Oral arsenic trioxide poisoning and secondary hazard from gastric content.
In a suicide attempt, a 54-year-old man ingested arsenic trioxide. Gastric lavage was performed, but most of the poison remained as a mass in his stomach. A total gastrectomy was also performed to avoid intestinal perforation and arsenic poisoning. After the operation, he developed ventricular fibrillation. At one point, his circulation recovered spontaneously, but he later died from refractory circulatory failure. Many medical staff members were exposed to fumes from the patient's stomach. Some of the staff were diagnosed with corneal erosion or laryngitis. Because arsenic trioxide reacts with acid to produce arsine, the symptoms experienced by medical staff are directly attributable to arsine produced as a result of the reaction of arsenic trioxide with gastric acid. This case highlights the need for the introduction of protective measures to safeguard medical staff from exposure to arsine gas during the treatment of patients poisoned from ingested arsenic trioxide.
Kinoshita
Hidenori
H
Niigata City General Hospital, Niigata, Japan. kinosita@hosp.niigata.niigata.jp
Hirose
Yasuo
Y
Tanaka
Toshiharu
T
Yamazaki
Yoshihiko
Y
D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects* / Q000737:chemistry; D004636:Emergency Service, Hospital; D017809:Fatal Outcome; D005740:Gases / Q000009:adverse effects; D005744:Gastric Acid / Q000737:chemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D010087:Oxides / Q000737:chemistry / Q000506:poisoning*; D010564:Personnel, Hospital; D013406:Suicide, Attempted
D001152:Arsenicals; D005740:Gases; D010087:Oxides; D000077237:Arsenic Trioxide; C006633:arsine