Arsenic Poisoning In Bangladesh

Arsenic poisoning is a medical condition caused by increased levels of the element arsenic in the body. Arsenic interferes with cellular longevity by allosteric inhibition of an essential metabolic enzyme. Symptoms of arsenic poisoning include headache, confusion, convulsion, diarrhoea, vomiting, and in severe cases coma and death.

Routes of exposure include contaminated water, air, and food. Occupational exposure to arsenic may occur with copper or lead smelting and wood treatment and among workers involved in the production or application of pesticides.

Signs and symptoms

Symptoms of arsenic poisoning begin with headaches, confusion, severe diarrhoea, and drowsiness. As the poisoning develops, convulsions and changes in fingernail pigmentation called leukonychia may occur. When the poisoning becomes acute, symptoms may include diarrhea, vomiting, blood in the urine, cramping muscles, hair loss, stomach pain, and more convulsions. The organs of the body that are usually affected by arsenic poisoning are the lungs, skin, kidneys, and liver. The final result of arsenic poisoning is coma to death.

Arsenic is related to heart disease (hypertension related cardiovascular), cancer, stroke (cerebrovascular diseases), chronic lower respiratory diseases, and diabetes. 

Night blindness

Long term exposure to arsenic is related to vitamin A deficiency which is related to heart disease and night blindness.

Cause

In addition to its presence as a poison, for centuries arsenic was used medicinally. It has been used for over 2,400 years as a part of traditional Chinese medicine. In the western world, Arsenic was used extensively to treat syphilis before penicillin was introduced. It was eventually replaced as a therapeutic agent by sulfa drugs and then by antibiotics. Arsenic was also an ingredient in many tonics (or "patent medicines").

In addition, during the Elizabethan era, some women used a mixture of vinegar, chalk, and arsenic applied topically to whiten their skin. This use of arsenic was intended to prevent aging and creasing of the skin, but some arsenic was inevitably absorbed into the blood stream.

Some pigments, most notably the popular Emerald Green (known also under several other names), were based on arsenic compounds. Overexposure to these pigments was a frequent cause of accidental poisoning of artists and craftsmen. One of the biggest unintentional cases of arsenic poisoning via well water consumption is in Bangladesh and called by the World Health Organization as the "largest mass poisoning of a population in history."

Research has shown that the inorganic arsenites (trivalent forms) in drinking water have a much higher acute toxicity than organic arsenates (pentavalent forms). The acute minimal lethal dose of arsenic in adults is estimated to be 70 to 200 mg or 1 mg/kg/day. Most reported arsenic poisonings are caused by one of arsenic's compounds, also found in drinking water, arsenic trioxide which is 500 times more toxic than pure arsenic.

Diagnosis

Arsenic may be measured in blood or urine to monitor excessive environmental or occupational exposure, confirm a diagnosis of poisoning in hospitalized victims or to assist in the forensic investigation in a case of fatal over dosage. Some analytical techniques are capable of distinguishing organic from inorganic forms of the element. Organic arsenic compounds tend to be eliminated in the urine in unchanged form, while inorganic forms are largely converted to organic arsenic compounds in the body prior to urinary excretion. The current biological exposure index for U.S. workers of 35 µg/L total urinary arsenic may easily be exceeded by a healthy person eating a seafood meal.

There are tests available to diagnose poisoning by measuring arsenic in blood, urine, hair, and fingernails. The urine test is the most reliable test for arsenic exposure within the last few days. Urine testing needs to be done within 24–48 hours for an accurate analysis of an acute exposure. Tests on hair and fingernails can measure exposure to high levels of arsenic over the past 6–12 months. These tests can determine if one has been exposed to above-average levels of arsenic. They cannot predict, however, whether the arsenic levels in the body will affect health. Chronic arsenic exposure can remain in the body systems for a longer period of time than a shorter term or more isolated exposure and can be detected in a longer time frame after the introduction of the arsenic, important in trying to determine the source of the exposure.

