MANAGEMENT OF ARSENIC POISONING
SUPPORTIVE CARE
-Stabilize airway, breathing and circulation
-IV fluids (isotonic crystalloids) for replacement of fluid loss
-Continuous BP and cardiac monitoring
-Correct electrolyte abnormalities –may require supplemental Potassium and Magnesium
-Hemodialysis in cases of renal failure
DECONTAMINATION
GASTRIC DECONTAMINATION
-Gastric lavage usually not required due to repeated vomiting but in patients with radio graphically
apparent Arsenic it has value
-Whole Bowel Irrigation with Polyethylene Glycol solution enhances elimination
-Activated Charcoal does NOT adsorb Arsenic
SKIN EXPOSURE
-Remove from source and remove contaminated clothes
-Wash with soap and water
CHELATION THERAPY
INDICATIONS OF CHELATION
-Severely symptomatic patient with confirmed acute ingestion
-Symptomatic patient with urinary arsenic levels more than 50µg/L
-Asymptomatic patients with urinary arsenic levels more than 200µg/L
BAL/DIMERCAPROL
-Given intramuscularly
-Dose: 3-5mg/kg/dose 4 hourly for 5 days
SUCCIMER/DMSA
-Given orally, as effective as BAL
-Dose: 30mg/kg 8 hourly for 5 days, then
20mg/kg 12hourly for 14 days
DMPS/DIMAVAL
-Can be given orally or IV
-Structurally similar to BAL but forms complex with arsenic that is less likely to penetrate CNS
TREATMENT FOR ARSINE GAS
-Remove from source of exposure
-Give Oxygen
-Administer IV fluids
-Cardiac monitoring
-Blood Transfusion for severe anemia
-Alkalization of urine with Sodium Bicarbonate
-Haemodialysis in cases of renal failure