The patient was brought to the emergency ward with a history of rashes, blebs on the skin mainly on the arms and feet, tingling and numbness in the hands and feet. He had consumed water from his workplace for the past 3 days and had been suffering from severe gastroenteritis. On examination, he had nail changes, sensory loss, dermatitis and went into shock, requiring admission to the ICU.

1. A patient was bought to the Emergency ward with history of rashes and blebs all over his skin mainly on his arms and feet. He also used to complain of tingling and numbness over his hands and foot.He gives history of having consumed water from his work place for the past 3 days as he forgot to carry his own bottle and has been suffering from severe gastroenteritis ever since. Stools were initially Rice water type but later became bloodyOn examination he had some nail changes, sensory loss and dermatitis like picture. His blood picture and abdomen radiography were as in the images. Patient went into shock and finally was admitted in the ICU1Telugu Doctors.co.in

2. Arsenic PoisoningA presentation by Telugu Doctor2

3. History Of Arsenicits very name has become synonymous with poison.

4. the Italian family of Borgias used arsenic as their favorite poison for political assassinations.

5. It is believed that Napoleon was poisoned by arsenic-tainted wine served to him while in exile. 3Telugu Doctors.co.in

6. Arsenic in the WorldArsenic is ubiquitous in the environment.

7. It ranks 20th in abundance in the earth's crust, 14th in seawater, and 12th in the human body. 12th20th14th4Telugu Doctors.co.in

8. Possible Arsenic poisoningToday, arsenic poisoning occurs through industrial exposure, from contaminated wine or moonshine, or because of malicious intent.

9. The possibility of heavy metal contamination of herbal preparations and so-called nutritional supplements must also be considered. 5Telugu Doctors.co.in

10. Arsenic – Medicinal Value?There has been a resurgence of interest in arsenic as a medicinal agent for treatment of Acute promyelocyticleukemiasMultiple myelomaMyelodysplastic syndromes and Assorted resistant solid tumors6Telugu Doctors.co.in

11. Protection from Arsenic ?The population was recently surveyed and those individuals who had diets deficient in certain B vitamins and antioxidants appeared to have greater risk of arsenic dermatoses.

12. An inverse correlation was found between consumption of vitamins A, C, and E, riboflavin and folic acid, and the existence of dermatological manifestations or chronic arsenic exposure. 7Telugu Doctors.co.in

13. Poisonous Compounds of ArsenicArsenic oxide or Arsenic TrioxideIt is the most common form of arsenic used.

14. It is also known as White Arsenic.

15. No taste or smell and is sparingly soluble in water.

16. It is heavier than water by three and half times but freely floats on water.8Telugu Doctors.co.in

17. Uses Of ArsenicCalico printingFruit spraysSheep-dipsRat poisonsPreserving timber and skin against white antsFly papersTaxidermyWeed-killers9Telugu Doctors.co.in

18. Mode Of ActionArsenic interferes with cellular respiration by combining with the sulphydryl groups of mitochondrial enzymes.

19. It particularly targets vascular endothelium leading to increased permeability, tissue edema and hemorrhage, especially in the intestinal canal.10Telugu Doctors.co.in

20. Mode Of ActionLocally it causes irritation of the mucous membranes and remotely depression of the nervous system.Arsenic also interferes with glycolysis.11Telugu Doctors.co.in

21. Circumstances Of PoisoningIt is cheap

22. Easily obtained

23. Colourless

24. No smell

25. No taste

26. Small quantity is required to cause death.

27. Can be easily administered with food or drink.

28. Onset of symptoms is gradual

29. Symptoms simulate those of Cholera.12Telugu Doctors.co.in

30. Circumstances Of PoisoningDisadvantages Of Arsenic:It delays putrefaction

31. Can be detected in completely decomposed bodies.

32. Can be found in bones, hairs and nails for several years.

33. Can be detected in charred bones or ashes.13Telugu Doctors.co.in

34. Signs And SymptomsThe Fulminant typeThe Gastroenteric Type14Telugu Doctors.co.in

35. The Fulminant typeMassive doses of arsenic when rapidly absorbed cause death in one to three hours from shock and peripheral vascular failure.

36. All the capillaries are markedly dilated, especially in the splanchnic area with a marked fall of blood pressure.15Telugu Doctors.co.in

37. The Gastroenteric TypeThis is the common form of acute poisoning and resembles bacterial food poisoning.

38. Symptoms usually appear half to one hour after ingestion, but may be delayed many hours especially when arsenic is taken with food.

39. Burning and colicky pain in the esophagus, stomach and bowel occur.

40. Intense thirst and severe vomiting which may be projectile are the common symptoms.16Telugu Doctors.co.in