Hair is a potential bioindicator for arsenic exposure due to its ability to store trace elements from blood. Incorporated elements maintain their position during growth of hair. Thus for a temporal estimation of exposure, an assay of hair composition needs to be carried out with a single hair which is not possible with older techniques requiring homogenization and dissolution of several strands of hair. This type of biomonitoring has been achieved with newer microanalytical techniques like Synchroton radiation based X ray fluorescence (SXRF) spectroscopy and Microparticle induced X ray emission (PIXE).The highly focused and intense beams study small spots on biological samples allowing analysis to micro level along with the chemical speciation. In a study, this method has been used to follow arsenic level before, during and after treatment with Arsenious oxide in patients with Acute Promyelocytic Leukemia.

Arsenic commonly known as arsenic, arsenic poisoning in children generally due to the application of drug overdose caused by arsenic. Because arsenic can also be eaten rat poison, pesticides, snail control drugs, and was recently sprayed insecticide in fruits, vegetables, poisoned poultry, meat etc. caused. Mother poisoning can cause fetal and infant feeding poisoning.
Early oral manifestations of acute arsenic poisoning: dry throat and mouth, pain, burning, tight feeling, hoarseness, nausea, vomiting, difficulty swallowing, abdominal pain and diarrhea. Sick child with garlic-like smell of vomit, feces began to water, after the bloody or Migan Shui-like, quickly dehydration, acidosis resulting in shock. At the same time may have headaches, dizziness, irritability, confusion, paresthesia, could not identify the direction, speech disorders, toxic myocarditis, multiple neuritis. Seriously sick child poisoning a few days after 24 hours to respiratory, circulatory, liver and kidney failure and central nervous system lesions, respiratory difficulties, convulsions, coma and other severe signs, a small number of patient soon died. Weak performance of chronic arsenic poisoning, loss of appetite, nausea, vomiting, diarrhea, can also have white blood cells and thrombocytopenia, alopecia, stomatitis, skin pigmentation, and liver and heart damage.
Arsenic poisoning sick child hair, urine and elevated levels of arsenic in nails can help confirm the diagnosis.
Treatment of this disease: immediate vomiting, gastric lavage and give antidote hydroxide detoxification, the absence of such drugs can be activated carbon, oral administration of milk or egg white, then sodium and other drugs catharsis, if necessary, hemodialysis, and then use the special effects detoxification agent sodium dimercaptosuccinic II. To have gastrointestinal symptoms, neuritis, convulsions and liver and kidney damage were symptomatic treatment should be. Penicillamine treatment of chronic poisoning are available.

Because arsenic poisoning can cause severe respiratory, circulatory, central nervous system, liver and kidney failure, treatment is not timely will definitely adversely affect mental development in children, therefore, to actively prevent. Arsenic dose is not too large; arsenic pesticides, rodent, snail control drugs to be properly placed, can not let the children get; can not eat arsenic poisoned poultry medicines, meat category; can not eat just with drugs containing arsenic sprayed over the vegetables and fruits. If found to be positive rushed to hospital poisoning, reduce the harm of children.

 Inhalation of the powder production process, smoke or pollution, skin toxicity is also common. After oral administration of 5 ~ 50mg of arsenic trioxide poisoning can be lethal to 60 ~ 100mg. The bodies of arsenic poisoning death was dehydration like skin, lips, nails clear and blue. Smelting or roasting of ore containing arsenic, the arsenic vapor state of dispersion in the air, the rapid formation of arsenic oxide; lead arsenate Pb3 (AsO4) 2, arsenic calcium Ca3 (AsO4) 2 such as pesticides for insecticidal molluscicide; that arsenic trioxide, agriculture for pesticide rodent, fur industry for the disinfection of corrosion, the glass industry as a bleaching agent. Orpiment As2S3, realgar As2S2, Paris green (copper arsenate acetate) can be made of arsenic pigments, the application of the motherland Medical realgar, arsenic trioxide for the treatment of skin diseases for external use.

