Acute toxic inorganic arsenic exposure and arsine gas exposure can rapidly result in death, and there are only a few ways to possibly save the patient's life. Arsine is used as a doping agent in the semiconductor industry and in the manufacture of crystals for fiberoptics and computer chips. Interference with cellular respiration explains the potent toxicity of arsenic. arsine gas can be trapped in the victim’s clothing or hair after a large exposure, but are not likely to create a hazard for personnel outside the Hot Zone. Table Z-1: Limits for air contaminants. Ann N Y Acad Sci. 2005. Arsine gas poisoning requires careful monitoring of hematocrit/hemoglobin and renal function. Chowdhury R, Chowdhury S, Roychoudhury P, Mandal C, Chaudhuri K. Arsenic induced apoptosis in malignant melanoma cells is enhanced by menadione through ROS generation, p38 signaling and p53 activation. In contaminated shellfish/fish. ATSDR can also tell you the location of occupational and environmental health clinics. The main goal of the emergency medicine physician is to support vascular, renal, hematologic, and cardiorespiratory function. A doctor may give the exposed patient fluids through a vein to protect the kidneys from damage. Patients with significant hemolysis may require folate or iron supplementation. This study developed an in vitro model of arsine hemolysis, using the solubility of arsine gas in aqueous solutions. 2007. Bjørklund G, Mutter J, Aaseth J. Skeletal muscle injury or necrosis have been reported (HSDB 2007). Released patients should also be instructed to rest and to drink plenty of fluids. Victims who are unable to walk may be removed on backboards or gurneys; if these are not available, carefully carry or drag victims to safety. your next appointment. Inhalation may cause headache, delirium, nausea, vomiting, general malaise, tightness in the chest and pain in the abdomen or loins. Gas was passed into an absorption pipette containing a known volume of liquid S. The final volume of gas was measured at the barometric pressure, Ptotal. AIHA. Li C, Srivastava RK, Athar M. Biological and environmental hazards associated with exposure to chemical warfare agents: arsenicals. ____________________________________ Metal toxicology. Flammability: Extremely flammable; may be ignited by heat, sparks, or flames. Hazardous Substances Data Bank. Hesdorffer CS, Milne FJ, Terblanche J, Meyers AM. in the practice of ________. 4.2 High risk circumstance of poisoning Most cases of arsine poisoning do not result from use of the gas itself; rather they occur when arsine is accidentally generated as by-product of a chemical reaction involving a metal containing an arsenic impurity and an acid or a strong alkali. 2016 Dec. 48:214-224. Leukocytosis and signs of intravascular coagulation can be observed during the hemolytic phase (IPCS 1997). Arsenic (As) is a nearly tasteless odorless toxic metalloid element that is found ubiquitously in the environment. After absorption by the lungs, arsine enters red blood cells (RBC) where different processes may contribute to hemolysis and impairment of oxygen transport. Metabolism and toxicity of arsenicals in mammals. EDTA (adults) Dimercaprol, succimer (kids) Chelate for 5 days, then allow redistrubution from bone and repeat. New York, NY: Academic Press, 287-304. Patients who are comatose or hypotensive should be treated in the conventional manner.  Possible sources of occupational exposure are many, including microchip production in the semiconductor industry and other industries in which workers are involved in galvanizing, soldering, etching, and lead plating. INTRODUCTION: Exposure to arsine gas can cause fatal hemolysis and multiorgan damage. Toxicity of arsine to humans was first demonstrated in 1815, when a German chemist accidentally inhaled arsine vapor during an experiment (Romeo et al., 1997). Arsine results. If the exposure happened at work, you may wish to discuss it with your employer, the Occupational Safety and Health Administration (OSHA), or the National Institute for Occupational Safety and Health (NIOSH). Blood transfusions may be necessary if hemolysis causes severe anemia (Reigart and Roberts 1999). In case of frostbite injury, irrigate with lukewarm (42 °C) water according to standard treatment. Ingestion of arsine is unlikely, but ingestion of metallic arsenides can lead to arsine gas production and toxicity. arsine. Arsine gas can cause toxicity within a short span to organisms . Effects of Toxic Gas Exposure to Ammonia, Arsine, Arsenic, Bromine, Carbon Dioxide, Carbon Monoxide, flue gases, heating equipment exhaust gases, Hydride, as well as odors & smells. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Arsenic in food is an increasingly recognized exposure path-way. All exposure victims should be evaluated and observed. CNS disorders can develop several days after severe exposure; signs include restlessness, memory loss, disorientation, and agitation. [Medline]. Department if you develop any unusual signs or symptoms within More information about arsine can be obtained from your regional poison control center; your state, county, or local health department; the Agency for Toxic Substances and Disease Registry (ATSDR); your doctor; or a clinic in your area that specializes in occupational and environmental health. Patty's industrial hygiene and toxicology. Toxic, flammable liquefied gas . Occupational arsine gas exposure. 