Until the 1940s, arsenicals (Salvarsan and Fowler’s solution) were widely used in the treatment of various diseases such as syphilis and psoriasis. What are the potential sources of arsenic exposure for the patient described in the case study? In the U.S., the diet is a predominant source of exposure for the general population with smaller amounts coming from drinking water and air. Arsenic Case Study- Student Guidelines The World Water Forum is the main water-related event in the world, aimed at putting water on the international agenda. If acute renal insufficiency develops, hemodialysis may be of value in removing the dimer-caprol-arsenic complex. Follow-up studies of Japanese children who chronically consumed arsenic-contaminated milk revealed an increased incidence of severe hearing loss, mental retardation, epilepsy, and other brain damage. Oxidation-reduction reactions result in some interconversion of arsenate (+5) and arsenite (+3) in vivo. ❑ In arsenic-exposed workers, there is a systematic gradient in lung cancer mortality rates, depending upon duration and intensity of exposure. One hundred and fifty‐six cattle with arsenic toxicosis from 16 outbreaks. Increased incidence of spontaneous abortions, infant congenital malformations, and decreased birth weights have been reported among women and their offspring living near a smelter in Sweden; however, it is not clear that these events can be ascribed to arsenic alone. Special report on ingested inorganic arsenic: skin cancer; nutritional essentiality. If patients are treated within several hours after arsenic ingestion, chelation is likely to be beneficial. Dermal absorption is generally negligible, although toxic systemic effects have resulted from rare occupational accidents where either arsenic trichloride or arsenic acid was splashed on workers’ skin. ❑ When total urinary arsenic is measured, it is important to inquire about recent diet. ❑ Arsenic-exposed patients develop destruction of axonal cylinders leading to peripheral neuropathy. Fish arsenic can significantly increase total urinary arsenic levels; therefore, it may be prudent to take a dietary history of the previous 48 hours or repeat the urinary arsenic test in 2 or 3 days. In the general population, the main route of arsenic exposure is via ingestion of arsenic-containing food and water. Case Study 33: Pesticide Food Poisoning from Contaminated Watermelons in California, 1985 588–595; Case Study 34: Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides 596–604; Case Study 35: Polynuclear Aromatic Hydrocarbon (PAH) … This is a review paper of forensic analysis of a murder case of Wakayama arsenic poisoning incident. Table 1. Thus, because her arsenic ingestion was markedly lower and of shorter duration than her husband’s, she has not yet developed signs or symptoms of chronic arsenic intoxication. ❑ Latency for skin cancer associated with ingestion off arsenic may be 3 to 4 decades, while the noncarcinogenic skin effects typically develop several years after exposure. Family history is unremarkable; his wife, parents, and two younger brothers are in good health. Replacing the stable phosphate anion with the less stable arsenate anion leads to rapid hydrolysis of the high-energy bonds in compounds such as ATP. The patient’s drinking water, obtained from an artesian well, may contain elevated levels of arsenic due to leaching from natural mineral deposits in the surrounding bedrock. The forensic analyses on Wakayama arsenic poisoning incidence … He had lost approximately 15kg Burden of Arsenic Poisoning.• Mortality/Morbidity– (AAPCC) & (NPDS), 6 individuals suffered majoreffects and 3 died from exposure to nonpesticidearsenic exposure in 2011.Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Dart RC. The fatal human dose for ingested arsenic trioxide is 70 to 180 milligrams (mg) or about 600 micrograms per kilograms (kg)/day [ATSDR 2007]. The clinical picture was characterized by Poison is as ancient an instrument of murder and mayhem as the club or blade. ducted in 1970 reported that up to 1% of community water supplies in the United States had arsenic concentrations exceeding 10 ppb. In episodes of multiple acute exposures, several Mees lines may occur within a single nail. Both acute and chronic arsenic intoxication may be associated with encephalopathy. Arsenic and non-cirrhotic portal hypertension. Falk H, Caldwell GG, Ishak KG, et al. In most cases, arsenical keratoses show little cellular atypia and may remain morphologically benign for decades. Arsenic-induced skin changes generally result from chronic arsenic exposure and have a latency of several years. Neurologic examination reveals diminished proprioception in the hands and feet, with a hyperesthetic response to pinprick sensation on the soles. Environmental Alert . ❑ Unlike other arsenicals, arsine gas causes a hemolytic syndrome. Franklin M, Bean W, Harden RC. The standard tests listed above will aid in evaluating the status of an arsenic-exposed patient. MyNAP members SAVE 10% off online. However, given the patient’s clinical presentation, exposure to toxic inorganic arsenic is likely. Arsenic is highly toxic for the human body. Arsenic is excreted primarily through the kidneys. When the methylating capacity of the liver is exceeded, exposure to excess levels of inorganic arsenic results in increased retention of arsenic in soft tissues. The amount of arsenic absorbed by inhalation has not been determined precisely, but is thought to be in this range. In industry, arsenic is a byproduct of the smelting process for many metal ores such as lead, gold, zinc, cobalt, and nickel. Arsenic causes chromosomal damage in cultured mammalian cells, which may be mediated by arsenic’s effects on the enzymatic processes involved in DNA replication and repair. Arsenic Case Study- Student Guidelines The World Water Forum is the main water-related event in the world, aimed at putting water on the international agenda. Two mechanisms of arsenic toxicity that may lead to injury in a number of organ systems have been described. Case reports have also linked chronic high-level arsenic exposure with hepatic angiosarcoma, a rare form of cancer. Arsenic-containing compounds vary in their toxicity to mammals, depending on valence state, whether it is in the inorganic or organic form, physical state—gas, solution, or powder—and factors such as solubility, particle size, rates of absorption and elimination, and presence of impurities. arsenic poisoning. The patient’s wife, who resides with the patient and may consume the same well water, is at risk for chronic arsenic poisoning. Arsine gas poisoning results in a considerably different syndrome from that caused by other forms of arsenic. In the United States it has been the subject of long and bitter legal disputes, because many city water supplies, especially in the American Southwest, rely on arsenic-tainted groundwater. Selzer PM, Ancel MA. Consistent laboratory findings include a CBC and peripheral blood smear displaying macrocytic anemia, relative eosinophilia, and occasional basophilic stippling, and a chemistry panel revealing slight elevation in liver transaminases. In acute arsenic poisoning, death is usually due to cardiovascular collapse and hypovolemic shock. NTIS report no. ", "Madness of King George Linked to Arsenic - AOL News", "Doctors Reconsider Health and Death of 'El Libertador,' General Who Freed South America", "Forensic scientists: China's reformist second-to-last emperor was murdered,", "Arsenic killed Qing emperor, experts find,", https://web.archive.org/web/20140303180052/http://www.qanon302.net/news/news.php?action=view&id=7230%2F, "Mutinta Mazoka Mmembe - Young, focused & forward thinking", "Munir: The Indonesian Assassination Case That Won't Go Away", "I'm not a crocodile: Zimbabwe's president has Lunch with the FT", https://en.wikipedia.org/w/index.php?title=Arsenic_poisoning_cases&oldid=1012099912, Poisoning by drugs, medicaments and biological substances, Creative Commons Attribution-ShareAlike License, This page was last edited on 14 March 2021, at 16:16. Report no. Most arsenic cases are in result of the lack of necessary education available to those in secluded areas. Government set the acceptable level o arsenic in drinking water at 50 micrograms per liter (50 parts per billion or ppb). People living near smelters and other arsenic-emitting facilities also have potential risk of exposure from fugitive airborne emissions and groundwater contamination. In: Handbook on the toxicology of metals. Schenker's findings offer a cautionary tale for consumers who use herbal treatments and dietary supplements. However, because the arsenic content of hair and nails may be increased by external contamination, caution must be exercised in using the arsenic content of these specimens to diagnose arsenic intoxication. Also included is a guide on where to obtain additional information for treatment, referral, and follow-up for diseases with possible environmental and/or occupational origins. ACUTE ARSENIC POISONING A REPORT OF SEVEN CASES AND A STUDY OF ARSENIC EXCRETION WITH ESPECIAL REFERENCE TO THE HAIR THEODORE L. ALTHAUSEN, M.D. Because of the likelihood that other wells in the area contain elevated levels of arsenic, public health intervention may be necessary to prevent other cases of hazardous arsenic exposure. The fatal dose of ingested arsenic in humans is difficult to determine from case reports and depends upon many factors (e.g., solubility, valence state, etc.). poisoning may be provided by dermatologic and neurologic findings. Residents in the surrounding geographical area, who may also be obtaining water from artesian wells should be considered at risk. However, there is no information on morbidity or mortality from exposure to arsenic in soil at hazardous waste sites. The Reinsch test for the stomach contents and liver homogenate was positive for arsenic. Early electrodiagnostic testing may reveal features indistinguishable from Guillain-Barré syndrome (acute inflammatory demyelinating polyneuropathy). (6) What further medical work-up is indicated for the patient described in the case study? ❑ Gastrointestinal effects are seen primarily after arsenic ingestion, and less often after inhalation or dermal absorption. There were no obvious external signs of arsenic poisoning; but we observed marked endocardial hemorrhages, hepatomegaly, diffuse gastric mucosal hemorrhages, and slight brain edema at autopsy. Nasal septum perforation, as well as conjunctivitis and dermatitis, have also been reported. Arsenic is a type of carcinogen that’s gray, silver, or white in color. ❑ Lung cancer has been reported in populations of arsenic-exposed smelter workers. The patient’s problem list includes peripheral neuropathy, hyperpigmentation and hyperkeratotic skin lesions, macrocytic anemia, and liver transaminase elevation. Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text. At low levels arsine is a potent hemolysin, causing dose-dependent intravascular hemolysis. The patient consumes one to two alcoholic drinks a week, and quit smoking 2 years ago after a 15-pack-year history. According to survey data from 2000 to 2010, an estimated 35 to 77 million people in the country have been chronically exposed to arsenic in their drinking water in what has been described as the largest mass poisoning in history.2,3 Enjoy unlimited free revisions for 2 Case Study Arsenic Poisoning weeks after you’ve received your paper. Am J Ind Med 1981;2:43– 50. 1, pp. Human volunteers with an average pretest urinary. Methylation efficiency in humans decreases with increasing arsenic dose. Motor bulk and tone are normal, but there is slight bilateral muscular weakness in dorsiflexors of the toes and ankles, wrist extensors, and hand intrinsics. Drinking water is obtained from an artesian well located on his property. Toxicological profile for arsenic. The CBC can provide evidence of arsenic-induced anemia, leukopenia, thrombocytopenia, or eosinophilia. Arsenicals are still used as antiparasitic agents in veterinary medicine, and, in some countries, they are occasionally used to treat trypanosomiasis and amebiasis in humans. Arch Environ Health 1984;39:276–9. He also reported general malaise, abdominal tenderness, mild fever, numbness in his arms and legs and blurring of vision. Recent studies suggest that the risks of certain kinds of cancer from a lifetime of drinking water with 50 ppb of arsenic may be as high as 1 … Article PubReader PDF–323K Cite. No ataxia, dysphagia, visual symptoms, or bowel or bladder incontinence have been noted, and he has not complained of headaches, back or neck pain, or confusion. Poisoning is one of the most horrifying ways to be murdered. Sensory effects, particularly painful dysesthesia, occur earlier and may predominate in moderate poisoning, whereas ascending weakness and paralysis may predominate in severe poisoning. People are increasingly concerned about potential environmental health hazards and often ask their physicians questions such as: "Is the tap water safe to drink?" Johns Hopkins University School of Medicine, "The mysterious death of Francesco I de' Medici and Bianca Cappello: an arsenic murder? Methods. Skin lesions in patients with chronic arsenic exposure may require biopsy to rule out skin cancer. . Methyl transferase enzymes play a necessary role in the methylation of arsenic in mammals. Do you enjoy reading reports from the Academies online for free? After a single intravenous injection of radiolabeled trivalent inorganic arsenic in human volunteers, most of the arsenic cleared through urinary excretion within 2 days, although a small amount of arsenic was found in the urine up to 2 weeks later. Robin Warder . Clinical presentation of the disease, treatments, and variables associated with survival are described. In 1989, EPA instituted a phaseout of certain arsenic-containing ant poisons in an effort to reduce the incidence of children’s arsenic ingestion. The value of chelation therapy in preventing an incipient neuropathy has been suggested but not adequately demonstrated. 2 Case Study Arsenic Poisoning weeks of free revisions. Other findings in acute arsenic poisoning may include fever and facial edema. Although arsenic poisoning is under-investigated in the Kingdom, we report the first case of arsenic poisoning in 2018 at Jeddah, Saudi Arabia. The relative contribution from endogenous and exogenous sources cannot be distinguished through bulk hair analysis. How might these findings be explained? ❑ There is little agreement between governmental regulations and the recommendations of advisory organizations on the acceptable levels of arsenic in the workplace. Compare this to the patient’s 6000 µg/L urinary arsenic level and 100 ppm arsenic in the hair. Coordination and cranial nerve function are within normal limits. (8) Who else in the case study is at risk for exposure to arsenic? The fundamental GI lesion appears to be increased permeability of the small blood vessels, leading to fluid loss and hypotension. With few exceptions, inorganic arsenic is more toxic than organic arsenic. Outbreak of fatal arsenic poisoning caused by contaminated