The content of arsenic in the crust is not great, but it everywhere in nature. Arsenic in the crust and sometimes in the free state exists, but mainly in the form of sulphide ore, such as orpiment (As2S3), realgar (As2S2) and arsenopyrite (FeAsS). No matter what kind of metal sulfide ores contain a certain amount of arsenic sulfide. So people have long recognized that arsenic and its compounds. Arsenic biological principles to be absorbed into the body, destruction of the cellular redox capacity, affecting the normal metabolism of cells, causing tissue damage and body disorders can directly cause poisoning. If the arsenic in the human body part, initially irritation, tissue necrosis occurred a long time. Arsenic has a stimulating effect on the mucous membrane, can directly damage capillaries. The mucosal (vaginal), or skin absorption of arsenic and compounds, mainly deposited in the hair, nails, bone, liver and kidneys and other organs. Arsenic and hair, skin and nails of keratinized tissue affinity, whether chronic or acute arsenic poisoning, arsenic poisoning, as long as the poisoning is still alive more than 1 week can be found in more content from the hair of arsenic. Edit this section | Back to the top of the arsenic poisoning - the main types of arsenic poisoning, arsenic poisoning is generally caused by the oral administration. Symptoms of acute arsenic poisoning, there are two types, namely, paralytic and gastrointestinal type. Particularly among the more common gastrointestinal type. A large number of arsenic into the body, can paralyze the central nervous, painful limbs cramps, confusion, delirium, coma, weak pulse rate, blood pressure, breathing difficulties, a few hours the death of internal poison inhibition of central nervous system. In this case, gastrointestinal symptoms occurred too late or very mild symptoms. This is the paralytic symptoms. In real life, such symptoms are more common. Type of arsenic poisoning were gastrointestinal symptoms, 1 to 2 hours in the poison, or even 15 to 30 minutes, which happened severe nausea, vomiting, abdominal pain, diarrhea, exactly like cholera or severe gastroenteritis, stool and blood samples also into water, may be associated with dehydration and shock. General poisoning can die within a day or two. This is common in daily life symptoms of arsenic poisoning. In addition, the inhalation of hydrogen arsenide poisoning can be acute, and its mainly for hemolysis.
Ordinary clothing into arsenic trioxide 0.01 ~ 0.05g, to poisoning, symptoms of poisoning; services into the 0.06 ~ 0.2g, can be lethal; in arsenic, hydrogen is 1mg / l of air, breathing 5 to 10 minutes, and can be fatal poisoning.
After weeks of ordinary people exposed to arsenic can occur with chronic poisoning. The apparent symptoms of headache, insomnia, loss of appetite, indigestion, weight loss, multiple neuritis, paralysis occurs perception, motor Ma ringworm, optic atrophy, hand, foot keratinized layer thickening.
If an autopsy, you can see the internal organs congestion, spotting very obvious; efforts of non-condensable, color dark red, the left ventricular endocardial spotting; intestinal contents as loose stools or yellow rice soup-like liquid, mixed a yellow precipitate (arsenic sulfide). Who died a few days delay, heart, liver and kidney fatty degeneration or necrosis, and some even become acute yellow liver atrophy.
Reproductive and developmental toxicity of arsenic toxicity data less. Nordstrom et al (1979) reported that in northern Sweden during pregnancy in a metal smelting stone women to work in 291 newborns, 17 (5.8%) had congenital malformations, and newborn children in the control group of women workers congenital malformations rate was 2.2% (P <0.05) 6   multiple malformations in newborns, five mothers during pregnancy continued work. Also observed, as the place to live and to shorten the distance between the smelter (from> 30km to the non-distance) gradually increased miscarriage rate, from 7.6 to 11.0%. And women working in the smelter low birth weight newborns. Transplacental transfer of arsenic can. Arsenic levels in fetal tissues increased with the growth of gestational age, term newborns bone, liver, skin and brain levels stillborn fetus is 7 months 2 to 4 times. Study of 101 women's results, levels of arsenic in cord blood and maternal blood levels in the same (Kagey, 1977).
Arsenic can be discharged from the milk. Animal experiments showed that inorganic arsenic to chickens, rats, golden hamsters can cause birth defects from occurring. The intravenous injection of 20mg/kg sodium arsenite golden hamster in vivo, in the injection on day 8 of pregnancy, there offspring exposed brain abnormalities, such as injection during late pregnancy, reproductive system abnormalities and appeared lip, cleft palate and so on. Ronald on pregnant mice between 6 to 12 days after intraperitoneal injection of 25mg/kg once the results of sodium arsenite, to between 7 to 10 days of pregnancy when injected into a higher incidence of malformation (26.4% ~ 63.0%), 6 , 11,12 does not appear abnormal on injectors, but the first injection of 11,12 persons at significantly increased rate of fetal absorption. Exposure The average body weight was significantly lower than the control and. SA fed ewes during pregnancy, offspring body slightly smaller. Edit this section | Back to the top of the arsenic poisoning - etiology Hechi City, Guangxi Province, arsenic poisoning thing

