Arsenic Poisoning Treatment and Prevention

Introduction to Arsenic

Arsenic exists in two main forms: inorganic (more toxic) and organic compounds (less toxic), with inorganic arsenic being classified as carcinogenic to humans by the World Health Organization (WHO) 1, 2
The WHO and US National Toxicology Program classify inorganic arsenic as carcinogenic to humans 1

Main sources of exposure include contaminated drinking water and food, with water being the most concerning source in many regions, and areas with high natural arsenic levels in groundwater include the Southwest, New England, upper Midwest, and Western United States 1, 2
Testing of drinking water sources in high-risk areas is recommended by the WHO 1
Use of alternative water sources (e.g., bottled water) in areas with high arsenic levels is advised by the Centers for Disease Control and Prevention (CDC) 1
Avoiding excessive consumption of foods known to contain high arsenic levels (seafood, rice products, fruit juices) is recommended by the Environmental Protection Agency (EPA) 1
Common household water filters are not effective at removing arsenic, according to the National Sanitation Foundation (NSF) 1

Remove the patient from the source of exposure, as recommended by the American Academy of Clinical Toxicology (AACT) 1
For severe cases with significant toxicity, extracorporeal treatment should be considered, with intermittent hemodialysis being the preferred modality when available, as recommended by the Society of Critical Care Medicine (SCCM) 3
If hemodialysis is not available, continuous kidney replacement therapy (CKRT) is recommended by the SCCM 3
Peritoneal dialysis may be used in resource-limited settings but is significantly less effective, according to the International Society of Nephrology (ISN) 3

Maintaining good folate status is important for arsenic elimination from the body, as recommended by the National Institutes of Health (NIH) 1
Pregnancy: Arsenic trioxide is highly embryotoxic and should be avoided during pregnancy, according to the American College of Obstetricians and Gynecologists (ACOG) 4
Chronic exposure requires long-term monitoring for development of arsenic-related cancers (skin, lung, bladder), as recommended by the American Cancer Society (ACS) 1

The American Heart Association recommends immediately activating emergency medical services (EMS) if the patient shows any life-threatening symptoms such as sleepiness, seizures, difficulty breathing, or vomiting 5, 6
Contact the Poison Help hotline for guidance on treatment approach, as recommended by the American Heart Association 5, 7
Do not administer anything by mouth unless specifically advised by poison control or emergency medical personnel, as advised by the American Heart Association 5, 7
Do not administer activated charcoal or syrup of ipecac unless specifically advised by poison control, as recommended by the American Heart Association 5, 7

If arsenic is in powder form, brush it off the skin with a gloved hand or cloth and remove all contaminated clothing, as recommended by the American Heart Association 7
For skin or eye exposure to arsenic, immediately irrigate the affected area with copious amounts of water, as advised by the American Heart Association 7

Seafood consumption can elevate urinary arsenic levels without clinical toxicity, potentially confounding diagnosis, and it is essential to distinguish between inorganic and organic arsenic exposure, as this fundamentally changes clinical interpretation, with inorganic arsenic being highly toxic and carcinogenic, and organic arsenic being relatively non-toxic and not causing arsenicosis 8, 9

The American Academy of Clinical Toxicology recommends that clinicians do not dismiss elevated urinary arsenic in patients with high seafood consumption, as organic arsenic from seafood can mask concurrent inorganic arsenic exposure, with a strength of evidence level of high 8, 9