What are the signs of arsenic poisoning?

Signs of Arsenic Poisoning

Arsenic poisoning presents with a constellation of symptoms affecting multiple organ systems, with gastrointestinal symptoms, skin changes, and neurological manifestations being the most prominent clinical features.

Acute Arsenic Poisoning Signs and Symptoms

Acute arsenic poisoning typically presents with rapid onset of symptoms following exposure:

Gastrointestinal Manifestations

• Severe nausea and vomiting
• Colicky abdominal pain
• Profuse, watery diarrhea (often rice-water like) 1
• Intense thirst 2
• Metallic taste in mouth 3

Cardiovascular and Respiratory Effects

• Hypotension
• Electrocardiographic abnormalities
• Respiratory distress or failure 1

Neurological Manifestations

• Mental status changes
• Toxic delirium and encephalopathy 3
• Muscle cramps 2

Chronic Arsenic Poisoning Signs and Symptoms

Chronic exposure to arsenic produces a different clinical picture:

Dermatological Manifestations

• Skin pigmentation changes (typically raindrop pattern)
• Palmar and plantar hyperkeratosis (thickened skin on palms and soles) 3, 2
• Mee's lines (horizontal white lines on fingernails) 3, 4
• A peculiar hand posturing that may precede other skin manifestations 4

Hematological Effects

• Anemia
• Bone marrow depression 3

Hepatic and Gastrointestinal Effects

• Liver disease
• Noncirrhotic portal hypertension
• Bleeding esophageal varices
• Splenomegaly 3

Vascular Effects

• "Blackfoot disease" (peripheral vascular disease)
• Raynaud's phenomenon
• Acrocyanosis 3

Neurological Effects

• Peripheral neuropathy 3

Diagnostic Considerations

When arsenic poisoning is suspected:

• Quantitative measurement of 24-hour urinary arsenic excretion is the most reliable laboratory test to confirm arsenic poisoning 1
• Analysis of blood, urine, and hair can help confirm the diagnosis 2
• Plain radiographs of the abdomen may show radio-opaque material if arsenic was recently ingested 5

Emergency Management

In cases of suspected acute arsenic ingestion:

1. Immediately contact poison control (800-222-1222 in US, 112 in Europe) 6
2. Do not administer anything by mouth (including water or milk) unless specifically advised by poison control 6
3. Do not administer activated charcoal without poison control direction 6
4. Monitor airway patency, respiratory status, and hemodynamic parameters 6
5. Chelation therapy may be indicated under medical supervision 3, 1

Important Considerations

• Inorganic arsenic compounds (like arsenic trioxide) are highly toxic, while organic arsenic compounds found in seafood are generally considered non-toxic 2, 7
• Common sources of arsenic exposure include contaminated drinking water, particularly from ground sources like wells 7
• Certain foods may contain higher levels of arsenic, including seafood, rice products, mushrooms, and poultry 7

Pitfalls to Avoid

• Arsenic poisoning may be misdiagnosed due to its nonspecific symptoms that can mimic other conditions 4
• Symptoms of chronic arsenic poisoning may be subtle and develop gradually over time
• Failure to consider arsenic poisoning in patients with unexplained gastrointestinal symptoms, particularly when accompanied by neurological and dermatological findings

Remember that early recognition and prompt treatment are essential for improving outcomes in arsenic poisoning cases.