Request PDF | Treatment for acute arsine poisoning with blood purification | Dear Editor,Accidental exposure to arsine (AsH3) can lead to intravascular hemolysis, multiorgan damage, and death [1, 2]. Make sure your boat is naturally ventilated. 2017 Dec. 91 (12):3787-3797. Dry with clean towels and keep victim warm and quiet. http://emergency.cdc.gov/agent/arsine/casedef.asp, https://www.atsdr.cdc.gov/MMG/MMG.asp?id=1199&tid=278, Association of Military Surgeons of the US, Society of United States Air Force Flight Surgeons. The patient should be intubated if the airway is not patent or protected. Chemical poisoning -- Arsine: Introduction. Positive pressure, self-contained breathing apparatus (SCBA) is highly recommended. Treatment of arsine poisoning should include: (a) immediate blood exchange transfusion to replace the destroyed red blood cells, and also to remove arsenic and the hemoglobin-arsine complex; (b) the administration of therapeutic amounts of dimercaprol (BAL); and (c) dialysis should be started if the patient has suffered kidney damage. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Mild arsine poisoning unaccompanied by oliguria may remain unrecognized and should therefore be considered in the differential diagnosis of any patient presenting with haematuria or jaundice, particularly if his occupation brings him in contact with acids and metals. Victims who have exposure only to arsine gas do not need decontamination. [Medline]. Consult a nephrologist for hemodialysis in patients with acute renal failure. Treatment is symptomatic and consists of measures to support respiratory, vascular, and renal function. 2007 Sep. 45(6):721-7. poisoning. There is no antidote to arsine gas toxicity, and chelation therapy has not demonstrated effectiveness. Methods. 5. It is considered a possible chemical agent in chemical warfare. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. Several dithiols are effective in saving the lives of rabbits, dogs and monkeys given doses of arsine ca. Some methods remove arsenic from the human body before it causes any damage. Arsine poisoning treatment should focus on restoring RBC concentrations, maintaining renal function, electrolyte replacement and aggressive supportive care. 2000 Jun. The best way to treat the condition is to eliminate arsenic exposure. Arsine is the gaseous and the most toxic form of the element, arsenic. We describe four cases of arsine exposure aimed to evaluate the effectiveness of extracorporeal arsenic removal in acute arsine gas poisoning. Several dithiols are effective in saving the lives of rabbits, dogs and monkeys given doses of arsine ca. Treatment. [18]. This website also contains material copyrighted by 3rd parties. 1990 Jul. Interestingly, the oxidative cytotoxicity potential of arsenic has been used as treatment for certain malignant cancers. The victim is transported to a medical facility as soon as possible. We are looking for partners and donors to assist. Rael LT, Ayala-Fierro F, Carter DE. Thank you for sharing this Journal of Pharmacology and Experimental Therapeutics article. Identifier(s) : arsine, toxicosis Geographical Location(s) : Australia australia Subject Category: Geographic Entities see more details Severe acute arsine poisoning treated by plasma exchange. Hypotension should be addressed with infusion of normal saline or lactated Ringer solution. Centers for Disease Control and Prevention. [Medline]. Initiate diuresis to avoid heme-pigment nephropathy. There are no published guidelines specific to the treatment of arsine poisoning during pregnancy. Please confirm that you would like to log out of Medscape. Arsine poisoning. Chemical protective clothing is usually not required since arsine gas is not directly absorbed through the skin. • Inhalation exposures: The signs and symptoms of acute poisoning are consistent with acute and massive hemolysis. 2,3-dimercaptopropyl ethyl ether has been shown to be effective in the treatment of arsine poisoning in rabbits, monkeys and dogs when administered either intramuscularly or percutaneously. 6. How to reduce the risk of carbon monoxide poisoning on a boat. [Medline]. Arsine causes massive hemolysis and results in anemia, jaundice, and hemoglobinuric renal failure. Paresthesias and peripheral neuropathy are common symptoms of a work-related arsenic poisoning. Specialist to Consult We are leading the charge towards a better future. [Medline]. Support personnel should always continue to manage ABCs, which includes supplementary oxygen and venous access. 