❓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)
📚 References 📚
- https://x.com/ASanchez_PS/status/1582054032222617601
- https://journals.lww.com/joem/fulltext/2018/12000/arsenic_exposure,_assessment,_toxicity,_diagnosis,.16.aspx
- https://onlinelibrary.wiley.com/doi/10.1111/j.1556-4029.2010.01581.x
- https://pmc.ncbi.nlm.nih.gov/articles/PMC1742758/
- https://x.com/theliverdr/status/1529125090587049984
- https://link.springer.com/article/10.1007/s12024-023-00654-x?fromPaywallRec=false
- https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.wired.com%2F2013%2F09%2Farsenic-nation%2F&psig=AOvVaw1S-OKx5xiu-58XI_dj2WNi&ust=1739549801519000&source=images&cd=vfe&opi=89978449&ved=0CBcQjhxqFwoTCNCN4pOGwYsDFQAAAAAdAAAAABAE