Arsenic is a highly toxic chemical element that has been used as a poison throughout history. Even small amounts of arsenic can be deadly if ingested or inhaled. So can you survive arsenic poisoning? The short answer is maybe, with prompt medical treatment. However, arsenic poisoning can be difficult to diagnose and treat effectively. Ultimately, survival depends on the dose and duration of exposure.
What is arsenic?
Arsenic is a naturally occurring semi-metal element found in the earth’s crust. In nature, arsenic combines with other elements such as oxygen, chlorine, and sulfur to form inorganic arsenic compounds. Arsenic combined with carbon and hydrogen forms organic arsenic compounds.
Inorganic arsenic compounds are far more toxic than organic ones. The most common inorganic arsenic compounds are arsenite (AsIII) and arsenate (AsV). Arsenite is more mobile and more than five times as toxic as arsenate in short term single dose exposure.
Historically, arsenic compounds were used as pharmaceutical agents and ingredients for many things. More well known uses of arsenic compounds were as pesticides, wood preservatives, and poisons.
Why is arsenic poisonous?
Arsenic is poisonous because it interferes with many biological processes and systems within the body. The exact mechanisms of arsenic toxicity are still being researched. Here are some of the known ways arsenic disrupts normal body functions:
– Arsenic inhibits important enzymes and proteins required for cellular energy processes, DNA synthesis and repair, and other vital functions. Even in small amounts, arsenic can disrupt and damage cells.
– Arsenic generates free radicals that damage proteins, cell membranes and DNA. This oxidative damage can lead to cell death and mutations.
– Arsenic alters and impairs immune responses, including inflammatory reactions and cytokine production needed to fight infections and diseases.
– Arsenic disrupts hormone receptors and signaling pathways, altering the function of many hormone systems including glucocorticoid, estrogen, androgen, thyroid, vitamin D, insulin, and growth hormone systems.
– Arsenic damages blood vessels and circulation, which can lead to various cardiovascular and cerebrovascular diseases over time.
Acute vs Chronic Arsenic Poisoning
Arsenic exposure can cause both acute and chronic poisoning:
– Acute arsenic poisoning happens when a person ingests a lethal dose of arsenic over a short period, usually from a single exposure event. Symptoms occur rapidly within hours or days. Acute arsenic poisoning has a high mortality rate if not treated immediately.
– Chronic arsenic poisoning is caused by repeated or continuous lower level exposures over weeks or years leading to a toxic accumulation in the body. Symptoms develop gradually over time. Chronic arsenic toxicity can lead to multisystem diseases and cancers in the long term.
The toxicity of arsenic depends on the absorbed dose, route of exposure, water solubility of the arsenic compound, and health status of the person. Age, genetics, nutritional status, and existing diseases also affect susceptibility to arsenic.
Routes of Arsenic Exposure
Arsenic can enter the body through:
– Ingestion: Eating or drinking contaminated food, water, beverages, alcohol, or medicines. Inorganic arsenic is very water soluble. Drinking arsenic contaminated water is a major cause of toxicity worldwide.
– Inhalation: Breathing in dust or powders containing arsenic. Arsenic trioxide fumes and dust are very toxic if inhaled. Occupational exposures are most common, but cigarettes can be another source.
– Absorption: Arsenic can be absorbed through the skin when touching or bathing in contaminated water. Arsenic is also used in some traditional medicines that are applied to the skin.
– Injection: Arsenic has been used for deliberate poisoning through injection or as contamination of injected drugs. Accidental contamination of medical products is also possible.
Once in the body, inorganic arsenic circulates in the bloodstream and is deposited into bones, muscles, skin, hair, and nails. Arsenic binding to hemoglobin also helps distribution. Arsenic leaves the body primarily in urine.
Signs and Symptoms of Acute Arsenic Poisoning
Acute arsenic poisoning usually occurs from a single high dose exposure. The lethal oral dose of inorganic arsenic for humans has been estimated to be 70 to 200 mg although much lower doses have caused death.
Early symptoms can begin within 30 minutes but generally develop in 4-8 hours after ingestion or exposure. Initial signs may include:
– Nausea, vomiting, diarrhea, abdominal pain
– Metallic or garlic taste in mouth
– Excessive salivation, sore throat, difficulty swallowing
– Headache, fatigue, muscle cramps, weakness
– Difficulty breathing, fluid in lungs
– Blanching and then darkening of the skin around the neck and upper chest
As toxicity progresses, more severe effects arise:
– Dehydration and drop in blood pressure
– Irregular heartbeat and other cardiac arrhythmias
– Kidney failure, swelling of tissues, and shock
– Confusion, hallucinations, seizures, coma
– Extensive internal bleeding and organ damage
– Death, typically within 24-48 hours from acute exposures
Acute Arsenic Poisoning Treatment
If acute arsenic poisoning is suspected, immediate medical treatment is vital for survival. Actions may include:
– Gastric lavage to flush the stomach of arsenic
– Activated charcoal to absorb arsenic in the gastrointestinal tract
– Chelation therapy to bind arsenic so it can be removed from the body
– Treatment of symptoms – IV fluids, anti-nausea medication, kidney dialysis
– Oxygen, heart monitoring, anticonvulsants, ventilation support if needed
– Find and remove the source of arsenic to prevent re-exposure
Signs and Symptoms of Chronic Arsenic Poisoning
Chronic arsenic poisoning usually results from continual low dose exposure over a period of months or years. Symptoms are generally milder at first but can progressively worsen over time and become debilitating or fatal.
