The document discusses arsenic poisoning, detailing its symptoms, diagnosis, and treatment, as well as the serious health consequences of exposure. It highlights the acute and chronic forms of arsenic poisoning, with diagnosis methods including urine and blood tests, and the importance of decontamination and supportive care. Additionally, it addresses arsenic contamination in drinking water, particularly in Bangladesh, where governmental initiatives have been implemented to mitigate the issue.

1. Arsenic Poisoning
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Presented by:
MD. MOHABBOT HOSSEN
B.Pharm (Hon’s)
Dhaka International University

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3. Poison
Poison is anything that kills or injures through its chemical actions.
Most poisons are swallowed (ingested). But poisons can also enter the
body in other ways:
Through the skin
By IV injection
From exposure to radiation
Venom from a snake bite or insect bite
By breathing
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4. Symptoms of Poisoning
Signs and symptoms of poisoning are so wide and variable that there is
no easy way to classify them.
Some poisons enlarge the pupils, while others dwindle them.
Some result in excessive drooling, while others dry the mouth and skin.
Some speed the heart, while others slow the heart.
Some increase the breathing rate, while others slow it.
Some cause pain, while others are painless.
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5. How Is Poisoning Diagnosed?
A combination of history, physical examination, and laboratory studies will help
reveal the cause of most poisonings.
History: As a family member or friend of a poisoned person, you can greatly assist
the doctor and provide valuable clues by telling the doctor about these details:
• Everything the person ate or drank recently.
• Names of all prescription and over-the-counter medications the person is
taking.
• Exposure to chemicals at home or at work.
• Whether others in the family or at work have been similarly ill or exposed.
• Whether the person has any psychiatric history to suggest an intentional
ingestion (suicide attempt). 5

