Korean J Med.  2005 Jul;69(1):101-106.

A fatal case of acute arsenic poisoning

• Wi HS
• Lee SH
• Seo YH
• Kim JG
• Kim GC
• Jang CS
• Roh HK

Abstract

Arsenic trioxide is the most prevalent natural inorganic form of arsenic, which is a widely used heavy metal and is ubiquitously distributed in the environment. A 71-year-old man ingested about 10 g of arsenic trioxide powder in an attempted suicide. He developed severe vomiting, watery diarrhea and abdominal pain, and he presented to the emergency room 15 hours after the ingestion. On admission he was slightly drowsy, but shocked. He showed metabolic acidosis, acute renal failure and abnormal electrocardiogram suspecting myocardial infarction. The chest and abdominal X-rays revealed radiopaque materials in the stomach and small bowel. The stomach was irrigated via a nasogastric tube and activated charcoal was given to bind unabsorbed arsenic. The whole bowel irrigation was tried to remove the remained arsenic in the gastrointestinal tract and BAL (British anti-lewisite) was repeatedly administrated. Despite of intensive supporting management with supplemental oxygen, aggressive volume expansion, correction of metabolic disturbances and administration of cardiotonic agents, he developed progressive hypotension and died 42 hours after the ingestion. Random urine arsenic concentration, which was collected at the time of admission, but confirmed after death, was 3,564 microgram/L.

Keyword

Arsenic; Acute; Poisoning

MeSH Terms

Abdominal Pain
Acidosis
Acute Kidney Injury
Aged
Arsenic Poisoning*
Arsenic*
Cardiotonic Agents
Charcoal
Diarrhea
Eating
Electrocardiography
Emergency Service, Hospital
Gastrointestinal Tract
Humans
Hypotension
Myocardial Infarction
Oxygen
Poisoning
Shock
Stomach
Suicide, Attempted
Thorax
Vomiting
Arsenic
Cardiotonic Agents
Charcoal
Oxygen