title: Survival after a lethal dose of arsenic trioxide.
abstract: A case of a 27-year-old woman who ingested 9000 mg arsenic trioxide (As2O3) is reported. Classical symptoms of an acute arsenicum (As) poisoning such as gastrointestinal cramps, vomiting, diarrhea, ECG changes and disturbed liver function tests were observed. The absorption of the ingested As was minimalized by a continuous gastric irrigation with highly concentrated NaHCO3 and intestinal cleansing with NaHCO3 and polyethyleneglycol was performed. Forced diuresis, BAL (2,3-dimercaptopropanol) and DMSA (meso-2,3-dimercaptosuccinic acid) were started and therapy to enhance the formation of methylated As derivatives, which are potentially less toxic and which can be excreted more easily, was then administered. The patient survived this massive dose of ingested inorganic As with only polyneuropathy one year later.
authors.affiliation: Department of Emergency Medicine, University Hospital Gasthuisberg, Leuven, Belgium. barbara.vantroyen@pandora.be
authors.forename: Barbara
authors.initials: B
authors.lastname: Vantroyen
authors.forename: J F
authors.initials: JF
authors.lastname: Heilier
authors.forename: Agnes
authors.initials: A
authors.lastname: Meulemans
authors.forename: Arnold
authors.initials: A
authors.lastname: Michels
authors.forename: J P
authors.initials: JP
authors.lastname: Buchet
authors.forename: Steven
authors.initials: S
authors.lastname: Vanderschueren
authors.forename: V
authors.initials: V
authors.lastname: Haufroid
authors.forename: Marc
authors.initials: M
authors.lastname: Sabbe
mesh_terms: D000328:Adult; D000931:Antidotes / Q000627:therapeutic use; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000493:pharmacokinetics; D002606:Charcoal / Q000627:therapeutic use; D002614:Chelating Agents / Q000627:therapeutic use; D004576:Electromyography; D005260:Female; D006801:Humans; D010087:Oxides / Q000493:pharmacokinetics / Q000506:poisoning*; D011860:Radiography, Abdominal; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D012965:Sodium Chloride / Q000627:therapeutic use; D013406:Suicide, Attempted; D007507:Therapeutic Irrigation
chemical_list: D000931:Antidotes; D001152:Arsenicals; D002614:Chelating Agents; D010087:Oxides; D002606:Charcoal; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D000077237:Arsenic Trioxide