Arsenic poisoning (arsenicpoisoning) generally due to the application of drug overdose caused by arsenic, but also because eating rat poison containing arsenic, snail control, insecticide, pesticide, and was just kind of fruits and vegetables sprayed , poisoned poultry, meat and so on.
Arsenic trioxide (also known as arsenic, red, white letter stone, etc.) commonly used in seed dressing in rural northern China, killing pests drugs, very toxic, and its appearance and pure salt, sugar, flour, gypsum and other similar, can be due to eating the misuse of lead poisoning.
Arsenic trioxide has also been a result of eating contaminated well water and food poisoning occurred. Mother, fetus and suckling poisoning can lead to poisoning. It has been reported one after another in recent years taking tablets caused Niuhuangjiedu cases of chronic arsenic poisoning, have to pay attention, because Niuhuangjiedu film contains realgar (mainly arsenic trisulfide). Edit this section | Back to the top of the arsenic poisoning - clinical manifestations endemic arsenic poisoning
Oral acute arsenic poisoning early common gastrointestinal symptoms such as mouth and throat are dry, pain, burning, tight feeling, hoarseness, nausea, vomiting, dysphagia, abdominal pain and diarrhea. Vomit and Mi Ganshui first sample of gastric contents, followed by mixed with blood, mucus and bile, sometimes mixed with small pieces of arsenic is not absorbed; can have garlic-like vomit smell. Mimicking severe cholera, began to discharge large amounts of water like stool, later became bloody, or Mi Ganshui sample mixed with bloodshot eyes, and soon dehydration, acidosis and even shock. At the same time may have headaches, dizziness, irritability, delirium, toxic myocarditis, multiple neuritis. A small number of epistaxis and bleeding in the skin. Seriously sick child can be poisoned 24 hours to several days after the respiratory, circulatory, liver and kidney failure and central nervous system lesions, respiratory difficulties, convulsions, coma and other severe signs of poisoning after a small number of patients in 20-48 minutes appeared in shock and even death, while gastrointestinal symptoms is not significant. Sick children may have blood porphyria attack, gall of the original strongly positive urinary porphyrin.
Arsine poisoning often hemolysis. When sub-acute poisoning symptoms of multiple neuritis, limb paresthesia, first pain, numbness, followed by weakness, weakness, paralysis until the complete or incomplete paralysis, carpal down, foot down, and the disappearance of tendon reflexes; or dysphagia , pronunciation and breathing problems. Since vasomotor dysfunction, skin flushing or redness sometimes occurs. Performance of patients with multiple chronic poisoning weakness, loss of appetite, occasional nausea, vomiting, constipation or diarrhea. White blood cell can still occur and thrombocytopenia, anemia, red blood cells and bone marrow cells to produce disorder, hair loss, stomatitis, rhinitis, nasal septum ulcers, perforations, skin pigmentation, exfoliative dermatitis may have. Hyperkeratotic palms and toe skin, nails and dull and flat state, thin and brittle, there white stripes, and liver and heart damage. Hair arsenic poisoning patients, urinary arsenic and (toe) a higher arsenic content. Oral administration of a large number of arsenic of the sick child, for abdominal X-ray examination at the time, can be found in the gastrointestinal tract X ray can not penetrate the material. Edit this section | Back to the top of the arsenic poisoning - treatment of arsenic poisoning
