANCREATITIS ORAL BURNS HYPER SALIVATION VOMITTING PULMONARY OEDEMA MYOCARDIAL DEPRESSION TORSADES DE POINTES VENTRICULAR FIBRILLATION HAEMO GLOBINURIA ACUTE RESPIRATORY FAILURE BRONCHO SPAM ACUTE HAEMOLYSIS ACUTE TUBULAR NECROSIS WITH KIDNEY INJURY HEPATO MEGALY BONE MARROW SUPPRESSION ACUTE
- 8. EXFOLIATIVE DERMATITIS CONJUNC TIVITIS SKIN LESIONS DETAIL FEATURES OF ARSENIC POISONING MEES’ LINES (NAILS) JAUNDICEANEROXIA ABDOMINAL PAIN PERIPHERAL ARTERIAL DISEASE CIRRHOSIS CORONARY HEART DISEASE PERICARDITIS LIVER CANCER APLASTIC ANEMIA LYMPHOID CANCER ALOPECIA KERATOSES ON PALMS & SOLES HYPER PIGMEN TATION HEPATO MEGALY CORNEAL ULCERATION WEIGHT LOSS DIARRHEA HYPER TENSION DEV. OF PORTAL FIBROSIS MYOCARDITIS BLADDER & KIDNEY CANCER PANCYTO PENIA LUNG CANCER LARYNGEAL CANCER CHRONIC
- 9. ACUTE CHRONIC PERIPHERAL NEUROPATHY MUSCLE FASCICULATION & WASTING ATAXIA CANCER CNS DEPRESSION ENCEPHALOPATHY SEIZURE COMA
- 10. The features of ACUTE neurological disorders caused by arsenic. 1) Impaired concentration, confusion and abnormal thinking. 2) Mood swings including anxiety, agitation, depression, paranoia (feeling very anxious or nervous) and euphoria (feeling very happy). 3) Sleep disturbance including insomnia, drowsiness, vivid dreaming and nightmares. 1) Abnormal movements or shaking of hands or arms (tremulousness) 2) Agitation, excitement, or seizures (occur rarely) 3) Disorientation. 4) Drowsiness or confusion. 5) Strange behavior or severe personality changes. 6) Slurred speech. 7) Slowed or sluggish movement. 1) Losing consciousness, which is followed by confusion. 2) Having uncontrollable muscle spasms. 3) Drooling or frothing at the mouth. 4) Falling. 5) Having a strange taste in your mouth. 6) Clenching your teeth. 7) Biting your tongue. 8) Having sudden, rapid eye movements. 1) Closed eyes. 2) Depressed brainstem reflexes, such as pupils not responding to light. 3) No responses of limbs, except for reflex movements. 4) No response to painful stimuli, except for reflex movements. 5) Irregular breathing. CENTRAL NERVOUS SYSTEM (CNS) DEPRESSIONS ENCHEPHALO PATHY SEIZURE COMA
- 11. The features of CHRONIC neurological disorders caused by arsenic. 1) Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms. 2) Sharp, jabbing, throbbing, freezing or burning pain. 3) Extreme sensitivity to touch. 4) Lack of coordination and falling. 1) Fasciculations (primary symptom) Blepharospasms (Eye spasms) 2) Generalized fatigue. 3) Muscle pain. 4) Anxiety (Which can also be a cause) 5) Exercise intolerance. 6) Globus sensation. 7) Paraesthesias. 8) Muscle cramping or Spasms. 1) Impaired coordination in the torso or arms and legs. 2)Frequent stumbling. 3) An unsteady gait. 4) Uncontrolled or repetitive eye movements. 5) Trouble eating and performing other fine motor tasks. 6) Slurred speech. 7) Vocal changes. 8) Headaches. 1) Skin cancer 2) Lung cancer 3) Bladder cancer 4) Kidney cancer 5) Lymphoid cancer 6) Laryngeal cancer PERIPHERAL NEUROPATHIES ATAXIA CANCER MUSCLE FASCICULATION & WASTING
- 12. 12 ARSENIC (Elemental & Inorganic) : 0.01 mg/m3 ARSINE: 0.05 ppm ARSINE ILH (Immediate Lethal to Health): 150 ppm
- 13. 13 Determinants Arsenic (As) and soluble compounds including Arsine (inorganic As plus methylated metabolites in urine) Sampling Time End of work week Biological Exposure Index (BEI) 35 µg/L Pre-placement ♦ Nervous system ♦ Liver, liver function tests ♦ Skin, Nasal septum, lungs and lymph nodes. ♦ Estimation of urinary arsenic content in early morning specimen ♦ History of smoking, medicines taken, alcohol consumption, previous job. Periodic - Annually Organic and Inorganic As ♦ All cases of definite/suspected poisoning and excessive absorption ♦ Cases with urine arsenic levels ≥300µg/L in 2 successive examinations. ♦ All cases with evidence of cancer ♦ All breast-feeding & pregnant women ♦ Workers w persistent liver abnormalities Arsine ♦ All cases as stated above ♦ All cases with anaemia, proteinuria or haematuria. MEDICAL EXAMINATIONS BIOLOGICAL EXPOSURE DETERMINANTS MEDICAL REMOVAL PROTECTION MEDICAL SURVEILLANCE
- 14. PREVENTION AND CONTROL Reduce levels of arsenic in drinking water Reduce occupational exposure from industrial process Education and community engagement on awareness of exposure risks and sourceImprovement of workplace hygiene Use of approved Personal Protective Equipment High risk population should also be monitored for early signs of arsenic poisoning
- 15. REFERENCES • Guidelines on Medical Surveillance 2001, Occupational Safety and Health (Use and Standard of Exposure of Chemicals Hazardous to Health) Regulations, 2000 P.U.(A)131 (JKKP:GP(1)/4/2001), ISBN 983-2104-16-6, pg 8-14 • Henry's Clinical Diagnosis and Management by Laboratory Methods (pg. 361-362) • Lippincott's Manual of Toxicology (pg. 197) • http://www.who.int/features/qa/55/en/ • https://www.ncbi.nlm.nih.gov/pubmed/21306980 • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4026128/pdf/40572_2014 _Article_12.pdf • https://www.atsdr.cdc.gov/csem/csem.asp?csem=1&po=11 • https://en.wikipedia.org/wiki/NFPA_704 • http://www.who.int/mediacentre/factsheets/fs372/en/
Editor's Notes
- Gastrointestinal and Hepatic Effects Renal Effects Cardiovascular Effects Neurologic Effects Dermal Effects Respiratory Effects Hematopoietic and Hematologic Effects Reproductive Effects Carcinogenic Effects Skin Cancer Lung Cancer Other Health Effects
- ACUTE 1. Garlic odour - often present in breath and body tissues. 2. Gastrointestinal (GI): Hypersalivation, abdominal pain, vomiting, diarrhea leading to hypovolaemic shock. Trivalent arsenic is corrosive - may cause oral burns, dysphagia and GI bleeding. 3. Cardiovascular: 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. 4. Respiratory: Pulmonary oedema, adult respiratory distress syndrome and acute respiratory failure. Inhaled arsenic causes irritation, bronchospasm and pulmonary oedema. 5. Renal and hepatic: Haematuria or haemoglobinuria (from acute haemolysis), proteinuria, acute tubular necrosis with acute kidney injury. Jaundice, hepatomegaly, pancreatitis. 6. Neurological: CNS depression, encephalopathy and coma. Seizures. 7. Haematological: Acute haemolysis. Bone marrow suppression. Basophilic stippling and rouleaux formation may be seen on a blood film. 8. Skin: rashes. CHRONIC 1. Skin lesions: Skin lesions are the most common effect of chronic exposure. They typically start about ten years after first exposure. Keratoses on the palms and soles are characteristic. Mees' lines (transverse white lines on nails).[6] Hyperpigmentation (especially on the arms and upper chest) - diffuse dark areas or 'raindrop' pigmentation. Also, exfoliative dermatitis, alopecia, conjunctivitis, corneal ulceration. 2. GI: Anorexia, weight loss, abdominal pain, diarrhea. Jaundice, hepatomegaly; development of portal fibrosis and cirrhosis. 3. Cardiac/respiratory:[12][13] Coronary heart disease, increased further in those who also smoke. Myocarditis, pericarditis. Hypertension. Peripheral arterial disease. Restrictive or obstructive lung disease. Effects in children are seen after an average of seven years of exposure. 4. Haematological: Pancytopenia, Aplastic anaemia. 5. Neurological: Peripheral neuropathy (sensory and motor at 1-3 weeks). Muscle fasciculation and wasting. Ataxia. 6. Diabetes - increased risk. 7. Cancer - increased risk of cancers: Basal cell carcinoma and squamous cell carcinoma of the skin.[14] Lung. Bladder and kidney. Possibly also lymphoid, laryngeal and liver.
