Why is arsenic dangerous for humans?

IMPORTANT
The information in this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Poisoning with arsenic and its compounds is an acute or chronic intoxication that occurs when the poison is ingested or inhaled. The main symptoms are severe diarrhea, severe abdominal pain, vomiting, and dehydration. A paralytic variant is possible, which is manifested by hearing loss, convulsions, and coma. The pathology is diagnosed on the basis of a toxic-chemical study, radiography, and clinical picture. Treatment – nonspecific antidotes, antitoxic and symptomatic therapy.

ICD-10

• Causes
• Pathogenesis
• Classification
• Symptoms of arsenic poisoning
• Complications
• Diagnostics
• Treatment for arsenic poisoning
  • First aid
  • Hospital treatment
  • Recovery

  Overview

  Arsenic (As) is a metalloid, a transition element of group V of the periodic table. Its effect on the human body resembles that of heavy metals and their salts. More than 6 thousand organic and inorganic compounds of this substance are known, with varying levels of toxicity. The lethal dose of the component in its pure form, taken orally, is 0,3-0,6 grams. Common compounds are hydrogen arsenic and anhydride, sodium arsenite, potassium arsenite, calcium arsenite, osarsol, Parisian green. Poisoning occurs among workers in wood processing and agricultural enterprises.

  Causes

  Arsenic poisoning occurs among employees of organizations involved in wood conservation, cotton processing, and spraying fields with insecticides containing As. This occurs when safety precautions are violated and respiratory protection equipment is not used. In addition, chemical injuries are recorded in accidents involving the release of arsenic hydrogen. Other possible reasons:

  • Outdated medications. Potassium arsenite, which has antiseptic properties, is sometimes used to gargle for sore throat. This drug can be absorbed, penetrate into the systemic bloodstream and have a negative effect. The risk group includes young and middle-aged children whose parents use medications with potentially toxic effects.
  • Crime. Representatives of the criminal world mix arsenic for the purpose of murder. In addition, the substance is often used to commit suicide attempts. The effectiveness of such methods is low, since the poison does not have an immediate effect, death occurs only after a few hours.
  • Household poisoning. They develop when accidentally ingesting arsenic, which looks like sugar. Symptoms of chemical damage occur in children, the elderly, and people with mental disabilities who are not aware of their actions. Capable adult members of society rarely find themselves in such situations.

  Pathogenesis

  The effects of trivalent and pentavalent arsenic compounds differ. As3+ blocks pyruvate dehydrogenase. Arsenic poisoning is accompanied by disruption of glycolytic processes. There is a decrease in the resynthesis of adenosine triphosphate and the formation of oxaloacetic acid, and the processes of gluconeogenesis suffer. The consequence is hypoglycemia, lack of hepatic glutathione, weakening of the specific resistance of erythrocyte membranes.

  As5+ replaces inorganic phosphorus in biochemical reactions. Instead of triphosphoglycerate, which takes part in the formation of ATP, 1-arseno-3-phosphoglycerate is synthesized, which does not have the necessary properties. There is a separation of oxidation from phosphorylation and other disturbances in intracellular processes. The processes of energy formation and the work of antioxidant mechanisms are inhibited, and signs of multiple organ failure appear.

  Classification

  Arsenic poisoning is divided according to the form of its flow. There are intestinal-toxic and paralytic types of the disease. Pathology is also divided according to the type of toxic agent (intoxication with a pure substance, its inorganic or organic complexes). It is possible to systematize the severity of the lesion (severe, moderate, lethal, mild). Structuring according to the nature of the pathology is of greatest practical importance:

  Symptoms of arsenic poisoning

  The clinical picture of As intoxication is quite diverse and depends on the type of damaging agent, its dosage and the period during which the poison entered the victim’s body. 70% of poisonings predominantly have symptoms of gastrointestinal damage: metallic taste in the mouth, vomiting and nausea, epigastric pain, intestinal colic. Due to profuse diarrhea, a picture of dehydration occurs. Signs of damage to other systems:

  • Central nervous system: weakness, inappropriate behavior, decreased memory and performance, convulsions, coma.
  • Peripheral nerves: neuropathy, narrowing of visual fields, pain in the extremities.
  • Respiratory system: cough, swelling of the respiratory tract, wheezing, suffocation.
  • Blood system: hemolysis of erythrocytes, agranulocytosis, anemia.
  • Kidneys: tubular necrosis, decreased functional capacity up to acute renal failure.
  • Skin: baldness, swelling, hyperemia, rash, hyperpigmentation, keratosis, basal cell carcinoma.
  • Heart and blood vessels: rhythm disturbance, hypotension, arrhythmia, cardiomyodystrophy.

  Acute arsenic poisoning manifests itself 30-120 minutes after taking the poison. The death of the victim most often occurs within the first hour after the onset of the characteristic clinic or after 1-3 days. The reason is the phenomenon of cardiovascular failure caused by dehydration. In a paralytic course, death is provoked by paralysis of the respiratory and vasomotor centers.

  Complications

  The main complication of As lesions is severe exicosis. Massive loss of fluid leads to a decrease in preload on the heart, a drop in coronary output and blood pressure, collapse of the circulatory system, and the occurrence of hypovolemic shock. If help was not provided on time, similar symptoms are detected in 80-85% of patients. With timely initiation of infusion therapy, dehydration can be avoided.

  The second problem is considered to be a critical weakening of the function of several organ systems – multiple organ failure. Usually damage to the kidneys, liver, and heart occurs. At the same time, the process of metabolization and elimination of the toxic substance slows down, which contributes to an increase in the severity of the pathology. MOF is diagnosed in 15-20% of victims with an acute form of intoxication, taken to the hospital a few hours after taking a xenobiotic.

  Diagnostics

  A presumptive diagnosis of “arsenic poisoning” is made by the emergency medical team that arrived at the scene. Its employees are based on information that was obtained from the victim himself or his relatives. Confirmation is carried out in a toxicology hospital, which has a toxic-chemical and biochemical laboratory and an X-ray room. Consultations with a gastroenterologist, therapist, and, if indicated, a resuscitator are required. Examination methods:

  • Physical. Psychomotor agitation and inadequate assessment of reality are noted. The skin is pale, cold, pulse is rapid, blood pressure is reduced or within normal limits. The patient complains of uncontrollable vomiting and pain along the intestines. Pulmonary rales and muffled heart sounds may be heard. A specific symptom is the smell of garlic from the mouth.
  • Laboratory. The level of toxicant in urine during a single measurement exceeds 50 mcg/liter. Chronic arsenic poisoning is characterized by its appearance in hair and nails. A complete blood count reveals a decrease in the number of red blood cells. An increased level of glycated hemoglobin and a general decrease in the volume of solid fractions are detected. Urine contains protein and blood elements. Its daily amount has been reduced.
  • Hardware. The electrocardiogram shows symptoms of rhythm disturbance. X-ray of the lungs and abdominal organs makes it possible to visualize phenomena similar to the introduction of a barium suspension, since arsenic has a certain radiopacity.

  Treatment for arsenic poisoning

  Before doctors arrive, the victim should be induced to vomit. To do this, he is given 0,5-1 liter of clean water to drink, after which he is pressed with his fingers on the root of the tongue. The manipulation is carried out several times until a clean washing liquid begins to flow away, in which there are no foreign impurities. Next, the patient must be laid down and an influx of fresh air must be provided. For unconscious people, gastric emptying is contraindicated.

  First aid

  Acute arsenic poisoning requires first aid on the spot. The patient is advised to undergo gastric lavage using at least 10 liters of water mixed with adsorbent. After the procedure is completed, the patient is given 8-10 tablets of activated carbon and 50-100 ml of magnesium sulfate to drink as a laxative. An alternative is unithiol administered into the stomach through a tube. The same drug is infused intramuscularly.

  At the prehospital stage, other measures are taken to maintain vital functions. To eliminate hypovolemia and correct electrolyte balance, infusion therapy is started. Anticonvulsants are used for seizures. In order to reduce pain, antispasmodics and analgesics are prescribed. Transfer to mechanical ventilation and titrated supply of vasopressors may be required.

  Hospital treatment

  Unithiol therapy continues in the hospital setting. The drug is prescribed in a course of 5-6 days. In its absence, the patient should receive N-acetylcysteine, which acts as a donor of monothiol groups. In case of damage by arsenous hydrogen, mecaptide is added to the regimen. Active methods of detoxification are required: intestinal lavage with the introduction of 8-10 liters of saline enteral solution into the intestines, hemodialysis, repeated gastric lavage.

  After intestinal lavage is completed, the patient is given an antidiarrheal drug to drink. Infusion of saline solutions is required; in case of severe dehydration, infusion of colloids. Adult patients can receive fluids by mouth (rehydration solutions) as long as this does not cause vomiting. Additionally, glucocorticoids, ascorbic and nicotinic acid are prescribed. Severe metabolic acidosis is eliminated with sodium bicarbonate.

  Recovery

  After discharge from the hospital, the patient is recommended to be monitored by a local therapist to exclude the development of delayed consequences of chemical trauma. It is possible to visit gastroenterological sanatoriums. Food must meet the requirements of table No. 4 according to Pevzner. Restrictions must be observed until the gastrointestinal tract is completely stabilized.