18 In vivo interconversion of As +5 and As +3 occur, and chronic exposure to both forms has resulted in a similar pattern of toxicity. Ren M Kinoshita, DO Resident Physician, Department of Emergency Medicine, Carl R Darnall Army Medical Center It has a garlic-like or fishy odor that can be detected at concentrations of 0.5 ppm and above. Woods JS. Hemolysis occurred after 1-2 hours and reached 40-50%. 2006 Sep. 46(9):1576-9. Arsine. First-aid measures after eye contact : Immediately flush eyes thoroughly with water for at least 15 minutes. October 11, 2007. Consult a nephrologist for hemodialysis in patients with acute renal failure. Arsenic is a type of carcinogen that’s gray, silver, or white in color. Hsu LI, Hsieh FI, Wang YH, Lai TS, Wu MM, Chen CJ, et al. It is difficult to determine at the scene which persons have had the most serious exposures and are likely to develop severe hemolysis; therefore, all persons who have potential exposure should be transported to a medical facility for evaluation. Mechanism of Toxicity. After inhalation, arsine rapidly binds to red blood cells, producing irreversible cell membrane damage. Hypotension should be addressed with infusion of normal saline or lactated Ringer solution. October 21, 2014; Accessed: February 16, 2019. In: Goyer RA, Klaassen CD, Waalkes MP, eds. Diseases & Conditions, 2002 Prophylaxis: N/A Treatment: There is no specific antidote for arsine. Since it was written to address the high toxicity and flammability of arsine where the consequences of handling the compressed gas could cause injury, death, and/or facility damage, the CGA G-16-2018 standard provides an understanding of the potential hazards involved in handling arsine and touches upon a breadth of information that can minimize risk potential. Immediately wash eyes with large amounts of tepid water for at least 15 minutes. Danielson C, Houseworth J, Skipworth E, Smith D, McCarthy L, Nanagas K. Arsine toxicity treated with red blood cell and plasma exchanges. After inhalation of arsine gas, it causes rapid destruction of RBCs, leading to hypoxia and renal failure. Song Y, Wang D, Li H, Hao F, Ma J, Xia Y. There are no data on the carcinogenicity of arsine in humans or in experimental animals. Synonyms include arsenic hydride, arsenic trihydride, arseniuretted hydrogen, arsenious hydride, and Ren M Kinoshita, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic AssociationDisclosure: Nothing to disclose. Treatment relies on adequate respiratory and cardiovascular support with later renal replacement therapy for renal failure. Dry with clean towels and keep victim warm and quiet. Kosnett MJ. Inhaled arsine gas is distributed rapidly and causes massive red blood cell hemolysis that can potentially lead to global cellular hypoxia. [ ] Avoid taking the following medications: ANTIDOTE: There is no antidote for arsine (SA) toxicity. Br J Ind Med. [Medline]. 2009 Jan. 14(1):108-23. OSHA. 4.2 High risk circumstance of poisoning Most cases of arsine poisoning do not result from use of the gas itself; rather they occur when arsine is accidentally generated as by-product of a chemical reaction involving a metal containing an arsenic impurity and an acid or a strong alkali. Fumigation with phosphine gas is by far the most widely used treatment for the protection of stored grain against insect pests. J Natl Med Assoc. 1) Administer intravenous fluids and, if needed, osmotic … Do not administer arsenic chelating drugs. Arch Toxicol. The patient should be intubated if the airway is not patent or protected. If you log out, you will be required to enter your username and password the next time you visit. Monitor fluid balance carefully to avoid fluid overload if renal failure supervenes (Reigart and Roberts 1999); monitor plasma electrolytes to detect disturbances (particularly hyperkalemia) as early as possible, and monitor hematocrit. Depending on the severity of arsine exposure, patients should be evaluated periodically by their physician for several months; these examinations should include hematological and urinalysis tests. Most people do not develop long-term effects from a single, small exposure to arsine. for 72 hours; smoke may worsen the condition of your lungs. 2013 Nov 1. For the acute Mysid test, each replicate for each treatment level and the controls were sampled at 0 and 96 h of exposure, and analyzed using GC. Symptoms. Do not administer arsenic chelating drugs. Within hours after a serious exposure, symptoms such as headache, weakness, shortness of breath, and back or stomach pain with nausea and vomiting may develop; the urine, skin, and eyes may become discolored. SPECIFIC TARGET ORGAN TOXICITY (REPEATED EXPOSURE) (liver) - Category 2 AQUATIC HAZARD (ACUTE) - Category 1 AQUATIC HAZARD (LONG-TERM) - Category 1 Classification of the substance or mixture: Signal word :Danger Hazard statements :Extremely flammable gas. on ____ (date) at _____ AM/PM for a follow-up examination. [ ] Call for an appointment with Dr.