What are the symptoms of arsenic poisoning?

Symptoms of Arsenic Poisoning

The key signs of arsenic poisoning include gastrointestinal symptoms, skin changes, neurological manifestations, and multi-organ dysfunction, with presentation varying between acute and chronic exposure. 1

Acute Arsenic Poisoning Symptoms

• Gastrointestinal symptoms are predominant in acute poisoning, including dysphagia, nausea, vomiting, abdominal pain, diarrhea, and intense thirst 2
• Muscle cramps are commonly reported in acute arsenic intoxication 2
• Metabolic disturbances occur due to arsenic's interference with cellular energy production 2
• Toxic delirium and encephalopathy may develop in severe cases 3

Chronic Arsenic Poisoning Symptoms

Dermatological Manifestations

• Skin pigmentation changes are hallmark signs, presenting as general pigmentation or focal "raindrop" pigmentation 4
• Hyperkeratosis of the palms and soles is a characteristic finding, often visible as thickened, rough skin 3, 4
• Mee's lines (transverse white lines on fingernails) may be observed 3

Systemic Manifestations

• Gastrointestinal disturbances including a metallic taste are common 3
• Anemia and bone marrow depression frequently occur 3
• Liver disease and noncirrhotic portal hypertension with bleeding esophageal varices, splenomegaly, and hypersplenism may develop 3
• Peripheral neuropathy is a common neurological manifestation 3
• Vascular complications such as "Blackfoot disease" (associated with arsenic-contaminated drinking water in Taiwan), Raynaud's phenomenon, and acrocyanosis may occur 3

Carcinogenic Effects

• Chronic arsenic exposure is associated with increased risk of skin cancers, including Bowen's disease (carcinoma in situ), basal cell carcinoma, and squamous cell carcinoma 4, 5
• Characteristic features of arsenic-induced skin cancers include:
  • Occurrence on sun-protected areas of the body 5
  • Multiple and recurrent lesions 5
• Internal malignancies, particularly of the lung, urinary bladder, kidney, and liver, may develop with long-term exposure 3, 5

Diagnostic Considerations

• The diagnosis of arsenic poisoning must be confirmed by analysis of blood, urine, and hair samples 2
• It's essential to distinguish between inorganic arsenic (more toxic) and organic arsenic exposure (less toxic), as seafood contains high levels of relatively non-toxic organic arsenic compounds 1
• Clinical features of arsenic poisoning are often uncharacteristic, requiring a high index of suspicion 2
• Histopathological examination of skin lesions may show hyperkeratosis, parakeratosis, acanthosis, papillomatosis, increased basal pigmentation, and dysplastic changes 6

Sources of Exposure

• Main sources include contaminated drinking water, particularly from ground sources in certain geographic regions 1, 7
• Occupational exposure in mining and other industries 4
• Intentional poisoning in homicide attempts 3

Clinical Pitfalls to Avoid

• Failing to consider arsenic poisoning in patients with unexplained peripheral neuropathy, especially when accompanied by skin changes 3
• Not investigating water sources in areas with known high arsenic levels in groundwater 7
• Missing the diagnosis due to the uncharacteristic nature of symptoms 2
• Overlooking the need for cancer screening in patients with chronic arsenic exposure, particularly those with skin manifestations 5