The oral acute poisoning, induce vomiting immediately with lukewarm water or saline, 1% sodium thiosulfate solution, such as gastric lavage (Although more than 6 hours of oral or vomiting, gastric lavage should still be careful.) Freshly prepared after a service The antidote to iron hydroxide (12% ferrous sulfate solution and 20% magnesium oxide suspension, mixed in with the same amount of preparation before, when shaken with), so that combined with the arsenic to form insoluble ferric arsenate, every 5 10 minutes serving a spoon, until the vomiting, stop administration. The absence of such drugs may be given activated charcoal suspension, milk or egg white water, and then sodium sulfate or magnesium sulfate catharsis. Application of hemodialysis when necessary. At the same time the rapid selection of specific antidote, such as sodium dimercaptosuccinic II, two sulfonate, two enzymes of mercapto alcohols and amines such as green (the same dose and route of mercury poisoning.) Intravenous fluids to promote excretion of toxic and correct water and electrolyte imbalance. On gastrointestinal symptoms, neuritis, convulsions, and liver and kidney damage, etc., should be given symptomatic treatment. If severe hemolysis, can shake. Severe abdominal pain and muscle, can be slow intravenous injection of calcium gluconate.
Chronic poisoning can give young enzyme amine treatment. Collected 24 hours before treatment for urinary arsenic in urine quantitative, if> 66.5 mol (50 g), continuous treatment 5, 10 days of arsenic in urine decreased by <66.5 mo1/24 hours (50 g/24 hour) speed, give 1 2 5 courses. Also be given intravenous sodium thiosulfate 10%, day 1, every 10 ~ 20mg/kg. The other for the symptomatic treatment.
Use of acute arsenic poisoning antidote   two sulfur C sodium sulfonate;   dimercapto propanol;   penicillamine. Renal failure should occur as soon as possible with hemodialysis, and may also apply appropriate antidote to the smaller penicillamine on the renal toxicity as well, dose of 100 ~ 200mg, 2 or 3 times a day. Caused by severe acute arsine hemolysis, blood transfusion may be considered according to the disease, a blood transfusion is about 3000ml. Exchange transfusion should be noted that the process of transfusion reactions, acid-base balance, blood clotting functions.
The treatment of chronic arsenic poisoning: an antidote application methods see chronic mercury poisoning, but can also with 10% sodium thiosulfate 10ml, intravenous injection, to support arsenic excretion. Available at the skin or mucous membrane lesions dimercapto propanol 2.5% dexamethasone ointment or cream.
Control hemolysis, early dialysis and exchange transfusion therapy, rational use of drug detoxification is the key to successful treatment.
1 hemolytic treatment: because of severe hemolysis, hemoglobin, arsenic - hemoglobin complex with red blood cells and debris can block toxic renal tubules. After hemolytic anemia and lead to renal hypoxia and increased kidney damage. Therefore, large doses of hormones control hemolysis, and alkalization of urine intravenous sodium bicarbonate added to maintain urinary pH 7 ~ 8, to reduce hemoglobin on renal tubular obstruction.
2 dialysis and blood transfusion therapy: acute arsine poisoning with acute renal failure who required dialysis treatment as soon as possible, and exchange transfusion therapy. Blood exchange transfusion therapy can emit red blood cell debris, arsenic - hemoglobin complex, ghost cells, etc.; supplement normal red blood cells, anemia, ischemia, hypoxia is a special arsine poisoning treatment. Exchange transfusion should be closely observed the process of change in vital signs, especially blood pressure changes, such as low blood pressure, normal blood pressure underwent exchange transfusion should be in treatment, or after the first blood transfusion to ensure adequate blood volume, close observation of blood transfusion reaction. Hemodialysis, 1 / d, each dialysis 5 h, the first 3 h. Because patients with coagulation disorders, it should reduce the heparin dose of dialysis; gastrointestinal bleeding in patients with combined heparin-free dialysis, application of systemic and local hemostatic. Observed daily urine output, blood pressure, body edema, patients can get out of bed walking weight should be monitored to determine the amount of dialysis dehydration to avoid heart failure. Note whether the potassium, sodium, calcium, metabolic acidosis and other clinical manifestations.
