❓What❓
- A highly toxic heavy metal used for centuries as a poison due to its potency, lack of taste or odor, & difficulty in detection before modern forensics (”poison of kings & king of poisons”)
- As[III] has a strong affinity for sulfhydryl groups essential to numerous cellular enzymes, thus interfering w/ the citric acid cycle & causing massive oxidative stress. As[V] itself replaces phosphate in oxidative phosphorylation, leading to further mitochondrial damage
❓Epidemiology❓
- Should be considered in anyone exposed to natural drinking water (contaminated by either natural geologic or man-made sources), anyone involved in agriculture (pesticide development) or manufacturing (ammunition, batteries, chips), & anyone taking “natural supplements” (e.g. Ayurvedic cocktails)
- If no clear environmental exposure but compatible syndrome, can also consider arsenic-contaminated food supply (rice, seafood)
❓Presentation❓
High-grade ingestion vs. Injected → Acute 🚰
- Hemorrhagic gastroenteritis
- Acute liver injury → failure
- Acute HFrEF 2/2 toxic myocarditis
- AIDP-like polyneuropathy, Cerebral edema
- DIC & marrow suppression
Low-grade ingestion vs. Skin-absorbed → Chronic 🚰
- Insidious fatigue, anorexia, weight loss
- Hyperpigmentation, Palmar/solar keratosis, & Mees’ lines of the nails → Angiosarcoma
- Non-cirrhotic portal fibrosis
- Chronic HFrEF
- AIDP-like polyneuropathy, cognitive changes
- Black foot disease
❓Diagnosis❓
- Heavy metal blood panel
❓Treatment❓
- Chelation +/- Decontamination (e.g. activated charcoal)