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September 19, 2022 - BY Vaishali Sinha

Arsenic Poisoning

Arsenic is found in significant concentrations in the groundwater of a number of countries. In its inorganic form, arsenic is extremely hazardous. The greatest concern to human health from arsenic is contaminated water used for drinking, food preparation, and irrigation of food crops. Arsenic poisoning from drinking water and eating can lead to cancer and skin sores over time. It has also been linked to diabetes and cardiovascular disease. In prenatal and early childhood exposure has been related to poor cognitive development and an increase in the number of young adults who die. The most critical measure in impacted communities is to provide a safe water source to prevent further arsenic exposure.

As it is not absorbed from the GIT hence Metallic arsenic (black in colour) is non-poisonous in nature. It is a normal component of all animal tissues, in small amounts.

Toxic Compounds and their Uses

  • Arsenious oxide or arsenic trioxide (Sankhya, somalkhar, white arsenic or arsenic): A most poisonous form of arsenic. It is tasteless or smel-less and is partially soluble in water. It is used in fruit sprays, sheep dips, for killing weeds, killing insects, poisoning rats, fly strips, calico-printing, painting, synthetic flowers and as for dyeing fabrics.
  • Copper arsenite (Scheele's green) and copper acetoarsenite (Paris green or emerald green): For many substances, it is used as a colouring agent included in the art of making confections.
  • Sodium and potassium arsenate
  • Arsenic sulphide: Yellow orpiment (hartal) or arsenic trisulphide, and red realgar or arsenic disulphide are used in cream that removes hairs, colouring pigment and in fly strip
  • Arseniuretted hydrogen or arsine is a non-coloured gas and has an odour like garlic.
  • The soil, water and some sea fish (mussels, prawns) are the natural sources of arsenic. Elevated arsenic content of soil and subsoil water of some places is the reason of endemic toxicity (from shallow tube wells inserted for drinking water).  The two badly affected areas in the world are Bangladesh and West Bengal, India According to World Health Organization the maximum permissible limit of arsenic in drinking water is 50 µg/l.5. In 42 districts in southern Bangladesh and in nine adjacent districts in West Bengal, 79.9 million and 42.7 million people respectively are exposed to higher arsenic concentrations in groundwater.  In both these areas, the source of arsenic is naturally present, which contaminates the aquifers which provide water for over one million tube wells.
  • Tobacco smoke, particularly cigars also contains arsenic, and in some beers as impurities.


Historical Use of Arsenic 

Arsenic was used as a healing agent after Greek physicians such as Hippocrates and Galen popularized its use. Fowler's solution was 1% arsenic trioxide preparation which was mostly used during the 19th century.

Use of fowler solution

The long term use of Fowler’s solution causes chronic arsenic intoxication. In World War II, it was used for the treatment of syphilis. Arsphenamine (neoarsphenamine), a light yellow compound containing 30% arsenic was used intravenously to treat syphilis, yaws, and some protozoan infections.


Current Therapeutic Use of Arsenic

Arsenic continues to be an important component of many non-western traditional medicine products.  In Some Chinese traditional medications, realgar (arsenic sulphide) are present and are present in the form of pills, tablets, and other preparations. For the treatment of psoriasis, syphilis, asthma, rheumatism, haemorrhoids, cough and pruritus, arsenic is generally used. It is also recommended as a health tonic, an analgesic and also anti-inflammatory agent. It is also used for the treatment of malignant tumours. In India, herbal medicines containing arsenic are used for the preparation of some homoeopathic medicine and haematological malignancies. In Korea arsenic is present in herbal medicine which is used for the treatment of haemorrhoids.

Mechanism-

  • Arsenic interferes with cellular respiration and then uncouples mitochondrial oxidative phosphorylation and then gets combined with the sulfhydryl groups of mitochondrial enzymes, especially pyruvate dehydrogenase and certain phosphatases. Due to this activity, the citric acid cycle is decreased and hence the cellular ATP production also decreases.
  • It inhibits the uptake of cellular glucose, formation of glucose, oxidation of fatty acid and the production of acetyl CoA.
  • Hence the irritation in the mucus membrane takes place and due to this, the nervous system got depressed.
  • Since arsenic is a cancer-causing agent hence due to long exposure to arsenic, can cause cancer in the bladder, skin and lungs.

