Repetitive endoscopy and continuous alkaline gastric irrigation in a case of arsenic poisoning.
BACKGROUND
The poor prognosis of patients with persistent gastrointestinal radio-opacities after oral arsenic poisoning supports efficient gastrointestinal decontamination as critical for survival. In a case of massive arsenic ingestion, we performed repetitive gastric endoscopy and a continuous alkaline irrigation of the stomach over several days.


METHODS
A 41-year-old woman was admitted 4 hours after intentional ingestion of trivalent arsenic powder 5 g. The admission abdominal X-ray confirmed the presence of multiple gastric opacities. Initial treatment was gastric lavage with normal saline, dimercaprol chelation, and supportive therapy. Since gastric opacities persisted on the abdominal X-ray at 34 hours despite repeated gastric lavage, a gastroscopy was performed showing nonremovable agglomerates. In an attempt to achieve further gastric decontamination, we performed a continuous gastric alkaline irrigation. After 3 days of alkaline irrigation, the abdomen was normal on X-ray but the gastroscopy still showed arsenic concretions. Alkaline irrigation was continued for another 3 days until total disappearance of arsenic agglomerates at the gastroscopy. Admission urinary arsenic was 3663 microg/L. A total of 46.2 mg of inorganic arsenic, or less than 1% the ingested dose, was extracted from the stomach by this technique. The patient was discharged from the intensive care unit 20 days after admission without sequelae.
Michaux
I
I
Department of Intensive Care Medicine, Mont-Godinne, Yvoir, Belgium.
Haufroid
V
V
Dive
A
A
Buchet
J P
JP
Bulpa
P
P
Mahieu
P
P
Installé
E
E
D000328:Adult; D001151:Arsenic / Q000652:urine; D020261:Arsenic Poisoning / Q000000981:diagnostic imaging / Q000628:therapy* / Q000652:urine; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000493:pharmacokinetics; D005260:Female; D005750:Gastric Juice / Q000378:metabolism; D005751:Gastric Lavage / Q000379:methods*; D005753:Gastric Mucosa / Q000378:metabolism; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010087:Oxides / Q000493:pharmacokinetics; D011859:Radiography; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D013270:Stomach / Q000000981:diagnostic imaging
D001152:Arsenicals; D010087:Oxides; D017693:Sodium Bicarbonate; D001151:Arsenic; D000077237:Arsenic Trioxide