____ Other persons may still be at risk in the setting where this incident occurred. [Medline]. Airway: Ensure the airway is patent and protected. The Bunsen ab Circulation: Treat hypotension with normal saline (NS) or lactated Ringer solution. However, metal arsenides are solids that can react with acidic gastric contents, releasing arsine gas in the stomach. Maintain alkaline urine (i.e., pH >7.5) until urine is hemoglobin free. Centers for Disease Control and Prevention. There is no specific antidote for arsine. Poisons Information Monograph (PIM) 044. International Programme on Chemical Safety. Because arsine is nonirritating and produces no immediate symptoms, persons exposed to hazardous levels may be unaware of its presence. Positive pressure, self-contained breathing apparatus (SCBA) is highly recommended. Chemical protective clothing is usually not required since arsine gas is not directly absorbed through the skin. Other useful studies include renal-function tests (e.g., BUN, creatinine), and determinations of serum electrolytes and bilirubin levels. Observe patients who have inhaled arsine for up to 24 hours. Therefore, people deficient in the enzyme glucose-6-phosphate-dehydrogenase (G6PD) are more susceptible to hemolysis following arsine exposure. Evidence for oxidative damage to red blood cells in mice induced by arsine gas. [13, 14, 15, 16, 17] RBC-E and PE may have a synergistic effect with better outcome than RBC-E alone. Children exposed to the same levels of arsine as adults may receive larger doses because they have relatively greater lung surface area:body weight ratios and higher minute volumes:weight ratios. However, contact with the liquid (compressed gas) can cause frostbite injury to the skin or eyes (NIOSH 2005). See Appendix III for a list of agencies that may be of assistance. Arsine poisoning treatment should focus on restoring RBC concentrations, maintaining renal function, electrolyte replacement and aggressive supportive care. COVID-19: LOW risk Start test. The effects of sulfur, thiol, and thiol inhibitor compounds on arsine-induced toxicity in the human erythrocyte membrane. Arsine. There are no antidotes for arsine poisoning. Hemoglobinuria usually occurs within hours, jaundice within 1 or 2 days. Arsine. Inhalation is the major route of arsine exposure. These clinics specialize in recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances. Arsines are removed from gaseous stream, e.g., hydrocarbon or inert gas streams, comprising arsine impurities and also hydrogen sulfide, by contacting these gas streams with a sorbent material comprising copper oxide and zinc oxide. Arsine reacts with strong oxidizers, chlorine, and nitric acid. August 9, 2005. o Pigment overload from erythrocyte breakdown can cause renal failure. Cellular membranes are more permeable to trivalent arsenic (As +3) then pentavalent arsenic (As +5). [Medline]. Arsine has some properties that may make it useful as a chemical warfare (CW) agent  ; it is a colorless, odorless, nonirritating gas that is 2.5 times denser than air. [Medline]. Arch Environ Health. Support Zone personnel require no specialized protective gear if the victim has been exposed only to arsine gas. Follow local emergency management plan and protocols if intentional release of arsine is suspected. 2017 Dec. 70 (6):787-797. frequent infections (leukopenia) and easy bruising / petechia (thrombocytopenia) Anemia and leukopenia are common in chronic arsenic toxicity, are often accompanied by thrombocytopenia and mild eosinophilia Chronic arsenic exposure may be associated [pathologyoutlines.com] Monitor fluid balance and avoid fluid overload if renal failure supervenes (Reigart and Roberts 1999); monitor plasma electrolytes to detect disturbances (particularly hyperkalemia) as early as possible. The exception is exposure to compressed liquid gas that may cause frostbite injury to the skin or eyes. 1969 Jul. Although small amounts of arsine gas can be trapped in the victim's clothing or hair after an overwhelming exposure, these quantities are not likely to create a hazard for response personnel outside the Hot Zone. A) MANAGEMENT OF MILD TO MODERATE TOXICITY . A patient with arsine toxicity has recently been treated by both red blood cell exchange (RBC-E) and plasma exchange (PE) therapy and our experience is reported. Diseases & Conditions, You are being redirected to There is no antidote to arsine gas toxicity, and chelation therapy has not demonstrated effectiveness. If hemolysis is present, the patient/victim must be observed up to 72 hours for signs of renal failure. Monitor hematocrit. Washington, DC: Occupational Safety and Health Administration. Organic mercury. Agency for Toxic Substance and Disease Registration, http://www.epa.gov/opptintr/aegl/pubs/results2.htm, http://www.inchem.org/documents/pims/chemical/pim044.htm, http://www.cdc.gov/niosh/npg/npgd0040.html, http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9992, Agency for Toxic Substances and Disease Registry, Medical Management Guidelines (MMG) for Acute Chemical Exposure, U.S. Department of Health & Human Services. 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