35(2):299-301. Dai CW, Zhang GS, Shen JK, Zheng WL, Pei MF, Xu YX, et al. Ann N Y Acad Sci. Patient/victims with suspected arsine (SA) exposure should be monitored for hemolysis up to 24 hours. Arsine poisoning is a particularly dangerous industrial hazard because its occur- Certain dithiols will protect tissue respiration from inhibition by arsine and arsenite. Consider dopamine for hypotension or oliguria. Renal damage from industrial arsine poisoning. In all cases of poisoning, it must be determined if this was an suicidal attempt. Copyright © 2021 by the American Society for Pharmacology and Experimental Therapeutics, You may purchase access to this article. 1. Circulation: Treat hypotension with normal saline (NS) or lactated Ringer solution. NOTE: We request your email address only to inform the recipient that it was you who recommended this article, and that it is not junk mail. If available, the victim's electrolytes status, mainly potassium, and oxygenation status with ABG should be obtained. If arsenic poisoning occurs over a brief period of time, symptoms may include vomiting, abdominal pain, encephalopathy, and watery diarrhea that contains blood. 5. 2009 Jan. 14(1):108-23. Journal of Pharmacology and Experimental Therapeutics, CRV431 Decreases Liver Fibrosis and Tumor Development, Pharmacological Characterization of Nicotine-Induced Seizures in Mice. They may be transferred immediately to the support zone. Available at https://www.atsdr.cdc.gov/MMG/MMG.asp?id=1199&tid=278. The chest radiograph showed peri-hilar congestive changes. 5. Arsine poisoning can lead to acute renal tubular necrosis and ultimately to oliguric/anuric renal failure (Rogge et al., 1983). Apoptosis. Both intravenous mannitol and urinary alkalinization have anecdotal value. A thorough eye examination should be performed along with an ophthalmologist consultation if needed in patients with eye injuries. 2006 Sep. 46(9):1576-9. 4. Chlorine poisoning is a medical emergency. Exposure: Necessary with exposure to liquid compressed arsine gas. Dermal exposures: An abnormal pigmentation of the skin may be seen. Agency for Toxic Substances and Disease Registry. The prognosis of Naphthalene Poisoning is dependent on the amount of substance consumed, time between exposure and treatment, severity of the symptoms, as well as general health status of the patient If the individual can recover from the symptoms, with appropriate medication and prompt medical support, the outcome can be good. Interestingly, the oxidative cytotoxicity potential of arsenic has been used as treatment for certain malignant cancers. [Medline]. 19(1):133-43. Wilkinson SP, McHugh P, Horsley S, Tubbs H, Lewis M, Thould A, et al. Norepinephrine should be considered in cases of resistant shock. 121(1):1-8. [Medline]. 780176-overview
According to the Agency for Toxic Substances and Disease Registry, the following are recommendations for prehospital care of arsenic exposure. [13, 14, 15, 16, 17] RBC-E and PE may have a synergistic effect with better outcome than RBC-E alone. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Do not administer arsenic chelating drugs. Medical Management Guidelines for Arsine. Data from patients with severe acute arsine poisoning, treated with plasma exchange from December 2000 to December 2005 were collected and analyzed. This will require you to, Sign In to Email Alerts with your Email Address. There’s no specific method used to treat arsenic poisoning. Sattar A, Xie S, Hafeez MA, Wang X, Hussain HI, Iqbal Z, et al. Rescuers must be appropriately trained and attired before entering the hot zone. Related Pages. Disability: Assess the patient's neurological status. The effects of sulfur, thiol, and thiol inhibitor compounds on arsine-induced toxicity in the human erythrocyte membrane. 4. "Fat soluble" mono and dithiols have been found to prevent the lysis of erythrocytes by arsine in vitro when they are added five minutes after the cells have been exposed to arsine. Initially, there is painless hemoglobinuria, dizziness, weakness, nausea, vomiting, abdominal cramping and tenderness. Chronic poisoning has a better outcome. Acute toxic inorganic arsenic poisoning has only a fair to poor outcome. The recommended threshold limit in this country is 005ppm(Ministry ofLabour, 1966a, b). Initially, there is painless hemoglobinuria, dizziness, weakness, nausea, vomiting, abdominal cramping and tenderness. Inhalation exposures: The signs and symptoms of acute poisoning are consistent with acute and massive hemolysis. 4. This retrospective study evaluated the clinical and effects and arsenic clearance from the use of plasma exchange treatment of patients with acute arsine poisoning. Kermit D Huebner, MD, FACEP Research Director, Carl R Darnall Army Medical Center 2. The type and severity of symptoms varies depending on the amount of chemical involved and the nature of the exposure. Arsenic is a natural semi-metallic chemical that is found all over the world in groundwater. Kosnett MJ. arsine poisoning. Duane C Caneva, MD, MSc Senior Medical Advisor to Customs and Border Protection, Department of Homeland Security (DHS) Office of Health Affairs; Federal Co-Chair, Health, Medical, Responder Safety Subgroup, Interagency Board (IAB)Disclosure: Nothing to disclose. 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. The treatment depends on the type and stage of the arsenic poisoning. An incident is reported in which three men were accidentally poisoned by arsine (A s H 3) in an industrial chemical plant. TOXIC SYNDROME DESCRIPTION . [Full Text]. 2013 Nov 1. Request PDF | Treatment for acute arsine poisoning with blood purification | Dear Editor,Accidental exposure to arsine (AsH3) can lead to intravascular hemolysis, multiorgan damage, and death [1, 2]. If hemolysis is present, the patient/victim must be observed up to 72 hours for signs of renal failure. The limited efficacy of conventional drug therapy prompted us to investigate the application of hybrid blood purification treatment (HBPT) to … Arsenite can reversibly bind to sulfhydryl groups which are believed to cause dilation and increased permeability of capillaries. Ocular exposures: Red staining of the conjunctiva may be an early sign of arsine poisoning. Enter multiple addresses on separate lines or separate them with commas. It is considered a possible chemical agent in chemical warfare. 261586-overview
Victims who have exposure only to arsine gas do not need decontamination. Arch Environ Health. Be sure to have them regularly checked by a professional. [Medline]. MEDICAL TREATMENT: Warning: Arsenic chelating drugs are not effective for arsine (SA) poisoning and should not be administered. Airway: Ensure the airway is patent and protected. • Inhalation exposures: The signs and symptoms of acute poisoning are consistent with acute and massive hemolysis. The Role of Chelation in the Treatment of Arsenic and Mercury Poisoning. Patient/victims with suspected arsine (SA) exposure should be monitored for hemolysis up to 24 hours. 5. Click here for information on institutional subscriptions. Lee JY, Eom M, Yang JW, Han BG, Choi SO, Kim JS. 2002
The main goal of the emergency medicine physician is to support vascular, renal, hematologic, and cardiorespiratory function. Arsine Gas. Ren Fail. [Medline]. Arsine (AsH3) poisoning is a recognized industrial hazard (Buchanan, 1962), producing poisoning at less than 30ppm, aconcentration far belowthat at which its faint smell of garlic is detectable. The recommended threshold limit in this country is 005ppm(Ministry ofLabour, 1966a, b). Renal damage from industrial arsine poisoning. Case classification Suspected : A case in which a potentially exposed person is being evaluated by health-care workers or public health officials for poisoning by a particular chemical agent, but no … Danielson C, Houseworth J, Skipworth E, Smith D, McCarthy L, Nanagas K. Arsine toxicity treated with red blood cell and plasma exchanges. [Medline]. 2,3-dimercaptopropyl ethyl ether has been shown to be effective in the treatment of arsine poisoning in rabbits, monkeys and dogs when administered either intramuscularly or percutaneously. There are practical steps you can take to radically lower your risk of carbon monoxide poisoning onboard. J Med Toxicol. the L.D.100. Environmental: Detection of arsine in environmental samples, as determined by NIOSH. Do not administer arsenic chelating drugs. Industrial arsine poisoning was first recorded in 1900 by the In the event of acute arsine exposure in a pregnant patient, maternal toxicity is likely to be a major determinant of risk to the fetus. Share cases and questions with Physicians on Medscape consult. Acute kidney injury by arsine poisoning: the ultrastructural pathology of the kidney. There is no antidote for any of the marine toxins, and supportive care is the mainstay of treatment. April 4, 2018; Accessed: February 16, 2019. The limited efficacy of conventional drug therapy prompted us to investigate the