Massive arsenic poisoning — effect of hemodialysis and dimercaprol on arsenic kinetics

Abstract

In massive arsenic poisoning, the use of hemodialysis and dimercaprol (BAL) therapy is still controversial. Hemodialysis is thought of value only for supportive care. BAL therapy has been criticized because of its delayed action, its own toxicity and its possible influence on arsenic clearance during hemodialysis. We studied arsenic kinetics during an acute suicidal intoxication (10 g of sodium arsenate). Treatment included gastric lavage, oral charcoal and supportive measures. Hemodialysis was performed immediately and repeated the next day. BAL therapy was prescribed only on the second day. Cardiovascular collapse, anuria and hepatic disturbance recovered in a few days and the patient could be discharged on the 15th day. Instantaneous serum arsenic hemodialysis clearance was 85 +/- 75 ml/min without previous BAL injection and 87.5 +/- 75 ml/min with a previous 250 mg BAL injection (difference not significant) indicating that BAL did not impede arsenic dialysis. The calculated total hemodialysis clearance of arsenic was higher than mean serum hemodialysis clearance indicating that erythrocyte bound arsenic is also eliminated during dialysis. We propose to consider early hemodialysis as an elimination measure in massive arsenic poisoning and to choose BAL as a chelator when dialysis is required.

A Phase I Clinical Trial of Darinaparsin in Patients with Refractory Solid Tumors

“…Patients with acute arsenic poisoning typically present with gastrointestinal symptoms that include nausea, vomiting, abdominal pain, and diarrhea, followed by dehydration, hypotension, cardiac instability, and, more rarely, shock and death (35 -37). 7,8 Dimercaprol, hemodialysis, and 2,3-dimercapto-1-propanesulfonate have been used to treat arsenic poisoning, with variable results (38,39). The majority of adverse events related to arsenic are attributed to inactivated enzymes in the cellular energy pathway, whereby arsenic reacts with the thiol groups of proteins and enzymes, thus inhibiting their catalytic activity (40 -42).…”

Massive acute arsenic poisonings

“…Although arsenic poisonings are not as frequent as 20-30 years ago, nevertheless they are still important in the field of toxicology [4,5,7,[9][10][11][12]14,16,[18][19][20][21]. In recent years, there have usually been cases of suicidal or homicidal poisonings by ingestion of known or unknown amounts of, for the most part, arsenic(III) oxide [11,12,14,16,18,20,21], sometimes sodium arsenite [8,9], sodium arsenate [10], arsenic(III) chloride [22] or metallic arsenic [20,23].…”

“…In recent years, there have usually been cases of suicidal or homicidal poisonings by ingestion of known or unknown amounts of, for the most part, arsenic(III) oxide [11,12,14,16,18,20,21], sometimes sodium arsenite [8,9], sodium arsenate [10], arsenic(III) chloride [22] or metallic arsenic [20,23].…”

“…Accidental poisonings appear to be most common in the children [6][7][8], and occur occasionally in the older agegroup [1], whereas intentional and covert poisonings predominate in adults [4,6,[9][10][11][12][14][15][16]18,[20][21][22]. Most acute poisonings are fatal [1][2][3][4][5][7][8][9][10][11][12][13][14]18,[20][21][22], although some poisonings end in recovery [9,15,16,20].…”

A Review of Arsenic Poisoning and its Effects on Human Health

“…Analysis of scales has been formed as an additional measure by Prof. Saha. In cases of chronic arsenic poisoning one should consider BAL (British antilewisite) as a chelator if the signs of arsenicosis are severe or if the patient has complications. 77 Treatment by BAL is superior to penicillamine.…”