The Hidden Danger of Arsenic as a Poison: Symptoms, Treatment, and Prevention. Best in 2025

Arsenic As a Poison

Metallic Arsenic is not poisonous because it is not absorbed from intestines. The poisonous forms of arsenical compound as follows:

• Arsenic oxide/trioxide (Sankhya/most common
• Copper arsenite (Scheele’s green)
• Copper acetoarsenite (Paris green)
• Arsenic acid
• Sodium or Potassium arsenite
• Arsenic sulphide
• Arsenic trichloride (Butter of arsenic)
• Arsen
• Organic compound (Cacodylate, Atoxyl, acetarsone, Salvarsan mepharsan, etc.)

Character of Arsenic

• No taste
• No smell
• Sparingly soluble in water
• When added to water it floats on the surface
• Sublimes on heating
• Smooth, heavy crystalline white powder

Uses

• Fruit spray
• Sheep-dips
• Weed killer, Insecticide, Rat killer
• Flypaper
• Calico printing
• Taxidermy
• Wallpaper and artificial flowers
• Lath and timber preserving

AbsorptionOrally (pentavalent) from stomach also, dermally (arsenite), inhalation (arsine)

Distribution: All tissues of the body. Mostly in bones and keratin tissue such as hairs, nails, etc. In intermittent chronic poisoning, successive deposition of arsenic is seen in hair and nails. It appears in hair and nails within an hour of ingestion. It does not cross BBB.

Excretion-—mainly through urine, but also through bile, sweat, feces, milk, and other secretions. It appears in urine within half an hour of ingestion.

Tolerance-—A chronic user as an aphrodisiac may tolerate up to 0.3g. Such person is known as Arsenophagist

MECHANISM OF ACTION OF Arsenic As a Poison ON HUMAN BODY

   (1) Arsenic     >    Sulphydyl groups of Pyruvate Kinase and other Phosphatases (in Mitochondria) >  Interferes cellular respiration, i.e., glycolysis. Damage vascular endothelium > Dilatation of the vessels > Increases vascular permeability > Tissue edema & hemorrhage (especially in the intestinal canal) > Hemorrhagic Diarrhea > Hypovolumic Shock > Death.

  (2) Arsenic > Depression of CNS > Coma > Death.

  (3) Arsenic > Depression of myocardium > Cardiogenic shock > Death.

FATAL DOSE to 0.2 g

FATAL PERIOD – 01 to 02 days

DAILY NORMAL INTAKE– 0.5 to 1 mg 

SYMPTOMS AND SIGNS OF ARSENIC POISONING:

Fulminant Type

 It occurs due to ingestion of massive doses (0.3 to 0.5 gm). The poison is rapidly absorbed from the intestinal tract and causes massive dilatation of all capillaries and small arterioles, especially in the splanchnic areas, causing a sudden marked fall in blood pressure followed by hypovolemic shock and death. It also depresses the action of heart muscles, which is also a cause of cardiogenic shock.

Gastroenteric Type  

This is common form. Starts half to one hour after ingestion. May be delayed for some hours if taken with food.

• Burning and colicky pain in the throat and abdomen
• Dysphagia
• Severe projectile continuous vomiting
• Intense thirst
• Severe involuntary  purging with tenesmus, pain and irritation around anus
• Stool is firstly dark color and bloody, later on colorless, odorless, rice-water type
• Acute circulatory failure
• Oliguria, hematuria, dysuria
• Headache, vertigo, tremor
• Hair loss and eruption in skin.