application of hybrid blood purification treatment (HBPT) to improve the prognosis in … It is a nonirritating gas with a mild odor (odorless at low doses) that is used in the semiconductor and metals refining industries. Toxicology. If training or equipment availability is questionable, assistance should be obtained from local or regional HAZMAT team or other equipped response organization. Transfusion. The effectiveness of this compound in the treatment of arsine poisoning falls off rapidly as the time interval between exposure and treatment is increased. ObjectiveSevere acute arsine poisoning (SAAP) complicated by multiple organ dysfunction syndrome is a critical clinical illness. Bjørklund G, Mutter J, Aaseth J. 4. Descriptor(s) : poisoning poisoning Subject Category: Diseases, Disorders, and Symptoms see more details. Some people may need to have their blood cleaned by a machine if their kidneys fail. Arsine Poisoning is outlined here in terms of description, signs, symptoms, lab testing, imaging studies, diagnosis, and treatment Environ Toxicol Pharmacol. Exposure may result when arsenic containing metals (i.e., metal vats) undergo acid washes. 1975 Sep 6. Three main clinical syndromes of marine poisoning have important neurological symptoms—ciguatera, tetrodotoxin poisoning, and paralytic shellfish poisoning. 1389854-overview
Exposure to arsine gas can cause fatal hemolysis and multiorgan damage. 2016 Aug. 1378 (1):143-157. 2016 Dec. 48:214-224. 1969 Jul. Initially, there is painless hemoglobinuria, dizziness, weakness, nausea, vomiting, abdominal cramping and tenderness. Medical education now knows no borders and is accessible to anyone. If hemolysis is present, the patient/victim must be observed up to 72 hours for signs of renal failure. In treating malignant melanoma, a … Arsine poisoning treated by plasma exchangeYUGUO SONG, M.D. see more details, are treated with aluminium, while molten in order to purify them. [Medline]. Arsine toxicity aboard the Asiafreighter. 2013. Such dross is set aside until it has accumulated sufficiently to be sent on elsewhere for other metallurgical processes. Blood transfusions and intravenous fluids (that is, fluids injected directly into a vein) may be needed. Whole blood exchange transfusion and hemodialysis have been recommended to treat severe acute arsine poisoning, but are associated with significant complications and sub-optimal outcomes. Where treatment is required, management should be the same as for a non-pregnant patient. Inhalation exposures: The signs and symptoms of acute poisoning are consistent with acute and massive hemolysis. [Medline]. October 21, 2014; Accessed: February 16, 2019. Arsine (AsH3) poisoning is a recognized industrial hazard (Buchanan, 1962), producing poisoning at less than 30ppm, aconcentration far belowthat at which its faint smell of garlic is detectable. Method. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODMzNzQwLXRyZWF0bWVudA==. Chemical poisoning -- Arsine: Arsine is a chemical used in the making of semiconductors and in the metal refining industry. SHELLFISH POISONING. Industrial arsine poisoning was first recorded in 1900 by the Clin Toxicol (Phila). Dimercaprol and dimercaptosuccinic acid are chelating agents that sequester the arsenic away from blood proteins and are used in treating acute arsenic poisoning. Chelating agents (eg, 2,3-dimercaptopropanol, British antilewisite [BAL]) have not been shown to be of benefit in acute arsine toxicity. Breathing: Administer supplementary oxygen or intubation as necessary. Song Y, Wang D, Li H, Hao F, Ma J, Xia Y. Arsenite's affinity for thiols, more predominately, dithiols leads to favorable transfer of arsenite to the chelating agent, dithiol 2,3-dimercaptosuccinic also known succimer. Moisture reacts with aluminium arsenide in such dross with the generation of arsine. • Dermal exposures:An abnormal pigmentation of the skin may be seen. 2006 Dec. 98(12):1998-2001. Two mildly affected individuals recovered quickly-without treatment but the third, who was severely poisoned, developed oliguric renal failure. Progress and treatment Liver function The jaundice faded rapidly. Unintentional exposures have also occurred during refining of ores (e.g., lead, copper, zinc, iron… Centers for Disease Control and Prevention. Install a carbon monoxide detector in sleeping areas and enclosed spaces, including helm positions. Diseases & Conditions, 2002
Ocular exposures: Red staining of the conjunctiva may be an early sign of arsine poisoning.