6. CONTD..
Testing: Many poisons can be detected in the blood or urine.
A specific blood test will give serum levels of some drugs,
including phenytoin, theophylline, digoxin, lithium and acetaminophen.
• Some drugs affect the electrical activity of the heart.
An electrocardiogram (ECG) may reveal toxicity.
• Sometimes a person is unconscious for no obvious reason. A CT
scan of the brain will help tell if there has been a structural change in
the brain, such as a stroke.
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7. Background on Arsenic(As)
• According to the U.S. Agency for Toxic Substances
and Disease Registry, arsenic is the number one
most hazardous substances.
• Taste less, color less, and odor less.
• The lethal dose for humans is 125 mg.
• As is mostly excreted through urine, skin hair.
In excess in can be deposited into tissues, which can lead to
inhibition of cellular activities.
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8. Major Forms of Arsenic Intoxication
Acute Inorganic
Arsenic Poisoning
Chronic Inorganic
Arsenic Poisoning
Arsine Gas Poisoning
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9. Acute Inorganic Arsenic Poisoning
Exposure to high doses (tens to hundreds of milligrams) of soluble
inorganic arsenic compounds.
• Delirium
• Encephalopathy
• coma
CNS
effects:
Initial gastrointestinal signs and symptoms:
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain.
Pancytopenia usually develops within 1 week
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10. DIAGNOSIS
Elevated amounts of inorganic
arsenic and its metabolites in the
urine (several thousand micrograms
in the first 2–3 days).
Arsenic disappears rapidly from the
blood, and except in anuric
patients, blood arsenic levels should
not be used for diagnostic purposes.
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11. TREATMENT
Gut decontamination
Intensive supportive care
chelation with-
Unithiol, 3–5 mg/kg,
intravenously every 4–6 hours.
or Dimercaprol, 3–5 mg/kg.
Intramuscularly every 4–6 hours.
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12. Chronic Inorganic Arsenic Poisoning
Chronic absorption of more than 0.01 mg/kg/d (∼ 500–1000 mcg/d in
adults).
Symptoms:
• fatigue
• weight loss
• weakness
• Anemia
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13. CONTD..
Cancer of the lung, skin, bladder, and possibly other sites, may appear years after
exposure to doses of arsenic that are not high enough to elicit other acute or chronic
effects.
Skin changes—among the most characteristic
effects—typically develop after years of exposure
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14. Diagnosis of Chronic Inorganic Arsenic Poisoning
The urine concentration of the
sum of inorganic arsenic and its
primary metabolites MMA and
DMA is less than 20 mcg/L in the
general population.
All seafood should be avoided for
at least 3 days before submission
of a urine sample for diagnostic
purposes.
The arsenic content of hair and
nails (normally less than 1 ppm)
may sometimes reveal past
elevated exposure.
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15. Management
Termination of exposure and nonspecific supportive care.
Short-term oral chelation with unithiol or succimer may be
considered, it has no proven benefit beyond removal from
exposure alone.
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16. Arsine Gas Poisoning
2 hours to 24 hours post inhalation, massive intravascular hemolysis may
occur.
• Malaise
• Headache
• Dyspnea
• Weakness
• Nausea
• Vomiting
• Abdominal pain
• Jaundice
• Hemoglobinuria.
Initial symptoms may include:
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17. Treatment of Arsine Gas Poisoning
Intensive supportive care including –
Exchange transfusion
Vigorous hydration
Hemodialysis
Currently available chelating agents have not been
demonstrated to be of clinical value in arsine
poisoning.
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18. Where can we find Arsenic?
Arsenic can be found all over the world both from-
Human activities
In the earth crust
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19. How has Arsenic entered into the water sources?
Release of As is due to
dropping water levels in the
river, for agriculture uses,
allows for oxidation of the As.
Another source is from the
water running over As rich
rocks into the wells.
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20. Effects of Arsenic Poisoning
1. Melanosis (darkening of the skin)
2. Keratosis (growth of keratin on the skin)
3. Dark spots on the chest, back, limbs, and gums
4. Enlargement of the liver, kidneys, and spleen
Short term
1. Cancers of the skin, lung, or bladder.
2. Blood vessel diseases in the legs and feet.
3. Nephropathy and hepatopathy.
4. Gangrene (death of tissues in part of the body).
Long term
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21. EPA and WHO Standards
EPA standard for arsenic in drinking water
is 10 ppb, which replaced the old
standard of 50 ppb in 2001.
WHO has the standards of 0.01mg/L in
drinking water for Europe and North
America.
The WHO standard for Bangladesh still stands at 0.05mg/L
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22. Ground water & Arsenic Poisoning
The excess amount of arsenic in drinking water has been reported from various
parts of the world, such as Argentina, Bangladesh, Chile, China, Hungary, India,
Mexico, Nepal, Taiwan, and USA.
50 million people being at risk
of exposure.
Groundwater contains a higher
concentration of arsenic than
surface water sources.
Tube wells which were
installed within the depth of
15–50 m.
In Bangladesh
However, in some areas, the arsenic contamination is found in the tube
wells that were installed in greater depths. 22

23. Arsenic mitigation program in
Bangladesh
a countrywide screening for arsenic contamination in tube well water was initiated in 1996.
The initial screening that concluded in 1999 had tested 51,000 tube wells, which revealed that
arsenic contamination was present in 211 out of 460 upazillas.
Subsequently, in 2003, a nationwide blanket survey was conducted by Bangladesh Arsenic
Mitigation Water Supply Project (BAMWSP), covering 57,482 villages located in 271 upazillas,
where it was reported that out of 4.95 million tubewells for arsenic contamination, 1.44 million
tubewells were contaminated.
In 2004, the government formulated National Policy for Arsenic Mitigation (NPAM) to confront
the “groundwater arsenic problem,” on the basis of which Arsenic Policy Support Unit (APSU) and
Implementation Plan for Arsenic Mitigation (IPAM) guided by a national committee were formed.
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24. Wish you have a healthy life with a safe water
THANK YOU
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26. • Pancytopenia is a medical condition in which there is a reduction in
the number of red and white blood cells, as well as platelets.
• Delirium is a serious disturbance in mental abilities that results in
confused thinking and reduced awareness of the environment.
• Encephalopathy is a term that means brain disease, damage, or
malfunction. Encephalopathy can present a very broad spectrum of
symptoms that range from mild, such as some memory loss or subtle
personality changes, to severe, such as dementia, seizures, coma, or
death.
• Anuria is when the kidneys stop producing urine
• monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA)
• United States Environmental Protection Agency
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27. Hemoglobinuria is a condition in which the oxygen transport protein
hemoglobin is found in abnormally high concentrations in the urine
Malaise is a feeling of general discomfort, uneasiness, or pain, often
the first sign of an infection or other disease.
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