Absorption and Excretion

  • The absorption takes place through GIT, lungs, skin or through the parental fluid.
  • In almost all tissues it is present; in the liver, it is present in the largest amount then in the kidney and in the spleen.
  • If the patient survives then – muscle (for a few months) and in bones, hair, nails and skin (sulfur-containing keratin) for years.
  • A major part of arsenic is excreted through urine and some parts are excreted through faeces, bile, sweat, milk, nails and hair.
  • In the case of chronic poisoning, the deposition of arsenic generally occurs in nails and hairs.
  • After absorption, it is secreted in the stomach and intestine even if it is absorbed through the mouth or by any other route.


Acute Poisoning

When a large dose of arsenic is taken for a short duration of time.

Table 1 - Signs and Symptoms

Sr. No.
Sign and symptoms
1Eye- Dilated pupil, sunken eye.
2Skin- Cold, calmly, skin eruption.
3Breath rate- Difficulty in breathing.
4Heartbeat- Slows down.
5Stool-  Contain blood, mucous and watery like rice water.
6Vomiting- Contains bile content, stomach content, blood and mucus. continuous vomiting occurs.
7Thirst-Excessive thirst.
8Legs- Cramps, shaking legs.
9Face- Pale.
10Urine-Pain during urination.
11CNS- Headache, dizziness, increases in temperature, tremors, seizure, coma, general paralysis.
12Oesophagus -Burning sensation, garlic-like odour in the mouth.


Fatal Dose- 120-200 mg of arsenic trioxide (adults), 2 mg/kg (children) is fatal dose.

Fatal Period-1-2 days.

Treatment-

  • Hemodynamic stabilization is of primary importance, and large amounts of crystalloid solutions may be required because of significant GI losses (i.e. vomiting and diarrhoea).
  • Gastric lavage is done continuously with huge amount of warm water and milk; activated charcoal does not adsorb arsenic effectively and is not advised in patients whom coingestants are not suspected.
  • Demulcents (butter or greasy substances) avoid absorption.
  • Whole bowel irrigation with polyethylene glycol may be efficient to avoid GIT absorption of arsenic.
  • Antidote is BAL or dimercaprol and DMSA.
  • Alkalis should not be given by mouth as they increase the solubility of arsenic.
  • Purgatives (castor oil/magnesium sulphate) are given to remove unabsorbed poison from intestine.
  • To combat shock and improve alkali reserve, Glucose-saline with sodium bicarbonate is useful.
  • Hemodialysis or exchange transfusion may be done[10]


Postmortem Finding-

It depends upon the amount of dose and the period which has elapsed before death.

Externally the body becomes dehydrated and appears blue in colour. The eyeball got sunken. The skin appeared wrinkled. Rigour Mortis last for a long time. Putrefaction is retarded.

Internally- Given in the below table 

Table 2 - Post mortem Appearance in Internal Body Organ

Sr. No.
OrganAppearance
1Stomach- Appear as red velvet.
2Mucosa- appears red, Swollen in patches. 
3Pyloric entry- Small Ulceration are present.
4Liver- Fatty degenerative changes and jaundice are also present frequently.
5Heart and kidney- Fatty degeneration, Subendocardial petechial haemorrhages are present in the heart.
6Decomposition- Is not slowed down.
7Small intestine- In faeces, a large amount of mucus is present, little sign of inflammation, and submucous haemorrhages are present; mucus is of pale violet in colour. 
8Caecum and rectum-Slightly inflammated.
9Brain- Edema with patchy necrosis or hemorrhagic encephalitis. The meninges are congested.


Chronic Poisoning

It may occur due to:

  • Recovery from acute poisoning.
  • Accidental ingestion of small doses repeatedly by those working with the metal.
  • Intake of food/drink in which there are traces of arsenic (may be homicidal in nature).

Sign and Symptoms 

It generally occurs in 4 stages-

  • The first stage of nutritional and gastrointestinal disturbances- gradual emaciation is the 1st sign. There is loss of appetite, nausea and alternating attack of vomiting and diarrhoea are common.
  • The second stage of catarrhal changes-

Table 3 - Second Stage of Chronic Poisoning - sign and Symptoms

Sr. No.
Features
1Mucous membrane- inflamed.
2Eyes and nose- runny.
3Voice- Hoarseness, coughing.


  • The third stage of skin rashes-

Table 4 - Third Stage of Chronic Poisoning - Signs and Symptoms

Sr. No.
Feature
1Skin- Irritation, vesicular eruption, Raindrop type pigmentation-due to long exposure the patchy brown pigmentation develops in the skin.
2Palm and sole- Hyperkeratosis develops.
3

Nail- Brittleness 

Mee’s line- generally occurs around the nails of fingers and toes, they indicate the period of arrested growth due to interference with normal metabolism.


  • The fourth stage of nervous disturbance-

Table 5 - Fourth Stage of Chronic Poisoning - Sign and Symptoms

 Sr. No.Feature
1Hand and feet- Tingling, numbness.
2Muscle softness.
3Arsenical neuritis- Headache, damage in vision and in mental activity .thee symptoms are related to chronic alcoholism.
4Kidney damage.
5Liver damage.


Treatment-   

  • take out the patient from the source of exposure and applies the doses of BAL.
  • Vitamin B complex and sodium thiosulphate are helpful.
  • Symptomatic treatment.


Postmortem Appearance 


Table 6 - Postmortem Appearance in Chronic Poisoning

 Sr. No.
OrganAppearance
1External appearance- Emaciation, pigmentation, keratosis, alopecia, white streaks on nails, jaundice, wasting of muscles, and ulceration of nasal septum.
2Small intestine- Red in appearance with thick mucosa.
3Liver- Fatty degeneration.
4Kidney necrosis
5Heart- Myocardial necrosis.
6GIT- Congestion
7Decomposition retardation


Medicolegal Aspects 

It can be used for the following purpose-

Homicidal purpose-in the past it was a popular homicidal agent because it is less expensive and easily accessible. The fatal dose is small. The fatal period was also small. It has no taste; no odour hence can be mixed easily into food without anyone’s notice. The symptoms also develop gradually and resemble cholera. Very less quantity is needed.

Disadvantage-

  • It slows down putrefaction.
  • Its presence can be easily detected in decomposed/buried bodies.
  • Arsenic can be found in bones, hair and nails for several years and also in charred bones or ashes.
  • It can be used to kill cattle.
  • Accidental death may be due to admixture with articles of food or from its improper medicinal use. Chronic poisoning results from drinking well water containing arsenic.
  • Arsenic exposure can be occupational in those working in a metal foundry, mining, glass production or in the semiconductor industry.
  • It is sometimes ingested or applied locally in the form of a paste or ointment on abortion sticks to procure abortion.


Postmortem Imbibitions of Arsenic-

While performing postmortems and exhumations, the imbibition from natural sources should be taken into consideration. Hence necessary measures should be taken so that arsenic could not be able to percolate in the body through any of the natural sources like soil, groundwater etc. If there is arsenic contamination outside then it can be easily absorbed by keratin tissue. Then in such case, the concentration will be higher in hair and nails and in the case of poisoning, the concentration of arsenic will be more than in soil/water.


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REFERENCES-

Parikh C.K. Textbook of Medical Jurisprudence Forensic Medicine and Toxicology - 6th edition 2007, CBS Publishers and Distributers.

Dr. K.S. Narayan Reddy and Dr. O.P. Murthy, The Essentials of Forensic Medicine and Toxicology, 33rd edition 2014, Jaypee Brothers Medical Publishers.

P.V. Guharaj, M R Chandran Forensic medicine 2nd edition, google book.