Narcotic Type-                                                                                                        

• Giddiness
• Tenderness of muscles
• Delirium       > Convulsion           >   Coma       >     Death
• Rarely complete paralysis of the muscles of the extremitie

TREATMENT OF ARSENIC As A POISONING

• Repeated stomach wash at intervals
• Demulcents prevent absorption
• AntidoteFreshly precipitated hydrated Ferric Oxide
• BAL—200 to 400 mg on the first day, 100 to 200 mg on the second and third days, and 50 to 100 mg for 7 to 10 days bd. DMSA or DMPS may be used instead of BAL. They are better. 
• Inj. Penicillamine- to 500 mg qds.
• PurgativesCastor oil or Magnesium Sulphate
• Cholera saline I/V to combat shock
• Antibiotics for preventing secondary infection.
• Analgesics and antispasmodic for controlling pain
• Hemodialysis or exchange transfusion may required

POSTMORTEM FINDINGS OF ARSENIC AS A POISONING:

External:

1. Signs of dehydration may be found
2. Rough, inelastic skin
3. Sunken eyes
4. Shrunken or emaciated body

Internal:

1. Stomach: Mucosa is swollen, edematous, and red in patches or as a whole, especially at the pyloric area, greater curvature, posterior part, and cardiac end. The mucosa appears as red velvet. Sometimes large submucous and subperitoneal hemorrhage is seen. Arsenic particles may be seen on the sticky mucus covering the mucosa. Some erosion and ulceration may also be seen.
2. Intestines-—Small intestines are flaccid and contain large flakes of mucus with very little fecal matter. The cecum and rectum show slight inflammation.
3. Liver, kidneys, and spleen are congested, enlarged, and show cloudy swelling, rarely fatty changes. Glomerular nephritis is commonly seen in the kidneys.
4. Hemorrhages are seen in the abdominal organs, larynx, trachea, and lungs.
5. Lungs are congested and subpleural ecchymoses.
6. Heart: Subendocardial petechial hemorrhages of the ventricles are seen, which is also pathognomonic.

D/D-

• Poisoning by phosphorus, barium, or mercury.
• Heatstroke
• Acute infectious disease, e.g., influenza
• Traumatic asphyxia

Special Features:

v  Arsenic in blood and liver is > mg%

v. Sometimes arsenic penetrates through the walls of the stomach and appears in the liver and omentum.

v. If putrefaction takes place, arsenic is seen as yellow streaks in the subperitoneal layer of the stomach and intestine. It is due to the conversion of absorbed arsenic into sulfide.

v  It is found in bones, hairs, nails and skin after few years also

Arsenic is a popular Homicidal poison because

• It is cheap
• Easily available
• Colorless
• Odorless
• Tasteless
• Low lethal dose
• Can easily administered with food or drink
• Onset of symptoms are gradual
• Symptoms mimics a natural disease

Disadvantage as Homicidal poison because

• Sometime symptoms appear quickly
• It delays putrefaction
• Can be detected in highly decomposed body
• Can be detected in bones, hairs, and nails after several years.

CHRONIC ARSENIC As a POISONING

Sources:

1. Drinking water
2. Adulterated food
3. Preserved food
4. Leather industries workers
5. Timber industries workers
6. Printing industries workers
7. Paint industries workers
8. Taxidermists

SYMPTOMS AND SIGNS

Skin

• Pigmentation (flexures, temple, eyelids, neck)- type
• Hyperkeratosis- (palm, soles, fingernails)-)
• Aldrich-Mees lines in fingernails

EyesCongestion, watering and photophobia

GIT-—Nausea, vomiting, abdominal cramps, diarrhea and salivation

CVS-CCF, dependant edema

LiverHepatomegaly, jaundice and cirrhosis of liver

Blood-—Anemia, thrombocytopenia, bone marrow depression

Kidney-—Chronic nephritis, oliguria, hematuria

CNS-—Polyneuritis, paraesthesia, numbness, encephalopathy

TERATOGENIC-—Can cause Lung and skin cancer and leukemia

TREATMENT:

• Removal of the patient from the source
• BAL or Penicillamine
• High protein diet, fresh vegetable
• Care of hands and feet
• Antibiotic if secondary infection occurs

PM FINDINGS:

• Emaciated, jaundiced, hyperpigmented, hyperkeratosis
• StomachNormal or signs of chronic gastritis
• IntestinesDilated with thickened mucosa
• Liver-—Fatty change or necrosis
• Kidney-—Signs of tubular necrosis