drinking water. What factors could be responsible for this level, and what additional history would you elicit? “For this study, we have used an advanced AI model, namely Random Forest, which has been proven to be the most efficient in predicting groundwater arsenic in one of our previous studies,” he said. The substantial amount of arsenic in the wife’s hair likely reflects external contamination from this source. The major sources of arsenic release to the environment are smelters and pesticides. The toxicity of trivalent arsenite is typically greater than that of pentavalent arsenate, but little is known about the toxicity of zero valent arsenic. Arsenic Poisoning By: Heba Numan Harara Jamila Temraz Submitted to: Prof.Dr. This phenomenon has been noted sporadically throughout the United States, including the Northwest. The supplier should also indicate whether purchased lumber has been treated with arsenical wood preservatives. Symptoms may last for several days. _________________________________________________________________. Published online 2019 Mar 18. doi: 10.3390/ijerph16060977. C: Case Studies in Environmental Medicine, Case Study 2: Seasonal Arsenic Exposure from Burning Chromium-Copper-Arsenate-Treated Wood, The National Academies of Sciences, Engineering, and Medicine, Environmental Medicine: Integrating a Missing Element into Medical Education, B: Medical School Courses and Clerkships: Access Points for Integrating Environmental Medicine, Case Study 7: Fetal Death Due to Nonlethal Maternal Carbon Monoxide Poisoning, Case Study 8: Carbon Tetrachloride Toxicity, Case Study 10: Chronic Reactive Airway Disease Following Acute Chlorine Gas Exposure in an Asymptomatic Atopic Patient, Case Study 14: Ethylene/Propylene Glycol Toxicity, Case Study 15: Formalin Asthma in Hospital Staff, Case Study 17: Hantavirus Pulmonary Syndrome: A Clinical Description of 17 Patients with a Newly Recognized Disease, Case Study 18: Lead Poisoning from Mobilization of Bone Stores During Thyrotoxicosis, Case Study 20: Legionaires' Disease: Description of an Epidemic of Pneumonia, Case Study 21: Mercury in House Paint as a Cause of Acrodynia: Effect of Therapy with N-Acetyl-D, L-Penixillamine, Case Study 24: Methylene Chloride Toxicity, Case Study 26: Fatal Outcome of Methemoglobinemia in an Infant, Case Study 28: An Outbreak of Nitrogen Dioxide-Induced Respiratory Illness Among Ice Hockey Players, Case Study 29: Pentachlorophenol Toxicity, Case Study 30: Aldicarb Poisoning: A Case Report with Prolonged Cholinesterase Inhibition and Improvement After Pralidoxime Therapy, Case Study 31: Cholinesterase-Inhibiting Pesticide Toxicity, Case Study 32: Infertility in Male Pesticide Workers, Case Study 33: Pesticide Food Poisoning from Contaminated Watermelons in California, 1985, Case Study 34: Poisoning of an Urban Family Due to Misapplication of Household Organophosphate and Carbamate Pesticides, Case Study 35: Polynuclear Aromatic Hydrocarbon (PAH) Toxicity, Case Study 36: Polychlorinated Biphenyl (PCB) Toxicity, Case Study 39: Residential Radon Exposure and Lung Cancer in Sweden, Case Study 40: Community Oubreaks of Asthma Associated with Inhalation of Soybean Dust, Case Study 41: Tetrachloroethylene Toxicity, Case Study 43: Occupational Asthma Due to Toluene Diisocyanate Among Velcro-like Tape Manufacturers, Case Study 45: Trimethyltin Encephalopathy, Case Study 46: Trichloroethylene Toxicity, Case Study 48: Work-Related Disorders of the Neck and Upper Extremity, Case Study 49: Contact Dermatitis in Surgeons from Methylmethacrylate Bone Cement, Case Study 50: Skin Lesions and Environmental Exposures: Rash Decisions, Case Study 51: Acoustic Trauma Caused by the Telephone: A Report of Two Cases, Case Study 52: Behavioral and Audiologic Manifestations of Noise-Induced Hearing Loss, Case Study 53: Reproductive and Developmental Hazards, Case Study 54: Childhood Asthma and Indoor Enviromental Risk Factors, Case Study 55: Populations at Risk From Particulate Air Pollution - United States, 1992, D: Resources: Agencies, Organizations, Services, REferences, and Tables of Environmental Health Hazards. The use of arsine gas (AsH3) as a dopant in the production of semiconductors is also expected to increase, although substitutes of lower toxicity such as tributylarsine have recently been used. Its particle size determines whether arsenic will reach. A portion of the arsenite is then biomethylated, predominantly in the liver, to methylarsonic acid and dimethylarsinic acid. Arsenic has different forms and can occur naturally in plants and soil at low levels, but most poisonings occur from exposure to arsenic modified for pesticidal use. ❑ EPA limits the emissions from copper smelters, glass manufacturing plants, and other arsenic-using facilities; however, no ambient air standard for arsenic currently exists. Arsenic is also found in some homeopathic and naturopathic preparations, and in folk remedies such as kushtay, a tonic used in Asian cultures to cure various sexual disorders. 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