Arsenic poisoning
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| ICD-10 | T57.0 |
|---|---|
| ICD-9 | 985.1 |
Arsenic poisoning kills by allosteric inhibition of essential metabolic enzymes, leading to death from multi-system organ failure.
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[edit] Symptoms
Symptoms include violent stomach pains in the region of the bowels; tenderness on pressure; retching; vomiting; sense of dryness and tightness in the throat; thirst; hoarseness and difficulty of speech; the matter vomited, greenish or yellowish, sometimes streaked with blood; diarrhea; tenesmus; sometimes excoriation of the anus; urinary organs occasionally affected with violent burning pains and suppression; convulsions and cramps; clammy sweats; lividity of the extremities; countenance collapsed; eyes red and sparkling; delirium; death. Some of these symptoms may be absent where the poisoning results from inhalation, as of arseniuretted hydrogen.
Symptoms of arsenic poisoning start with mild headaches and can progress to lightheadedness and usually, if untreated, will result in death.
Arsenic poisoning can lead to a variety of problems, from skin cancer to keratoses of the feet.
[edit] Treatment and Testing
It is extremely important to seek medical advice immediately if arsenic poisoning is suspected.
Chemical and synthetic methods are now used to treat arsenic poisoning. Dimercaprol or Succimer 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. Succimer is considerably more toxic than dimercaprol.[1]
One way to test for arsenic poisoning is by checking hair follicles. If arsenic is within the bloodstream, it will enter hair and remain there for many years.
[edit] Potency
The LD50 for pure arsenic is 763 mg/kg (by ingestion) and 13 mg/kg (by intraperitoneal injection). For a 70 kg (~155 lb) human, this works out to about 53 grams (less than 2 ounces). However, compounds containing arsenic can be significantly more toxic.[2]
[edit] Unintentional poisoning
In addition to its use as a poison, arsenic was used medicinally for centuries and, in fact, was used extensively to treat syphilis before penicillin was introduced. Arsenic was 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 Victorian era, some women used a mixture of vinegar, chalk, and arsenic applied topically to whiten their skin. The use of arsenic was intended to prevent ageing 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. They were a frequent cause of accidental poisonings.
[edit] Arsenicosis - chronic arsenic poisoning from drinking water
Chronic arsenic poisoning results from drinking water with high levels of arsenic over a long period of time. This may occur due to Arsenic contamination of groundwater.
Effects include changes in skin color, formation of hard patches on the skin, skin cancer, lung cancer, cancer of the kidney and bladder, and can lead to gangrene. The World Health Organization recommends a limit of 0.01 mg/L of arsenic in drinking water; consumption of higher levels over long periods of time can lead to arsenicosis.
Non-carcinogenic chronic effects include liver injury - jaundice and cirrhosis, peripheral vascular disease involving blueness of the extremities, Raynaud's syndrome, and blackfoot disease (a type of gangrene); anemia, resulting from impaired heme biosynthesis, hyperkeratosis of the skin.
There are also multiple lines of evidence for the carcinogenic effects of arsenic.
Arsenic has been known to cause many problems in third world countries where ground water supplies have been contaminated by arsenic derived from geologically recent fluvial deposits containing arseno-pyrites. This is a particular problem in Bangladesh where tube wells installed since the 1970s have intercepted ground waters flowing in the fluvial deposits. Concentrations in these wells can exceed 1 part per thousand whereas the WHO maximum level is 10 parts per billion. See Arsenic contamination of groundwater.
Roger Smith, Professor of Pharmacology and Toxicology Emeritus, Dartmouth Medical School, has confirmed that natural arsenic contamination of drinking water has also been a problem in wells in New Hampshire. Chronic low level arsenic poisoning, or arsenicosis, such as is seen in Bangladesh can potentially result in the victim developing cancer.
[edit] Intentional poisoning
In the 700's, an Arab alchemist named Jabir became the first to prepare arsenic trioxide, a white, tasteless, odorless powder. Jabir's preparation seemed the ideal poison as it left no traceable (at the time) elements in the body.
Arsenic became a favorite murder weapon of the Middle Ages, particularly among ruling classes in Italy. Because the symptoms are similar to those of cholera, which was common at the time, arsenic poisoning often went undetected. By the 19th C. it had acquired the nickname "Inheritance powder".
[edit] Famous victims (known and alleged)
Arsenic poisoning, accidental or deliberate, has been implicated in the illness and death of a number of prominent people throughout history.
