What are the signs of arsenic poisoning?

Signs and Symptoms of Arsenic Poisoning

The key signs of arsenic poisoning include gastrointestinal symptoms (nausea, vomiting, abdominal pain, severe diarrhea), skin changes (pigmentation and hyperkeratosis), neurological manifestations, and multi-organ dysfunction, with presentation varying between acute and chronic exposure. 1, 2, 3

Acute Arsenic Poisoning Signs

• Initial presentation includes severe gastrointestinal distress with nausea, vomiting, colicky abdominal pain, and profuse watery diarrhea 4
• Hypotension and fluid/electrolyte disturbances may develop rapidly 4
• Mental status changes and encephalopathy can occur as toxicity progresses 3
• Electrocardiographic abnormalities may be present 4
• Respiratory failure can develop in severe cases 4
• A metallic taste in the mouth is commonly reported 2
• Bone marrow depression leading to anemia and other hematologic abnormalities 2

Chronic Arsenic Poisoning Signs

• Characteristic skin changes:
  • Hyperpigmentation (patchy darkening of skin) 2, 3
  • Palmar and plantar hyperkeratosis (thickening of skin on hands and feet) 2
• Gastrointestinal symptoms that persist over time 2
• Liver disease and dysfunction 2
• Noncirrhotic portal hypertension with:
  • Bleeding esophageal varices
  • Splenomegaly
  • Hypersplenism 2
• Peripheral neuropathy with sensory and motor symptoms 2, 3
• "Mee's lines" - horizontal white lines on fingernails 2
• Vascular complications:
  • "Blackfoot disease" (peripheral vascular disease)
  • Raynaud's phenomenon
  • Acrocyanosis 2
• Increased risk of skin, lung, bladder, and other cancers 2

Diagnostic Considerations

• Quantitative measurement of 24-hour urinary arsenic excretion is the most reliable laboratory test to confirm arsenic poisoning 4
• Blood, urine, and hair analysis can help confirm the diagnosis, especially in cases where the presentation is unclear 5
• The clinical features of arsenic poisoning are often nonspecific, making laboratory confirmation essential 5
• It's important to distinguish between inorganic arsenic (highly toxic) and organic arsenic (less toxic) exposure, as seafood contains high levels of relatively non-toxic organic arsenic compounds 6, 1

Source Considerations

• Arsenic poisoning may result from:
  • Contaminated drinking water, particularly from ground sources in certain geographic regions (Southwest, New England, upper Midwest, and Western United States) 1
  • Occupational exposure 2
  • Deliberate poisoning (homicide attempts) 2
  • Traditional remedies containing arsenic 3

Important Pitfalls to Avoid

• Don't dismiss the possibility of arsenic poisoning when gastrointestinal symptoms are prominent but nonspecific 4
• Avoid confusing arsenic toxicity with other conditions that cause similar symptoms (gastroenteritis, peripheral neuropathies) 3
• Remember that seafood consumption can elevate urinary arsenic levels but typically represents less toxic organic arsenic compounds 6, 1
• Don't delay treatment while awaiting confirmatory testing in cases of suspected acute poisoning 4
• Be aware that chronic low-level exposure may produce subtle symptoms that develop gradually over time 3