Early symptoms of chronic arsenic poisoning may include:
– Nausea, diarrhea, vomiting
– Abdominal pain and cramping
– Headache, fatigue, muscle aches and pains
– Pins and needles sensation in hands and feet
With prolonged exposure, more severe effects can develop:
– Hyperpigmentation and abnormal whitening of skin
– Dry, thickened skin, skin lesions and keratosis
– Brittle hair and nails, hair loss
– Peripheral neuropathy – numbness, tingling and pain in hands and feet
– Impaired kidney and liver function
– Cardiovascular disease, diabetes, reproductive issues
– Neurobehavioral effects – depression, anxiety, reduced IQ
– Increased risk of cancers (skin, bladder, kidney, lung, liver)
The minimal risk level of chronic oral exposure is estimated to be 0.3 μg/kg body weight/day. However, effects have been seen with much lower doses from drinking water over a decade or longer. Eliminating arsenic exposure and treating symptoms are keys to managing chronic arsenic toxicity.
How Much Arsenic Causes Death?
The amount of arsenic that is lethal depends on the chemical form, route of exposure, period of time, and individual susceptibility.
For acute lethal poisoning, estimated fatal oral doses of inorganic arsenic are:
– Arsenic trioxide: 70-180 mg
– Sodium arsenite: 10-60 mg
– Arsenic trichloride: 10-20 mg
However, fatalities have occurred from doses as low as 5 mg. Chronic poisoning can result from doses of 1-2 mg per day over weeks or months.
Inhaled arsenic is far more toxic. As little as 10 mg of arsenic trioxide dust can be fatal if substantial amounts are inhaled and retained in the lungs.
But again, age, health conditions, genetics and other factors significantly affect individual susceptibility to arsenic poisoning.
Famous Historical Arsenic Poisonings
Arsenic has been used to commit murders and assassinations throughout history. Some of the most infamous arsenic poisoning cases include:
– George III of England – The “Mad King” is now believed to have suffered from arsenic poisoning, causing his bizarre behavior. Arsenic was found in his hair samples.
– Napoleon Bonaparte – Arsenic was detected in Napoleon’s hair when his body was exhumed in the 1960s, leading to theories he was slowly poisoned during exile.
– Clare Boothe Luce – The playwright survived chronic arsenic poisoning allegedly orchestrated by her husband in the 1930s. She had many symptoms but ultimately recovered.
– Zhang Zhongjing – This famous ancient Chinese physician was poisoned with arsenic by Emperor Shang of Han in the 2nd century.
– Simon András – The Hungarian nobleman was poisoned with arsenic-laced pudding by his wife Elisabeth Báthory in 1609.
– Mary Ann Cotton – This 19th century serial killer poisoned 21 people including her husbands and children, largely with arsenic. She was caught and executed.
– Michael Swango – The American doctor and serial killer fatally poisoned at least 4 patients and poisoned many more with lethal injections of arrsenic and other drugs.
Detecting Arsenic Poisoning
Diagnosing arsenic poisoning can be difficult due to the variety of symptoms that may gradually emerge over time.
– Medical history – Environmental or occupational exposures to arsenic? Travel to regions with elevated arsenic in water or food?
– Physical exam – Skin abnormalities, nerve issues, fluid buildup suggest arsenic poisoning
– Urine test – Elevated arsenic in urine indicates recent or ongoing exposure
– Hair test – Segmental hair analysis detects past arsenic exposure looking back month-to-month along hair
– Nail test – Arsenic accumulates in nails and levels remain elevated for over a year
– Blood test – May reveal elevated arsenic but blood levels fluctuate so results are less diagnostic
– Tissue biopsy – Arsenic can be directly measured in tissues but an invasive procedure
Since arsenic is rapidly excreted in urine, specimens must be collected within 1-2 days of exposure for best detection. Hair and nails provide longer term exposure information.
Myths and Facts about Arsenic Poisoning
Myth: Arsenic poisoning is always fatal
Fact: If caught early, arsenic poisoning can be treated, and the patient may recover fully. However, long term exposure can still cause lasting health issues.
Myth: Arsenic poisoning causes immediate death
Fact: Except with very high doses, arsenic poisoning takes time to develop symptoms and result in death. Chronic lower doses may take months or years before causing mortality.
Myth: Hair loss only occurs right before death
Fact: Hair loss can happen with sublethal arsenic poisoning. New hair growth may be brittle and depigmented. Hair loss is not necessarily a sign that death is imminent.
Myth: Skin pigmentation changes only develop in chronic arsenic poisoning
Fact: Skin darkening and light patches can occur within 2-4 weeks of elevated acute arsenic exposure and are diagnostic of toxicity.
Myth: Arsenic remains detectable in the body for a long time
Fact: Arsenic is rapidly excreted in urine and only remains elevated for 1-2 days after exposure stops. Hair and nails can show longer term accumulation.
| Arsenic Compound | Oral LD50 (mg/kg) | Inhalation LC50 (mg/m3/30 min) |
|---|---|---|
| Arsenic trioxide | 14-30 | 21-69 |
| Sodium arsenite | 20 | 145 |
| Calcium arsenate | 20-44 | 27-77 |
| Arsenic trichloride | 41.5 | 4.6 |
| Arsenic pentoxide | 25-163 | N/A |
Table 1. Lethal dose (LD50) and lethal concentration (LC50) values for some arsenic compounds demonstrating relative acute toxicities.
Chelation Therapy for Arsenic Poisoning
Chelation therapy can be an effective treatment for acute arsenic poisoning or chronic high level exposure by binding arsenic in the body so it can be excreted in urine. Some medications used include:
| Drug | Administration | Mechanism |
|---|---|---|
| Dimercaprol | Intramuscular injection | