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Arsenic

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Critical Care Toxicology

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Abstract

Arsenic has captured the attention of the medical community for more than two millennia as a cause of disease and as a cure. Hippocrates and other ancient Greek physicians described the use of arsenic sulfides such as realgar (As2S2) or orpiment (As2S3) as a topical treatment for ulcers. During the first millennium AD, the roasting of realgar led to the discovery of the so-called white arsenic, or arsenic trioxide. Odorless, tasteless, and soluble in solution, it became a tool of deliberate poisoning and gained particular notoriety as a homicidal agent in Europe in the fifteenth through seventeenth centuries. In the late eighteenth century, Fowler [1] described the medical use of a 1 % solution of potassium arsenite as an oral treatment for fever and chorea. Known as liquor arsenicalis or Fowler’s solution, it was used extensively until the mid-twentieth century as a remedy for asthma and psoriasis. In the nineteenth century, arsenic compounds were used widely in commerce as pigments (e.g., copper arsenite or “Scheele’s green”). Several arsenic compounds were used through most of the twentieth century as pesticides (e.g., lead arsenate, calcium arsenate) or herbicides (e.g., sodium arsenite). Until recently, the wood preservative chromated copper arsenate represented the largest commercial use of arsenic, although use in new residential products has been discontinued. Ammoniacal copper zinc arsenate is still used as a wood preservative in limited industrial applications. Organic arsenic antibiotics were used extensively in humans in the first half of the twentieth century in the treatment of protozoan and spirochetal diseases, and until recently phenylarsenic agents were used as feed additives for poultry and swine. The link between environmental and occupational arsenic exposure and chronic nonmalignant and malignant disease became well established in the latter half of the twentieth century, leading to a reduction in many commercial applications and recent regulatory efforts to reduce permissible exposure levels in drinking water, where arsenic of geologic origin may occur as a natural contaminant.

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Authors and Affiliations

  1. Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Michael J. Kosnett

  2. Department of Environmental and Occupational Health, Colorado School of Public Health, Aurora, CO, USA

    Michael J. Kosnett

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  1. Michael J. Kosnett
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Editor information

Editors and Affiliations

  1. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Jeffrey Brent

  2. Office of New Drugs Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas' Hospital, London, United Kingdom

    Paul Dargan

  4. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Benjamin Hatten

  5. Med & Toxicological Intensive Care Unit, Lariboisière Hospital Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Robert Palmer

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Kosnett, M.J. (2016). Arsenic. In: Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., Palmer, R. (eds) Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_16-1

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