  Prognosis and prevention

  Arsenic poisoning has a favorable prognosis with mild to moderate uncomplicated course. Timely medical care allows complications to be avoided in 89% of cases. Symptoms of severe damage increase the likelihood of developing multiple organ failure, the mortality rate of which reaches 60-70%. There is a high risk of depression of the vasomotor and respiratory structures of the brain.

  Preventive measures include being careful when working with pesticides and other substances containing arsenic. It must be taken into account that even tiny amounts of it that regularly enter the body can cause intoxication. You should not keep the poison in food containers or within the reach of children and the elderly. Workers of enterprises dealing with As must be provided with gas masks and insulating clothing.

  You can share your medical history of what helped you in the treatment of arsenic poisoning.

  Sources of

  1. Poisoning with compounds containing arsenic / Markova V.I., Abezgauz A.M. — 1977.
  2. Military toxicology and toxicology of extreme situations / Bova A.A., Gorokhov S.S. — 2005.
  3. Handbook of clinical toxicology / Suvorov A.V. — 1996.
  4. This article was prepared based on materials from the site: https://www.krasotaimedicina.ru/

  IMPORTANT
  The information in this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor.

  Scientists suggest that it was arsenic that could have caused the death of Alexander the Great; Cleopatra considered this poison while contemplating suicide, and Nero, thanks to it, ascended the Roman throne. In his book “Poisons: The Magnificent History of Humanity,” Doctor of Sciences, professor of physiology and biophysics Neil Bradbury convincingly argues that the history of poisons is inseparable from the history of mankind. “Vedomosti” City” publishes an excerpt about German miners who, from the 17th century, began to sprinkle arsenic on bread and add it to coffee, considering this poison beneficial to health. And instead of dying, they became resistant to lethal doses.

  Mann, Ivanov and Ferber Publishing House

  Arsenic has been eliminating and creating rulers since ancient times. The Latin name for arsenic – arsenicum – was even associated with the Greek word arsen, which means “strong”, “powerful”. In France at the end of the 17th century, rich relatives who had the audacity to live long were poisoned with arsenic so often that it began to be called poudre de succession – “powder for heirs.” Obtaining arsenic from deposits was a long and labor-intensive process, so the drug was expensive and murders with its help remained the prerogative of the rich.

  Everything changed with the advent of the Industrial Revolution, which created a huge demand for lead and iron. Both metals were mined from ore that often contained arsenic impurities. When smelted in large furnaces at high temperatures, pure liquid metal was produced, and arsenic reacted with oxygen to form arsenic trioxide, which settled as a white powder. It had to be scraped off the pipes periodically to prevent them from clogging.

  Instead of throwing this powder away, it began to be sold as a poison against all kinds of pests – cockroaches, rats and stray animals – as well as against relatives and secret lovers. Now that production was established on an industrial scale, the cost of arsenic fell, and even the poor were able to use it to eliminate the urgent problem.

  From the point of view of potential poisoners, one of the main advantages of arsenic was that doctors often confused the symptoms of arsenic poisoning with natural diseases, especially if the victim died from the accumulation of poison as a result of repeated small doses. Death from arsenic was mistaken for death from cholera, influenza, and even simple food poisoning – all these troubles literally haunted humanity until the 20th century.

  We will never know how many arsenic murders were attributed to common diseases.

  The first symptoms of acute arsenic poisoning are gastrointestinal upset, severe vomiting and diarrhea. Due to significant loss of fluids, a person begins to feel signs of rapid and severe dehydration – extreme thirst and unbearable abdominal pain. For the same reason, the corpses of people poisoned with arsenic sometimes look slightly wrinkled and emaciated. Vomiting and diarrhea are caused by irritation of the stomach, which can be seen at autopsy in the form of bloody wounds. If arsenic reaches the intestines, similar damage appears there too.

  Low doses do not allow you to avoid symptoms: vomiting and diarrhea, as well as headaches, nausea, and dizziness will still appear. Due to progressive nerve damage, muscle cramps and paralysis often occur, as well as an irregular heart rhythm and galloping pulse. An unsuspecting victim can endure this for weeks until he finally dies from multiple organ failure. A common sign of chronic arsenic poisoning is hyperpigmentation, which is the appearance of dark patches on the skin that can develop into hardened, scaly areas called arsenic keratoses. When examining the hands, Massa stripes are visible on the nails – white transverse lines directed parallel to the nail bed.

  The popularity of arsenic as a poison is due to two factors. Firstly, it dissolves well, and secondly, unlike many plant alkaloids, it is almost tasteless, so it can be easily added to food, for example, mixed into soup or stew. However, most often arsenic was added to the victim in some drink: wine, coffee or cocoa.

  One sip of the liquid prepared in this way would be enough to kill. And yet some people—in particular, the inhabitants of an entire village in the Austrian Alps—learned to consume arsenic in doses that would send others to their graves.

