Exchange transfusions lower blood arsenic levels, but … Marine poisoning results from the ingestion of marine animals that contain toxic substances and causes substantial illness in coastal regions. In such a critical situation, the patient must be immediately removed from the source of arsenic and the contaminated clothes must then be removed. The effectiveness of this compound in the treatment of arsine poisoning falls off rapidly as the time interval between exposure and treatment is increased. METHODS: Data from patients with severe acute arsine poisoning, treated with plasma exchange from December 2000 to December 2005 were collected and analyzed. Occupational arsine gas exposure. 2006 Sep. 46(9):1576-9. Liver function tests indicated all sero-floccula tion tests to be abnormal. Contact the blood bank and hematologist regarding exchange transfusion. The best way to treat the condition is to eliminate arsenic exposure. 2009. Arsine or Stibine Poisoning. Make sure your boat is naturally ventilated. [Medline]. Rael LT, Ayala-Fierro F, Carter DE. Treatment: There is no specific antidote for arsine. 1389854-overview October 21, 2014; Accessed: February 16, 2019. 2017 Dec. 70 (6):787-797. Kermit D Huebner, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, Association of Military Surgeons of the US, Society for Academic Emergency Medicine, Society of United States Air Force Flight SurgeonsDisclosure: Nothing to disclose. Evidence for oxidative damage to red blood cells in mice induced by arsine gas. We describe four cases of arsine exposure aimed to evaluate the effectiveness of extracorporeal arsenic removal in acute arsine gas poisoning. According to the Agency for Toxic Substances and Disease Registry, the following are recommendations for prehospital care of arsenic exposure. Copyright © 2021 by the American Society for Pharmacology and Experimental Therapeutics, You may purchase access to this article. Several case reports have demonstrated the efficacy and benefits of exchange transfusion, to include both red blood cell exchange (RBC-E) and plasma exchange (PE). Case Definition: Arsine or Stibine Poisoning. Arsenite's affinity for thiols, more predominately, dithiols leads to favorable transfer of arsenite to the chelating agent, dithiol 2,3-dimercaptosuccinic also known succimer. There are no published guidelines specific to the treatment of arsine poisoning during pregnancy. Whole blood exchange transfusion and hemodialysis have been recommended to treat severe acute arsine poisoning, but are associated with significant complications and sub-optimal outcomes. How to reduce the risk of carbon monoxide poisoning on a boat. Three main clinical syndromes of marine poisoning have important neurological symptoms—ciguatera, tetrodotoxin poisoning, and paralytic shellfish poisoning. Hesdorffer CS, Milne FJ, Terblanche J, Meyers AM. Centers for Disease Control and Prevention. Arsine gas poisoning requires careful monitoring of hematocrit/hemoglobin and renal function. Am J Kidney Dis. OBJECTIVE: Severe acute arsine poisoning (SAAP) complicated by multiple organ dysfunction syndrome is a critical clinical illness. Ocular exposures: Red staining of the conjunctiva may be an early sign of arsine poisoning. Industrial arsine poisoning was first recorded in 1900 by the Initially, there is painless hemoglobinuria, dizziness, weakness, nausea, vomiting, abdominal cramping and tenderness. Norepinephrine should be considered in cases of resistant shock. poisoning. It is a nonirritating gas with a mild odor (odorless at low doses) that is used in the semiconductor and metals refining industries. Four patients with acute arsine gas poisoning were admitted to the Sverdlovsk Regional Poisoning Treatment Centre during 2014–2015, three of them were involved into the same exposure. Medical education now knows no borders and is accessible to anyone. 121(1):1-8. Arsenite can reversibly bind to sulfhydryl groups which are believed to cause dilation and increased permeability of capillaries. Arsine is the gaseous and the most toxic form of the element, arsenic. It is considered a possible chemical agent in chemical warfare. The chest radiograph showed peri-hilar congestive changes. Report of five cases in the petroleum industry and a discussion of the indications for exchange transfusion and hemodialysis. 35(2):299-301. [Medline]. If a person swallows or inhales a chlorine-based product and shows symptoms of poisoning, contact the … Positive pressure, self-contained breathing apparatus (SCBA) is highly recommended. Bjørklund G, Mutter J, Aaseth J. Patient/victims with suspected arsine (SA) exposure should be monitored for hemolysis up to 24 hours. Ren M Kinoshita, DO Resident Physician, Department of Emergency Medicine, Carl R Darnall Army Medical Center Exposure may result when arsenic containing metals (i.e., metal vats) undergo acid washes. Toxicol Sci. 4. [12]. Arsine poisoning. Treatment is symptomatic and consists of measures to support respiratory, vascular, and renal function. Arsine (AsH3) poisoning is a recognized industrial hazard (Buchanan, 1962), producing poisoning at less than 30ppm, aconcentration far belowthat at which its faint smell of garlic is detectable. Scombroid poisoning usually responds well to antihistamines (H1-receptor blockers, although H2-receptor blockers may also provide some benefit). Arsenic poisoning is a medical condition that occurs due to elevated levels of arsenic in the body. Chemical protective clothing is usually not required since arsine gas is not directly absorbed through the skin. Thank you for sharing this Journal of Pharmacology and Experimental Therapeutics article. SHELLFISH POISONING. Moisture reacts with aluminium arsenide in such dross with the generation of arsine. Chronic poisoning has a better outcome. Use of all-trans retinoic acid in combination with arsenic trioxide for remission induction in patients with newly diagnosed acute promyelocytic leukemia and for consolidation/maintenance in CR patients. In cases of contact with liquid (compressed gas), gently wash frosted skin with water; gently remove clothing from affected area. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Install a carbon monoxide detector in sleeping areas and enclosed spaces, including helm positions. Metal chelators and neurotoxicity: lead, mercury, and arsenic. The limited efficacy of conventional drug therapy prompted us to investigate the application of hybrid blood purification treatment (HBPT) to improve the prognosis in … Fred Henretig, MD Director, Section of Clinical Toxicology, Professor, Medical Director, Delaware Valley Regional Poison Control Center, Departments of Emergency Medicine and Pediatrics, University of Pennsylvania School of Medicine, Children's HospitalDisclosure: Nothing to disclose. Victims who have exposure only to arsine gas do not need decontamination. • Dermal exposures:An abnormal pigmentation of the skin may be seen. Diseases & Conditions, 2002 1969 Jul. J Natl Med Assoc. Share cases and questions with Physicians on Medscape consult. Specialist to Consult We are leading the charge towards a better future. Arsine toxicity aboard the Asiafreighter. Chelating agents (eg, 2,3-dimercaptopropanol, British antilewisite [BAL]) have not been shown to be of benefit in acute arsine toxicity. 4. An incident is reported in which three men were accidentally poisoned by arsine (A s H 3) in an industrial chemical plant. Breathing: Administer supplementary oxygen or intubation as necessary. 3. Initially, there is painless hemoglobinuria, dizziness, weakness, nausea, vomiting, abdominal cramping and tenderness. In the event of acute arsine exposure in a pregnant patient, maternal toxicity is likely to be a major determinant of risk to the fetus. Contact us. Paresthesias and peripheral neuropathy are common symptoms of a work-related arsenic poisoning. [Full Text]. 2,3-dimercaptopropyl ethyl ether has been shown to be effective in the treatment of arsine poisoning in rabbits, monkeys and dogs when administered either intramuscularly or percutaneously. The type and severity of symptoms varies depending on the amount of chemical involved and the nature of the exposure. Maintain victims' airway, breathing, and circulation and transport them out of the hot zone. 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