[edit] George III of Great Britain
George III's (1738 – 1820) personal health was a concern throughout his long reign. He suffered from periodic episodes of physical and mental illness, five of them disabling enough to require the King to withdraw from his duties. In 1969, researchers asserted that the episodes of madness and other physical symptoms were characteristic of the disease porphyria, which was also identified in members of his immediate and extended family. In addition, a 2004 study of samples of the King's hair[3] revealed extremely high levels of arsenic, which is a possible trigger of disease symptoms. A 2005 article in the medical journal The Lancet[4] suggested the source of the arsenic could be the antimony used as a consistent element of the King's medical treatment. The two minerals are often found in the same ground, and mineral extraction at the time was not precise enough to eliminate arsenic from compounds containing antimony.
[edit] Napoleon Bonaparte
There is a theory that Napoleon Bonaparte (1769 – 1821) suffered and died from arsenic poisoning during his imprisonment on the island of Saint Helena. Forensic samples of his hair did show high levels, 13 times the normal amount, of the element. This, however, does not prove deliberate poisoning by Napoleon's enemies: Copper arsenite has been used as a pigment in some wallpapers, and microbiological liberation of the arsenic into the immediate environment would be possible. The case is equivocal in the absence of clearly authenticated samples of the wallpaper. As Napoleon's body lay for nearly 20 years in a grave on the island, before being moved to its present resting place in Paris, arsenic from the soil could also have polluted the sample. Even without contaminated wallpaper or soil, commercial use of arsenic at the time provided many other routes by which Napoleon could have consumed enough arsenic to leave this forensic trace.
[edit] Charles Francis Hall
American explorer Charles Francis Hall (1821-1871) died suddenly and unexpectedly during his third arctic expedition aboard the ship Polaris. After returning to the ship from a sledging expedition with an Inuit guide, Hall drank a cup of coffee and fell violently ill. He collapsed in what was described as a fit. For the next week he suffered from vomiting and delirium, then seemed to improve for a few days. At that time, he accused several of the ship's company, including ship's physician Dr. Emil Bessels with whom he had longstanding disagreements, of having poisoned him. Shortly after, Hall began suffering the same symptoms, died, and was taken ashore for burial. Once the remnants of the expedition returned, a US Navy investigation ruled that Hall had died from apoplexy.
However, in 1968, Hall's biographer Chauncey C. Loomis, a professor at Dartmouth College, traveled to Greenland to exhume Hall's body. Due to the permafrost, Hall's body, flag shroud, clothing and coffin were remarkably well preserved. Tissue samples of bone, fingernails and hair showed that Hall died of poisoning from large doses of arsenic in the last two weeks of his life, consistent with the symptoms party members reported. It is possible that Hall dosed himself with quack medicines which included the poison. But it is considered more probable that he was murdered by Dr. Bessels or one of the other members of the expedition.
[edit] Clare Boothe Luce
A later case of arsenic poisoning is that of Clare Boothe Luce, (1903 – 1987) the American ambassador to Italy in the years just following World War II. Although she did not die from her poisoning, she suffered an increasing variety of physical and psychological symptoms until arsenic poisoning was diagnosed, and its source traced to the old, arsenic-laden flaking paint on the ceiling of her bedroom. Another source (see below) explains her poisoning as resulting from eating food contaminated by flaking of the ceiling of the embassy dining room.
[edit] Impressionist painters
Emerald Green, a pigment frequently used by Impressionist painters, is based on arsenic. Cezanne developed severe diabetes, which is a symptom of chronic arsenic poisoning. Monet's blindness and Van Gogh's neurological disorders could have been partially due to their use of Emerald Green. Poisoning by other commonly used substances, including liquor and absinthe, lead pigments, mercury-based Vermilion, and solvents such as turpentine could also be a factor in these cases.
[edit] References
- ^ http://www.drugs.com/MMX/Dimercaprol.html
- ^ http://www.chemistry.org/portal/a/c/s/1/feature_tea.html?id=c373e90097f810dd8f6a17245d830100
- ^ http://news.bbc.co.uk/1/hi/health/3889903.stm
- ^ http://aolsvc.news.aol.com/news/article.adp?id=20050722092109990013
- WHO Water-related diseases
- PubMed
- Evaluation of the carcinogenicity of arsenic and arsenic compounds by the IARC.
[edit] External links
- Case Studies in Environmental Medicine: Arsenic Toxicity
- National Pollutant Inventory - Arsenic
- Luce case/Dartmouth
- Evaluation of the carcinogenicity of arsenic and arsenic compounds by the IARC.
[edit] Reference
- Kind, Stuart and Overman, Michael. "Science Against Crime". Doubleday and Company, Inc., New York, 1972. ISBN 0-385-09249-0.