  Arsenic to give strength and a healthy complexion

  Not far from the Hungarian border lies the historical region of Styria. The capital of this Austrian region is the city of Graz, and one of its most famous sons is Arnold Schwarzenegger, film actor and former governor of California.

  In 1851, about a hundred years before Iron Arnie was born, a report by the Swiss naturalist Dr. Johann Jakob von Tschudi was published in a Viennese medical journal. The scientist reported that peasants in this alpine region regularly eat arsenic and consider it a tonic.

  Styrian peasants chewed lumps of white arsenic with their teeth two or three times a week and rubbed it onto their bread. According to men, this remedy eased breathing in the Alpine highlands, gave physical strength, promoted digestion, prevented illness and increased sexual desire. Women, in turn, said that thanks to arsenic, the skin acquires a pleasant shade of “peaches and cream”, and the figure becomes more seductive. Arsenic actually stimulates the formation of hemoglobin – and red blood cells – thereby helping to supply the body with oxygen. Perhaps it was precisely because of this effect that the Styrians breathed easier at high altitudes after taking the poison.

  Local residents first tasted arsenic in the 17th century, when ore began to be mined in the region. During the smelting of metals, arsenic trioxide settled as a white powder in the pipes above the furnace. It was collected and sprinkled on bread like salt or dissolved in some warm liquid, such as coffee.

  Why did the miners start doing this? The name of the author of this idea is still shrouded in mystery. Young Styrians began with small portions of arsenic – the size of a grain of rice – and gradually acquired such a habit of arsenic that they could consume it in doses lethal to an unprepared person without any painful sensations. As a rule, arsenic eaters lived a long time, were freed from many infectious diseases, and used this “food supplement” regularly for more than forty years. Many men calmly ate three hundred milligrams at a time—much more than the lethal dose. They say that one person had almost a gram of white arsenic in a standard dose. In this way, the Styrians not only improved their lives, but also fed their horses with this powder.

  Amazingly, they believed that arsenic improved the health of animals, increased their stamina and helped them maintain a good appearance.

  Arsenic, in trace amounts, is indeed an essential nutrient for many living things. Studies have shown that tiny doses stimulate the formation of blood vessels in chickens, causing the birds to become fatter and the meat to take on a nice pink hue. Back in 2013, this element was added to the feed of all American chickens.

  It is not yet known whether arsenic is beneficial for humans, but it is possible that it promotes blood circulation and increases endurance at high altitudes.

  In the mid-19th century, the scientific and medical community was well aware of how deadly arsenic was, and even the idea that someone could safely eat it seemed unheard of.

  To dispel disbelief in the discovery, scientists needed a public demonstration, so in 1875, at the forty-eighth meeting of the German Association of Arts and Sciences in Graz, two men with this ability were presented to the audience. One of them ate four hundred milligrams of white arsenic, the other three hundred milligrams, and the next day they appeared before the crowd in good health. The urine samples taken from them definitely contained a large amount of poison, so all doubts disappeared: it is possible to eat arsenic, and a gradual increase in the dose helps the body become resistant to the poison.

  Eating arsenic has one strange consequence: the poison kills the bacteria that normally decompose the corpse. According to Styrian tradition, twelve years after death the deceased is removed from the grave to move the bones to the crypt and clear the grave for a new resident. The bodies of arsenic eaters were often so well preserved that even when exhumed, they were easily recognized by friends and family. Toxicologists call the ability of arsenic to significantly slow down post-mortem decomposition “arsenic mummification.” There is a version that the legends about vampires and other undead that exist in Central and Eastern Europe arose partly due to the discovery of these incorruptible remains.

  Word of arsenic’s supposed benefits spread so widely that it became a fashionable ingredient in medicines and cosmetics. However, not only the public was fascinated by the new scientific fact: the legal community also saw great opportunities in it.

  Lawyers handling arsenic poisoning charges came up with an argument for their clients that came to be called the “Styrian defense.” According to this theory, the discovery of arsenic in the corpse did not indicate a criminal intent, but that the victim, like the Alpine peasants, took poison as a tonic. If a person poisoned himself, there can be no talk of a crime and the accused must be released. Likewise, the discovery of arsenic during a search of a suspect did not prove malice, since he (or she, since the poisoners were often women) could have used the arsenic to improve skin tone.

  The Styrian defense has been a boon for lawyers and has been used in many trials, including the trial of Glasgow socialite Madeleine Smith. The correspondent of Chambers’s Edinburgh Journal then wrote, not without skepticism: “Let me urge all who resort to the Styrian system [of eating arsenic] to leave some written evidence of it, otherwise, if anything happens to them, one of their friends They might hang you by mistake.”