title: Massive human ingestion of orpiment (arsenic trisulfide).
abstract: BACKGROUND
  Because the toxicity of arsenic is well known, arsenic-containing compounds have frequently been ingested for suicidal purposes. We report a case of attempted suicide by massive ingestion of arsenic trisulfide, an arsenic mineral of low solubility, which resulted in minimal symptoms.
  
  
  METHODS
  An asymptomatic 57-year-old man presented to an Emergency Department 13h after his reported ingestion of approximately 84g of arsenic contained in a mineral specimen of orpiment (arsenic trisulfide) that had been crushed and mixed with an alcoholic beverage and food. His only symptom before presentation was nausea. Physical examination was unremarkable, and diagnostic tests included a normal electrolyte panel, a normal serum lactate, and a normal electrocardiogram. An abdominal radiograph revealed hyper-dense material scattered throughout the large intestine. As per the recommendations of the regional poison center, the patient was managed with whole bowel irrigation with a polyethylene glycol solution, maintenance intravenous hydration, and observation on a telemetry unit. Chelation was not performed. A spot urine specimen collected 12h after admission contained 1490μg of total arsenic per liter (background range<50μg per liter). The patient remained asymptomatic throughout his hospital course. Follow-up studies revealed a diminution in both intra-abdominal radiopacities and urine arsenic concentration. X-ray diffraction analysis of the specimen confirmed its identity as arsenic trisulfide.
  
  
  CONCLUSIONS
  Our experience demonstrates that massive ingestion of a poorly soluble inorganic arsenic compound can be successfully managed with gastrointestinal decontamination alone without chelation, provided that the patient remains asymptomatic during close clinical monitoring.
authors.affiliation: Department of Emergency Medicine, Denver Health and Hospital Authority, University of Colorado Denver School of Medicine, Denver & Aurora, Colorado, USA.
authors.forename: Jennie A
authors.initials: JA
authors.lastname: Buchanan
authors.forename: Aaron
authors.initials: A
authors.lastname: Eberhardt
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Tebb
authors.forename: Kennon
authors.initials: K
authors.lastname: Heard
authors.forename: Richard F
authors.initials: RF
authors.lastname: Wendlandt
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kosnett
mesh_terms: D000284:Administration, Oral; D001152:Arsenicals / Q000008:administration & dosage* / Q000009:adverse effects / Q000652:urine; D005440:Fluid Therapy; D006801:Humans; D007422:Intestines; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D013406:Suicide, Attempted; D013439:Sulfhydryl Reagents / Q000008:administration & dosage* / Q000009:adverse effects / Q000652:urine; D013440:Sulfides / Q000008:administration & dosage* / Q000009:adverse effects / Q000652:urine; D007507:Therapeutic Irrigation
chemical_list: D001152:Arsenicals; D013439:Sulfhydryl Reagents; D013440:Sulfides; C045816:arsenic trisulfide