Arsine toxicity aboard the Asiafreighter.

Abstract

SummaryEight sailors on board the Asiafreighter were exposed to arsine that had escaped from a cylinder in the cargo hold. Four suffered severe toxicity and within a few hours had developed fever, weakness, nausea, vomiting, diarrhoea, abdominal pain, and haemoglobinuria. These patients had pronounced intravascular haemolysis, which in one patient was complete.This patient was also stuporose and anoxic, a condition attributed to failure of oxygen transport and sludging of red cell debris in the cerebral and pulmonary circulations, but he regained a normal level of consciousness after exchange transfusion. Evidence of marrow depression was present: the reticulocyte response to the haemolysis was poor and there was a thrombocytopenia. All four patients developed renal failure, one being totally anuric for five weeks. Two patients developed peripheral neuropathy, and one was still severely disabled six months after the incident. The other four patients had a similar, though less severe, illness.

Acute and chronic arsenic toxicity

“…47 Haematological abnormalities reported are haemaglobinuria, intravascular coagulation, bone marrow depression, severe pancytopenia, and normocytic normochromic anaemia and basophilic stippling. [52][53][54] Renal failure was reported in four of eight sailors exposed to arsine. 53 Respiratory failure and pulmonary oedema are common features of acute poisoning.…”

“…[52][53][54] Renal failure was reported in four of eight sailors exposed to arsine. 53 Respiratory failure and pulmonary oedema are common features of acute poisoning. 54 The most frequent neurological manifestation is peripheral neuropathy that may last for as long as two years.…”

Severe acute arsine poisoning treated by plasma exchange

“…Arsine poisoning can cause long-term damage, such as peripheral sensory-motor neuropathy (34), and the use of a chelating agent such as dimercaptosuccinic ccid (DMSA or succimer) may be considered. However, DMSA may be contraindicated in patients with renal impairment in the period of poisoning (5,11).…”

Arsenic in HPV Related Oral Carcinoma- A New Threat of the Decade

“…Diarrhea characterized with bloody rice water stool resulting in severe dehydration, reduced circulating blood volume and consequent circulatory collapse are very frequent. Haematological abnormalities may include intravascular coagulation, haemaglobinuria, bone marrow depression, severe pancytopenia, normocytic normochromic anemia and basophilic stippling (Greenberg et al 1979, Wilkinson et al 1975, Lerman et al 1980. Renal failure (Wilkinson et al 1975) and respiratory failure with pulmonary oedema (Lerman et al 1980) and peripheral neuropathy (Freeman et al 1978, Le Quesne 1982 may also be the outcomes of acute poisoning of arsenic in humans.…”

“…Haematological abnormalities may include intravascular coagulation, haemaglobinuria, bone marrow depression, severe pancytopenia, normocytic normochromic anemia and basophilic stippling (Greenberg et al 1979, Wilkinson et al 1975, Lerman et al 1980. Renal failure (Wilkinson et al 1975) and respiratory failure with pulmonary oedema (Lerman et al 1980) and peripheral neuropathy (Freeman et al 1978, Le Quesne 1982 may also be the outcomes of acute poisoning of arsenic in humans. Chronic arsenic ingestion through contaminated drinking water results in the accumulation of arsenite and MA 3+ in vital organs and tissues, resulting in atherosclerosis, hypertension, ischemic heart diseases, diabetes, hepatotoxicity, nephrotoxicity (Hansen 1990, Chen et al 1995, Chen et al 1996, Rahman et al 1995, Liu et al 2000, Gurr et al 2003.…”