3, the rational application of drug detoxification: For patients with acute renal failure due to arsine poisoning antidote with renal toxicity, and the complex can not be discharged from the urine, so the dosage should be reduced, with the use of dialysis. Dimercapto-propanol after intramuscular injection of 30 min, the peak blood concentration, absorption and detoxification completed in 4 h, 4 h before it was dialysis intravenous injection. Moderate poisoning, 6 ~ 8 h intravenously dimercaptosuccinic disodium 1 g, and to maintain urine output> 1 500 ml / d, urinary arsenic to normal.
A) First aid inhalation poisoning should promptly left the scene, the skin immediately with plenty of water pollution to wash, change clothes. Oral poisoning vomiting as soon as possible. Gastric lavage may be given before the iron hydroxide, so that with the formation of insoluble ferric arsenate arsenic to prevent absorption. After a thorough gastric lavage can give milk, egg white, or activated carbon adsorption. No diarrhea may give sodium 20 ~ 30g catharsis.
(B) the application of sufficient quantities of antidote as soon as the second preferred sulfonate, adult dose of 2.5 ~ 5mg/kg, No. l ~ 2 days every 4 ~ 6h IM 1, 3 to 7 days l ~ 2 times a day later, as the gradual reduction of the disease. Mild reduction as appropriate. Caution with renal damage, or reducing the use. Can also be used every two Dimercaptosuccinic sodium 1.0g, slow intravenous injection after dilution, 8 ~ 12h, as the condition can be repeated after the injection of 1, after day 1, drug treatment ibid.
(C) symptomatic and supportive treatment vomiting, diarrhea, be fluid, to maintain water, electrolyte and acid-base balance. Control shock. Protect the heart, liver and renal function. Application when necessary, adrenocorticotropic hormone therapy as early as possible in order to promote better conditions, but should pay attention to their side effects. Addition to the application of arsenic dermatitis adrenal cortical hormone treatment, and use of vitamin C, not that more other drugs. Edit this section | Back to the top of the arsenic poisoning - prevention of attention
View of the arsenic compounds have teratogenic effects on a variety of animals, so although the effect on people is not yet final certainly less information, there are further observation is necessary, subject to a high degree of attention and vigilance. Chinese regulations, pregnant women, nursing mothers taboo in arsenic compounds in workplace air concentrations exceeding the maximum allowable concentration of labor.
There is no standard arsenic salt, the Chinese air of workplace regulations the maximum allowable arsine try to 0.3mg/m3. Edit entry Open Category:
Term evaluation of disease: participation in evaluating the authority of a total of 0 0% 0% rich professional good 0% 0% 0% I have to evaluate the poor

Treatment

Chelation

Chemical and synthetic methods are now used to treat arsenic poisoning. Dimercaprol and dimercaptosuccinic acid are chelating agents which sequester the arsenic away from blood proteins and are used in treating acute arsenic poisoning. The most important side effect is hypertension. Dimercaprol is considerably more toxic than succimer.

mineral supplements

Supplemental potassium decreases the risk of experiencing a life-threatening heart rhythm problem from arsenic trioxide.

nutritional intervention

In the journal Food and Chemical Toxicology, Keya Chaudhuri of the Indian Institute of Chemical Biology in Kolkata, and her colleagues reported giving rats daily doses of arsenic in their water, in levels equivalent to those found in groundwater in Bangladesh and West Bengal. Those rats which were also fed garlic extracts had 40 percent less arsenic in their blood and liver, and passed 45 percent more arsenic in their urine. The conclusion is that sulfur-containing substances in garlic scavenge arsenic from tissues and blood. 

The presentation concludes that people in areas at risk of arsenic contamination in the water supply should eat one to three cloves of garlic per day as a preventative.