Arsenic is an element found in nature, and in man-made products, including some pesticides. Arsenic is widely distributed in the Earth’s crust. It is found in water, air, food, and soil.
Arsenic is highly toxic in its inorganic form.
Exposure to arsenic-laden drinking water can induce symptoms of gastroenteritis and lead to cancer, diabetes, and neurological and vasculardysfunction.
Long-term arsenic exposure in drinking water shows a dose-response relationship to carotid atherosclerosis. The mechanism involves the induction of expression of genes coding inflammatory mediators.
Arsenic has also been linked to dermatosis and cancers of the skin, bladder, and lung.
Dietary arsenic is contributed by various foods including cereals and breads (18.1%), starchy vegetables (14.9%), and meats and fish (32.1%) of total average daily intake.
Arsenic exposure is associated with the following clinical symptoms:
– Neurological: Central depression with visual effects, headache and high fever
– Hematological: Abnormal RBC counts, increased megalocytes and microcytes
– GI tract: Increased peristalsis with “rice water” stools
– Skin: “Milk and roses” complexion from vasodilation, darkening and degeneration.
Laboratory values of arsenic represent both the toxic form of arsenic and the non-toxic form of arsenic. Because seafood is rich in the non-toxic form of arsenic, the clinician should rule out ingestion of seafood in cases of borderline or moderate arsenic elevation before implementing aggressive therapy.
Urinary arsenic is most commonly measured to screen for arsenic exposure. Urine reflects arsenic exposure in the few days prior to specimen collection. To eliminate the contribution of seafood to total arsenic levels, avoid seafood 72 hours before test.
Hair, nail and urinary arsenic levels have been shown to be comparable. Hair or nail arsenic represents several months of exposure prior to taking the specimen. Hair arsenic greater than 1 μg/g dry weight has been taken to indicate excessive exposure.
Since elevated arsenic in the serum drops within 6 to 10 hours, serum is not the best specimen for determining chronic arsenic exposure. Whole blood is suitable for identifying acute exposure to arsenic, and high levels should be addressed immediately.
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Seafood consumption 2-3 days prior to specimen collection can markedly elevate levels of total arsenic in urine. This dietary form of arsenic is non-toxic and is comprised primarily of arsenobetaine and arsenocholine. For monitoring exposure to the toxic forms of arsenic, the test for Arsenic, total toxic species is appropriate. Toxic species of arsenic include inorganic elemental arsenic (Arsenic (III) and Arsenic (V)) and methylated metabolites (monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA)). All measurements are expressed as the Arsenic component only.
Generally, inorganic arsenic is associated with industry and has a higher rate of toxicity than does the organic arsenic that is usually associated with dietary intake.
Arsenic poisoning of a chronic nature is often evidenced by cardiovascular abnormalities and neurological disorders. Acute exposures to high concentrations of arsenic may be evidenced by the following signs and symptoms:
- Gastrointestinal: Severe abdominal pain, nausea and vomiting, bloody or rice-water diarrhea
- Cardiovascular and respiratory: Hypotension, shock, ventricular arrhythmia, congestive heart failure, pulmonary edema
- Neurologic: Light-headedness, headache, weakness, lethargy, delirium, encephalopathy, convulsions, coma, sensorimotor peripheral neuropathy
- Hepatic and renal: Elevated liver enzymes, hematuria, oliguria, proteinuria, acute tubular necrosis, renal cortical necrosis
- Hematologic: Anemia, leukopenia, thrombocytopenia, disseminated intravascular coagulation
- Other: Rhabdomyolysis, garlic odor on breath, delayed appearance of Mees lines
In acute arsenic poisoning, death is usually due to cardiovascular collapse and hypovolemic shock.
Urine offers the better medium for analyzing a chronic or prolonged arsenic exposure. Possible dietary or domestic sources of arsenic should be considered if urine concentrations remain above the norm.
The most important action is the prevention of further exposure to arsenic. Sources could be drinking-water and food, from industrial processes, tobacco
Associated Symptoms and Diseases:
– Peripheral arteriosclerosis (“blackfoot disease”)
– “Ricewater” stools
– Proteinuria (=Protein in urine)
– Hyperkeratosis (=thickening of your skin’s outer layer)
– “Milk and roses” hyperpigmentation,
– Garlic breath odor
– Stomatitis (=inflammation of the mouth and lips)
Metal foundry, drinking water, seafood, glues, industrial exposure, contaminated wine, contaminated herbal supplements, cigarette smoke, arsenic-treated wood.
– Rat poisons
– Automobile exhaust
– Household detergents
– Wood preservatives
– Insecticide residues on fruits and vegetables
– Wine (if arsenic in pesticides used)
– Colored chalk
– Wallpaper dye and plaster
– Drinking water, seawater, well water
– Sewage disposal
– Seafood (source of nontoxic arsenic)
Selenium, Emblica officinalis, sulfur amino acids, glutathione
When arsenic toxicity is suspected, arsenic levels in drinking water should be measured. Support clearance of arsenic with B vitamins, especially folate. Take sulfur amino acids, antioxidants, as well as essential elements. Emblica officinalis, a medicinal plant, has shown promising results in animal studies. Talk to your doctor before starting any treatment.
Treatment of arsenic poisoning:
Treatment of arsenic poisoning in acute toxic poisonings needs to begin quickly; treatment involves removal of arsenic by dialysis, chelating agents, replacement of red blood cells, and if ingested, bowel cleansing.
BEI® (Biological Exposure Indices) based on 2010 Recommendations of the American Conference of Governmental Industrial Hygienists (ACGIH).
US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry. Arsenic toxicity. Case Studies in Environmental Medicine. 2000. Course: SS3060.
Tsalev DL, Zaprianov ZK. Atomic Absorption Spectrometry in Occupational and Environmental Health Practice. Boca Raton, FL: CRC Press; 1983-1984.
TLVs and BEIs, Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices 2010. American Conference of Governmental Industrial Hygienists (ACGIH).
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