Arsenic is a toxic metallic element that can cause poisoning through various routes of exposure. It acts by binding to sulfhydryl groups in enzymes and proteins, interfering with oxidative phosphorylation and other metabolic pathways. Acute arsenic poisoning presents with gastrointestinal symptoms, hemolysis, renal failure, and shock. Chronic arsenic poisoning can result in skin lesions, cancers, and neurological effects. Diagnosis involves blood, urine, hair, and imaging tests to detect arsenic levels. Treatment focuses on supportive care and chelation therapy to remove arsenic from the body.

1. ARSENIC POISONING
Clinical toxicology
Pharm.D (IV/VI)

2. INTRODUCTION :
• It is a silver grey ,tin white shiny ;brittle crystalline and metallic
looking element .
• TOXICITY LEVELS :
• Trivalent arsenate >>Pentavalent arsenate
• (Most toxic ) (less toxic )
• less water soluble
• Arsenic gas ↔most toxic gas →hemolysis
• 200 -300 mg for ArO3
• Most toxic form of arsine gas 25-30ppm lethal in 30 min .

3. MECHANISM OF ACTION :
• Ar binds sulphydryl containing proteins +enzyme in oxidative
phosphoryaltion
• ↓leads to
• Lacto acidosis ,shock ,multiple organ failure
• Hb synthesis →siderocytic anemia
• Meth amine synthetase →chromocystein anemia
,atherosclerosis
• Inhibition of metabolic pathways
• Ar also a clastogen ,human carcinogen .

4. CLINICAL(TOXIC) SYMPTOMS
ACUTE POSINONING ARSINE GAS POSINONING CHRONIC Ar POSINONING
ONSET OF SYMPTOMS BESIDES SYMPTOMS
OBSERVED
Dementia
LOCAL GI EFFECTS +Severe hemolysis leads to Bone marrow depression
Dysphasia haematuria Myelodysplasia
Vomiting Abdominal pain Mycocarditis
ARDS renal failure Black foot disease
Acute renal failure Hyperkalemia Lung cancer
Encephalopathy dysponea Alopecia

5. DIAGNOSIS :
• Hematology :
• CBC → early onset hemolysis .
• BIOCHEMISTRY :hepatic and renal toxicity
• lactic acidosis
• ECG :arrhythmias ,QT prolonged seen.
• Imaging abdominal x-ray : Identify Ar in GI
tract.
• Hair level :Important diagnostic criterion .

6. MANAGEMENT :
• Supportive measures
• 1.gastric lavage
• 2.cardiac monitoring
• 3.IV fluids
• Chelation therapy:
• BAL /Dimercaprol
• Antidotes
• Haemodialysis/exchange transfusion