Arsenic toxicity - Revision history

Blsimpso: /* Disposition */

2021-09-16T01:24:37Z

Disposition

← Older revision		Revision as of 01:24, 16 September 2021
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	==Disposition==		==Disposition==
	*Admit patient~~'s with significant symptoms~~		===Admission===
	*~~ED observation and discharge~~ with follow-up ~~for mildly symptomatic~~		*Admit patient to intensive care setting if symptomatic from acute exposure
			===Discharge===
			*Asymptomatic/mildly symptomatic patients or those with suspected chronic exposures may be discharged w/ outpatient follow-up after initial ED observation.

	==See Also==		==See Also==

Elcatracho: /* Management */

2021-03-08T21:35:41Z

Management

← Older revision		Revision as of 21:35, 8 March 2021
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	*IV fluids		*IV fluids
	*CHELATION therapy: if severe symptoms present		*CHELATION therapy: if severe symptoms present
	*Dimercaprol (BAL). 3-5mg/kg IM Q4-6h		*[[Dimercaprol]] (BAL). 3-5mg/kg IM Q4-6h

	==Disposition==		==Disposition==

Elcatracho: /* Subacute or chronic poisoning */

2021-01-15T21:35:30Z

Subacute or chronic poisoning

← Older revision		Revision as of 21:35, 15 January 2021
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	*[[Ataxia]]		*[[Ataxia]]
	*[[CNS Depression]]		*[[CNS Depression]]
			*Risk factor for [[squamous cell carcinoma]]

	==Differential Diagnosis==		==Differential Diagnosis==

Kxl328 at 17:43, 14 October 2018

2018-10-14T17:43:02Z

← Older revision		Revision as of 17:43, 14 October 2018
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	==Background==		==Background==
	*[[Heavy metal]]		*[[Heavy metal]]
	*~~readily~~ absorbed via GI tract and inhalation, poorly via skin		*Readily absorbed via GI tract and inhalation, poorly via skin
	*~~tasteless~~ and odorless		*Tasteless and odorless
	*~~organic~~ trioxide form used as chemotherapeutic agent		*Organic trioxide form used as chemotherapeutic agent
	*~~trivalent~~ form, As3+, is toxic to over 200 intracellular enzymes		*Trivalent form, As3+, is toxic to over 200 intracellular enzymes
	*~~known~~ carcinogen: skin, lung, other		*Known carcinogen: skin, lung, other
	*~~ingestion~~ fatal dose: 100-200mg		*Ingestion fatal dose: 100-200mg

	===Sources of Exposure===		===Sources of Exposure===
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	*GI symptoms that can resemble [[cholera]]		*GI symptoms that can resemble [[cholera]]
	**Vomiting may be bloody		**Vomiting may be bloody
	**"~~rice~~ water" like diarrhea		**"Rice water" like diarrhea
	*~~dehydration~~		*Dehydration
	*[[Pulmonary Edema]]		*[[Pulmonary Edema]]
	*[[Shock]]		*[[Shock]]
	*[[Rhabdomyolysis]]		*[[Rhabdomyolysis]]
	*[[~~altered~~ mental status]]		*[[Altered mental status]]
	*[[Seizure]]		*[[Seizure]]
	*[[~~coma~~]]		*[[Coma]]
	*~~death~~		*Death
	*~~cardiovascular~~ instability		*Cardiovascular instability
	[[File:Meeslines.png\|thumb\|"Mees lines"]]		[[File:Meeslines.png\|thumb\|"Mees lines"]]
	===Arsine gas exposure===		===Arsine gas exposure===
	*~~hemolysis~~ causing abdominal pain		*Hemolysis causing abdominal pain
	*[[~~hematuria~~]], urine often looks black		*[[Hematuria]], urine often looks black
	*[[~~jaundice~~]]		*[[Jaundice]]
	*~~shaking~~ chills		*Shaking chills
	*~~can~~ lead to [[altered mental status]]		*Can lead to [[altered mental status]]
	*~~immediately~~ lethal at 250 ppm		*Immediately lethal at 250 ppm

	===Subacute or chronic poisoning===		===Subacute or chronic poisoning===
	*[[Anemia]]		*[[Anemia]]
	*~~peripheral~~ neuropathy		*Peripheral neuropathy
	**~~typically~~ symmetric "glove and stocking" distribution		**Typically symmetric "glove and stocking" distribution
	*~~skin~~ changes		*Skin changes
	*White lines on the finger nails known as "Mees lines"		*White lines on the finger nails known as "Mees lines"
	*[[~~ataxia~~]]		*[[Ataxia]]
	*[[CNS Depression]]		*[[CNS Depression]]

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	*[[ECG]] to eval for [[QT Prolongation]] in acute exposure		*[[ECG]] to eval for [[QT Prolongation]] in acute exposure
	*CBC and retic count, expect hemolytic anemia		*CBC and retic count, expect hemolytic anemia
	*BMP, Mg, ~~phos~~, Ca, LFTs, CK		*BMP, Mg, Phos, Ca, LFTs, CK
	*~~type~~ and screen for possible transfusion in arsine gas exposure		*Type and screen for possible transfusion in arsine gas exposure
	*[[CXR]] if respiratory symptoms		*[[CXR]] if respiratory symptoms
	*Consider other ingestion labs including acetaminophen and salicylate level in intentional ingestions		*Consider other ingestion labs including acetaminophen and salicylate level in intentional ingestions
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	==Management==		==Management==
	*~~supportive~~ care, ABCs, IV, O2, monitor		*Supportive care, ABCs, IV, O2, monitor
	*~~removal~~ from exposure		*Removal from exposure
	*NO [[Charcoal]] if co-ingestion is not suspected - adsorbs poorly to arsenic		*NO [[Charcoal]] if co-ingestion is not suspected - adsorbs poorly to arsenic
	*~~consider~~ [[Whole Bowel Irrigation]] if large radiopaque material in GI tract on xray		*Consider [[Whole Bowel Irrigation]] if large radiopaque material in GI tract on xray
	*~~airway~~ management and mechanical [[ventilation]] if acute inhalation of arsine gas and respiratory distress		*Airway management and mechanical [[ventilation]] if acute inhalation of arsine gas and respiratory distress
	*IV fluids		*IV fluids
	*CHELATION therapy: if severe symptoms present		*CHELATION therapy: if severe symptoms present
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	==Disposition==		==Disposition==
	*~~admit~~ patient's with significant symptoms		*Admit patient's with significant symptoms
	*ED observation and discharge with follow-up for mildly symptomatic		*ED observation and discharge with follow-up for mildly symptomatic

Rossdonaldson1: /* Differential Diagnosis */

2018-08-12T20:43:15Z

Differential Diagnosis

@@ Line 52: / Line 52: @@
 ==Differential Diagnosis==
 {{Heavy metals list}}
+{{Diarrhea DDX}}
 ==Evaluation==

Mholtz: Text replacement - "==References== " to "==References== "

2017-07-24T01:12:18Z

Text replacement - "==References== " to "==References== <references/> "

← Older revision		Revision as of 01:12, 24 July 2017
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	==References==		==References==
			<references/>
	[[Category:Toxicology]]		[[Category:Toxicology]]

Rossdonaldson1: /* Diagnosis */

2016-12-04T14:43:18Z

Diagnosis

← Older revision		Revision as of 14:43, 4 December 2016
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	===Diagnosis===		===Diagnosis===
	*~~urine~~ arsenic level (usual normal level is <50mcg/L); both urine spot test and 24h urine collection		*Urine arsenic level (usual normal level is <50mcg/L); both urine spot test and 24h urine collection
	**~~lab~~ must differentiate inorganic from organic arsenic (treat for inorganic exposure only)		**Lab must differentiate inorganic from organic arsenic (treat for inorganic exposure only)
	*~~blood~~ arsenic level not helpful (cleared within 2 hrs of exposure)		*Blood arsenic level not helpful (cleared within 2 hrs of exposure)

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2016-12-04T14:43:04Z

Evaluation

← Older revision		Revision as of 14:43, 4 December 2016
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	==Evaluation==		==Evaluation==
	*urine arsenic level (usual normal level is <50mcg/L); both urine spot test and 24h urine collection		===Workup===
	**lab must differentiate inorganic from organic arsenic (treat for inorganic exposure only)		*Urine arsenic level
	*~~blood~~ arsenic level ~~not helpful (cleared within 2 hrs of exposure)~~
	*[[ECG]] to eval for [[QT Prolongation]] in acute exposure		*[[ECG]] to eval for [[QT Prolongation]] in acute exposure
	*CBC and retic count, expect hemolytic anemia		*CBC and retic count, expect hemolytic anemia
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	*[[CXR]] if respiratory symptoms		*[[CXR]] if respiratory symptoms
	*Consider other ingestion labs including acetaminophen and salicylate level in intentional ingestions		*Consider other ingestion labs including acetaminophen and salicylate level in intentional ingestions

			===Diagnosis===
			*urine arsenic level (usual normal level is <50mcg/L); both urine spot test and 24h urine collection
			**lab must differentiate inorganic from organic arsenic (treat for inorganic exposure only)
			*blood arsenic level not helpful (cleared within 2 hrs of exposure)

	==Management==		==Management==

Rossdonaldson1: /* Noninfectious */

2016-12-04T14:41:50Z

Noninfectious

← Older revision		Revision as of 14:41, 4 December 2016
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	*[[Toxidromes\|Toxicologic exposures]]		*[[Toxidromes\|Toxicologic exposures]]
	*Antibiotic or drug-associated		*Antibiotic or drug-associated
			*[[Arsenic toxicity]]

	====Watery Diarrhea====		====Watery Diarrhea====

Rossdonaldson1: Rossdonaldson1 moved page Arsenic to Arsenic toxicity

2016-12-04T14:35:26Z

Rossdonaldson1 moved page Arsenic to Arsenic toxicity

← Older revision	Revision as of 14:35, 4 December 2016
(No difference)