title: Survival after a massive overdose of arsenic trioxide.
abstract: Arsenic poisoning remains a therapeutic challenge, and outcomes are often poor. An 18-year-old man deliberately ingested termiticide containing a massive dose of arsenic trioxide. Arsenic concentration was 6.3 micromol/L in serum on ICU Day 1, and 253 micromol/L in the first 24-hour urine sample, with a urinary arsenic/creatinine ratio of 84 200 micromol/mol. He was treated with the chelating agent meso-2,3-dimercaptosuccinic acid (DMSA) (replaced by dimercaprol on Days 2-5) and required intensive support for multisystem organ failure, but recovered slowly. Nine weeks after the ingestion the only ongoing clinical issue was persistent but slowly improving peripheral neuropathy.
authors.affiliation: Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW. lawrence.h.c.kim@gmail.com
authors.forename: Lawrence H C
authors.initials: LH
authors.lastname: Kim
authors.forename: Simon J C
authors.initials: SJ
authors.lastname: Abel
mesh_terms: D000293:Adolescent; D020261:Arsenic Poisoning / Q000175:diagnosis / Q000628:therapy*; D000077237:Arsenic Trioxide; D001152:Arsenicals; D002614:Chelating Agents / Q000627:therapeutic use; D003422:Critical Care; D006440:Hemofiltration; D006801:Humans; D008297:Male; D010087:Oxides / Q000506:poisoning*; D010289:Parenteral Nutrition, Total; D013406:Suicide, Attempted
chemical_list: D001152:Arsenicals; D002614:Chelating Agents; D010087:Oxides; D000077237:Arsenic Trioxide