Mishra A, Shukla SK (2014) Heavy Metal Toxicity: A Blind Evil. J Forensic Res 5:e116. Doi: 10.4172/2157-7145.1000e116

Principles of Forensic Medicine and Toxicology by Rajesh Bardale (Author)

Akshita Verma ,Forensic Aspect of Metal Poisoning: A Review , International Journal for Research in Applied Science & Engineering Technology (IJRASET) ,Volume 6 Issue I, January 2018

Mathiharan K, Kannan K. editor. Modi A Textbook of Medical Jurisprudence and Toxicology. 23th ed. Nagpur: LexisNexis Butterworth’s Wadhwa; 2005 p139

Sharma, B.R. Forensic Science in Criminal Investigation and Trials (3rdEdn) Universal Law Publishing Co. Ltd, New Delhi, 2001, 782

Lyon’s Medical Jurisprudence & Toxicology (11thEdn) Delhi Law House Publishing Co. Ltd, New Delhi 2005, 1155

Gautam Biswas, Review of forensic Medicine & Toxicology (Incl Clinical & Pathological Aspects), Jaypee Brothers Medical Publishers Private Limited; 2 edition (2012)

Heitland P, Ko¨ster HD. ICP fast determination of arsenic species and total arsenic in urine by HPLCeICP-MS: concentration ranges for unexposed German inhabitants and clinical case studies. J Anal Toxicol 2008;32:308e14.

Lindberg AL, Goessler W, Grande´r M, Nermell B, Vahter M. Evaluation of the three most commonly used analytical methods or determination of inorganic arsenic and its metabolites in urine. Toxicol Lett 2007;168:310e8.

Huang Z, Pei Q, Sun G, Zhang S, Liang J, Gao Y. Low selenium status affects arsenic metabolites in an arsenic exposed population with skin lesions. Clin Chim Acta 2008;387:139e44.

Morton J, Mason H. Speciation of arsenic compounds in urine from occupationally unexposed and exposed persons in the UK using a routine LC-ICP-MS method. J Anal Toxicol 2006;30: 293e301.

Christian WJ, Hopenhavn C, Centeno JA, Todorov T. Distribution of urinary selenium and arsenic among pregnant women exposed to arsenic in drinking water. Environ Res 2006;100: 115e22.

Raml R, Goessler W, Traar P, Ochi T, Francesconi KA. Novel this arsenic metabolites in human urine after ingestion of an arsenosugar, 20 ,30 -dihydroxypropyl 5-deoxy-5-dimethylarsinoyl-a-d-riboside. Chem Res Toxicol 2005;18:1444e50.

Schmeisser E, Goessler W, Francesconi KA. Human metabolism of arsenolipids present in cod liver. Anal Bioanal Chem 2006; 385:367e76.

Pearson GF, Greenway GM, Brima EI, Haris PI. Rapid arsenic speciation using ion-pair LC-ICPMS with a monolithic silica column reveals increased urinary DMA excretion after ingestion of rice. J Anal At Spectrom 2007;22:361e9

Hata A, Endo G, Nakajima Y, Ikebe M, Ogawa M, Fujitani N, et al. HPLC-ICP-MS speciation analysis of arsenic in urine of Japanese subjects without occupational exposure. J Occup Health 2007;49:217e23.

Sirot V, Gue´rin T, Volatier JL, Leblanc JC. Dietary exposure and biomarkers of arsenic in consumers of fish and shellfish from France. Sci Total Environ 2009;407:1875e85.

Pan F, Tyson JF, Uden PC. Simultaneous speciation of arsenic and selenium in human urine by high-performance liquid chromatography inductively coupled plasma mass spectrometry. J Anal At Spectrom 2007;22:931e7.

Rabieh S, Hirner AV, Matschullat J. Determination of arsenic species in human urine using high-performance liquid chromatography (HPLC) coupled with inductively coupled plasma mass spectrometry (ICP-MS). J Anal At Spectrom 2008;23: 544e9.

Afton S, Kubachka K, Catron B, Caruso JA. Simultaneous characterization of selenium and arsenic analytes via ion-pairing reversed-phase chromatography with inductively coupled plasma and electrospray ionization ion trap mass spectrometry for detection. Applications to river water, plant extract and urine matrices. J Chromatogr A 2008;1208: 156e63

Kile ML, Hoffman E, Hsueh YM, Afroz S, Quamruzzaman Q, Rahman M, et al. Variability in biomarkers of arsenic exposure and metabolism in adults over time. Environ Health Perspect 2009;117:455e60

Huang YK, Huang YL, Hsueh YM, Yang MH, Wu MM, Chen SY, et al. Arsenic exposure, urinary arsenic speciation, and the incidence of urothelial carcinoma: a twelve-year follow-up study. Cancer Causes Control 2008;19:829e39