This document discusses arsenic poisoning. It describes arsenic as a heavy metallic inorganic irritant poison, with inorganic arsenic compounds being poisonous. Arsenic acts by binding to sulfhydryl groups in enzymes and replacing phosphorus in bones. Signs and symptoms of arsenic poisoning include acute fulminating poisoning with shock and death, subacute gastroenteritis-like poisoning, and chronic poisoning causing skin pigmentation, nail changes, and neuritis. Treatment involves gastric lavage, chelating agents like BAL, DMSA, and penicillamine. Arsenic poisoning was historically used for homicide due to its low cost and difficulty detecting symptoms.

1. ARSENIC POISONING
Dr. Badar Uddin Umar
MBBS, M.Phil (Pharmacology)

2. PROPERTIES OF ARSENIC (AS)
 It is a heavy metallic inorganic irritant poison
 Inorganic arsenic compounds are poisonous:
 Arsenic trioxide, sodium arsenite, arsenic sulphide,
copperarsenite, etc.
 Metallic arsenic is non poisonous if ingested
because it is not absorbed

3. MECHANISM OF ACTION
 Arsenic ion binds with sulphydryl group (-SH) of
enzymes in the liver, lungs, intestinal walls,
spleen
 It replaces phosphorus in bones where it may
remain for years
 It also gets deposited in the hairs

4. SIGNS & SYMPTOMS
 Arsenic poisoning clinically manifests in three
forms 1. ACUTE FULMINATING TYPE:
•
Symptoms occur within half an hour when
heavy dose (3-5 gm) is taken
•
Acts on sulphhydryl groups of enzymes and
capillaries inhibiting cellular metabolism and
causing marked dilation of capillaries and
myocardial failure resulting in shock and
death

5. 2.SUB ACUTE TYPE( GASTROENTERITIS TYPE):
• When small doses of arsenic are given at repeated intervals
• Resembles case of cholera or food poisoning
Arsenic poisoning
Cholera
 Vomiting precedes purging
 Purging precedes vomiting
 Stools are rice water
initially and later turn
bloodstained
 Stools are rice water
throughout and passed as
involuntary jet
 Pain in the throat
 No pain in the throat
 Voice remains unaffected
 Voice rough & whistling
 Conjunctiva is inflamed
 Conjunctiva is normal
 Vomitus contains mucus,
bile and streaks of blood
 Vomitus is watery

6. 3. CHRONIC TYPE:
Presents with a sequence of 5 different set of manifestations
 Gastrointestinal: presents with gradual weight loss,
malnutrition, fatigue, loss of appetite
 Catarrhal changes: presents with running nose,
headache, conjunctivitis, bronchial catarrh
 Raindrop pigmentation: known to produce milk & roses
complexion initially, followed by patchy brown
pigmentation of the skin (especially forehead, neck,
shoulders)

7. 3. CHRONIC TYPE:
 It might also show hyperkeratosis of the skin of
palms and soles
 Mees lines: whitish lines 1-2 mm breadth across the
nails of fingers and toes
 Arsenical neuritis: polyneuritis, optic neuritis,
paresthesias, atrophy of extensors resulting in wrist
and foot drop
 Diagnosis: urinary As level of > 100 mg/24 hrs.
Blood levels are not reliable

8. TREATMENT
 Butter and greasy substances act as demulcents
 Gastric lavage with warm water or freshly prepared
hydrated ferric oxide solution
 Hemodialysis is the line of choice in massive arsenic
poisoning
 BAL is the specific antidote. (3 – 5 mg/kg 4 hourly deep
IM for 2 days followed by 2 – 3 mg/kg 6 hourly for 2
days and then every 12 hours for 7 days)
 DMSA, Penicillamine can also be used
 Symptomatic therapy
 Inj. Vitamin B1 helps in peripheral neuritis

9. POSTMORTEM FINDINGS
 Stomach: velvety red or brownish, patchy areas
with ulceration. Gastric contents emit garlicky odor
 Heart: subendocardial haemorrhage
 Other viscera: fatty degeneration of liver, kidney &
heart
 Brain may show inflammation with haemorrhagic
spots

10. MEDICOLEGAL IMPORTANCE
 It was considered as an ideal homicidal poison as it
was Cheap
 Easy to obtain
 Could be easily mixed and given
 Symptoms were similar to cholera
 Accidental poisoning with those who consume for its
aphrodisiac effects
 Accidental poisoning with contaminated tube well
water is common in Asia