Clinical Information

Arsenic (As) exists in a number of toxic and nontoxic forms. The toxic forms are the inorganic species As(5+), also denoted as As(V), the more toxic As(3+), also known as As(III), and their partially detoxified metabolites, monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA). Detoxification occurs in the liver as As(3+) is oxidized to As(5+) and then methylated to MMA and DMA. As a result of these detoxification steps, As(3+) and As(5+) are found in the urine shortly after ingestion, whereas MMA and DMA are the species that predominate more than 24 hours after ingestion.

Blood concentrations of arsenic are elevated for a short time after exposure, after which arsenic rapidly disappears into tissues because of its affinity for tissue proteins. The body treats arsenic like phosphate, incorporating it wherever phosphate would be incorporated. Arsenic "disappears" into the normal body pool of phosphate and is excreted at the same rate as phosphate (excretion half-life of 12 days). The half-life of inorganic arsenic in blood is 4 to 6 hours, and the half-life of the methylated metabolites is 20 to 30 hours. Abnormal blood arsenic concentrations (>12 ng/mL) indicate significant exposure but will only be detected immediately after exposure. Arsenic is not likely to be detected in blood specimens drawn more than 2 days after exposure because it has become integrated into nonvascular tissues. Consequently, blood is not a good specimen to screen for arsenic, although periodic blood levels can be determined to follow the effectiveness of therapy. Urine is the preferred specimen for assessment of arsenic exposure.

A wide range of signs and symptoms may be seen in acute arsenic poisoning, including headache, nausea, vomiting, diarrhea, abdominal pain, hypotension, fever, hemolysis, seizures, and mental status changes. Symptoms of chronic poisoning, also called arseniasis, are mostly insidious and nonspecific. The gastrointestinal tract, skin, and central nervous system are usually involved. Nausea, epigastric pain, colic (abdominal pain), diarrhea, and paresthesias of the hands and feet can occur.