- ACUTE 1. Garlic odour - often present in breath and body tissues. 2. Gastrointestinal (GI): Hypersalivation, abdominal pain, vomiting, diarrhea leading to hypovolaemic shock. Trivalent arsenic is corrosive - may cause oral burns, dysphagia and GI bleeding. 3. Cardiovascular: 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. 4. Respiratory: Pulmonary oedema, adult respiratory distress syndrome and acute respiratory failure. Inhaled arsenic causes irritation, bronchospasm and pulmonary oedema. 5. Renal and hepatic: Haematuria or haemoglobinuria (from acute haemolysis), proteinuria, acute tubular necrosis with acute kidney injury. Jaundice, hepatomegaly, pancreatitis. 6. Neurological: CNS depression, encephalopathy and coma. Seizures. 7. Haematological: Acute haemolysis. Bone marrow suppression. Basophilic stippling and rouleaux formation may be seen on a blood film. 8. Skin: rashes.
- CHRONIC 1. Skin lesions: Skin lesions are the most common effect of chronic exposure. They typically start about ten years after first exposure. Keratoses on the palms and soles are characteristic. Mees' lines (transverse white lines on nails).[6] Hyperpigmentation (especially on the arms and upper chest) - diffuse dark areas or 'raindrop' pigmentation. Also, exfoliative dermatitis, alopecia, conjunctivitis, corneal ulceration. 2. GI: Anorexia, weight loss, abdominal pain, diarrhea. Jaundice, hepatomegaly; development of portal fibrosis and cirrhosis. 3. Cardiac/respiratory:[12][13] Coronary heart disease, increased further in those who also smoke. Myocarditis, pericarditis. Hypertension. Peripheral arterial disease. Restrictive or obstructive lung disease. Effects in children are seen after an average of seven years of exposure. 4. Haematological: Pancytopenia, Aplastic anaemia. 5. Neurological: Peripheral neuropathy (sensory and motor at 1-3 weeks). Muscle fasciculation and wasting. Ataxia. 6. Diabetes - increased risk. 7. Cancer - increased risk of cancers: Basal cell carcinoma and squamous cell carcinoma of the skin.[14] Lung. Bladder and kidney. Possibly also lymphoid, laryngeal and liver.
- As quoted by R N Ratnaike in ‘Acute and chronic arsenic toxicity’ ACUTE ARSENIC POISONING • Clinical features manifest in virtually all body systems. • Prominent features are nausea, vomiting, colicky abdominal pain, profuse watery diarrhoea, and excessive salivation. • Other features are acute psychosis, a diffuse skin rash, toxic cardiomyopathy, and seizures. • Haematological abnormalities occur and renal failure, respiratory failure, and pulmonary oedema are common. • Neurological manifestations include peripheral neuropathy or encephalopathy. • Urinary arsenic concentration is the best indicator of recent poisoning (1–2 days). CHRONIC ARSENIC TOXICITY • The clinical features manifest in virtually all body systems. • Absorbed arsenic accumulates in the liver, kidneys, heart and lungs, with smaller amounts in the muscles, nervous system, gastrointestinal tract, spleen, and lungs. • Arsenic is deposited in the keratin-rich tissues: nails, hair, and skin. • Mee’s lines occur in the fingernails and toenails. • The most serious consequence is malignant change in almost all organs of the body. • Dermatological changes are common, such as hyperpigmentation and both palmar and solar keratoses. • There is increased risk of cardiovascular disease, peripheral vascular disease, respiratory disease, diabetes mellitus, and neutropenia. • Effective treatment of chronic arsenic toxicity is not yet established.