Abstract
In massive arsenic poisoning, the use of hemodialysis and dimercaprol (BAL) therapy is still controversial. Hemodialysis is thought of value only for supportive care. BAL therapy has been criticized because of its delayed action, its own toxicity and its possible influence on arsenic clearance during hemodialysis. We studied arsenic kinetics during an acute suicidal intoxication (10g of sodium arsenate). Treatment included gastric lavage, oral charcoal and supportive measures. Hemodialysis was performed immediately and repeated the next day. BAL therapy was prescribed only on the second day. Cardiovascular collapse, anuria and hepatic disturbance recovered in a few days and the patient could be discharged on the 15th day. Instantaneous serum arsenic hemodialysis clearance was 85±75ml/min without previous BAL injection and 87.5±75ml/min with a previous 250mg BAL injection (difference not significant) indicating that BAL did not impede arsenic dialysis. The calculated total hemodialysis clearance of arsenic was higher than mean serum hemodialysis clearance indicating that erythrocyte bound arsenic is also eliminated during dialysis. We propose to consider early hemodialysis as an elimination measure in massive arsenic poisoning and to choose BAL as a chelator when dialysis is required.
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References
Hutton JT, Christians BL, Dippel RL (1982) Arsenic poisoning. N Engl J Med 307:1080
Ellenhorn MJ, Barceloux DG (1988) Medical toxicology, 1st edn. Elsevier, Amsterdam, pp 1012–1016
Robertson WO (1983) Arsenic and other heavy metals. In: Haddad LM, Winchester JF (eds) Clinical management of poisoning and drug overdose, 1st edn. Saunders, Philadelphia, pp 656–663
Klaassen CD (1980) Heavy metals and heavy metal antagonists In: Goodman LS, Gilman A (eds) The pharmacological basis of therapeutics, 6th edn. Macmillan, New York, pp 1615–1637
Sheabar FZ, Yannai S, Taitelman V (1989) Efficiency of arsenic clearance from human blood in vitro and from dogs in vivo by extracorporeal complexing hemodialysis. Pharmacol Toxicol 64:329–333
Berlin M, Ullrebg S (1963) Increased uptake of mercury in mouse brain caused by 2,3-dimercaptopropanol. Nature 197:84–85
Bismuth C (1983) Management of specific poisoning. In: Tinker J, Rapin M (eds) Care of the critically ill patient, 1st edn. Springer, Berlin, pp 811–839
Holak W (1969) Gas-sampling technique for arsenic determination by atomic absorption spectrophotometry. Anal Chem 41:1712–1713
Peters RA, Stocken LA, Thompson RHS (1945) British anti-lewisite (BAL). Nature 156:616–619
Aposhian HV, Tadlock CH, Moon TE (1981) Protection of mice against the lethal effects of sodium arsenite. A quantitative comparison of a number of chelating agents. Toxicol Appl Pharmacol 61:385–392
Graziano JH, Cuccia D, Friedhelm E (1978) The pharmacology of 2,3-dimercaptosuccinic acid and its potential use in arsenic poisoning. J Pharmacol Exp Ther 207:1051–1055
Stine ER, Hsu CA, Hoover TD, Aposhian HV, Carter DE (1984) N-(2,3 Dimercaptopropyl)phthalamide acid: protection, in vivo and in vitro, against arsenic intoxication. Toxicol Appl Pharmacol 75:329–336
Frejaville JP, Bescol J, Leclerc JP, Guillam L, Crabie P, Conso F, Gervais P, Gaultier M (1972) Intoxication aigüe par les dérivés arsenicaux (à propos de 4 observations personnelles): troubles de l'hémostase. Etude ultramicroscopique du foie et du rein. Ann Méd Interne 123:713–722
Smith SL, Wombolt DG, Venkatesan R (1981) Results of hemodialysis and hemoperfusion in the treatment of acute arsenic ingestion. Clin Exp Dial Apheresis 5:399–404
Giberson A, Varizi ND, Mirahamadi K, Rosen SM (1976) Hemodialysis of acute arsenic intoxication with transient renal failure. Arch Intern Med 136:1303–1304
Varizi ND, Upham FT, Barton CH (1980) Haemodialysis clearance of arsenic. Clin Toxicol 17:451–456
Gosselin B, Mathieu D, Desprez-Nolf M, Cosson A, Goudeman J, Haguenoer JM, Wattel F (1982) Intoxication à l'hydrogène arsenié. Nouv Presse Méd 11:439–442
Heydorn K (1969) Environmental variation of arsenic levels in human blood determined by neutron activation analysis. Clin Chim Acta 28:349–357
Vahter M, Norin H (1980) Metabolism of As-labeled trivalent and pentavalent inorganic arsenic in mice. Environ Res 21:446–457
Pontal PG, Bismuth C, Baud FJ, Galliot M (1982) Part respective du lavage gastrique, de l'hémodialyse, de l'hémoperfusion, de la diurèse et du métabolisme hépatique dans l'épuration du méprobamate. Nouv Prese Méd 11:1557–1558
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Mathieu, D., Mathieu-Nolf, M., Germain-Alonso, M. et al. Massive arsenic poisoning — effect of hemodialysis and dimercaprol on arsenic kinetics. Intensive Care Med 18, 47–50 (1992). https://doi.org/10.1007/BF01706427
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DOI: https://doi.org/10.1007/BF01706427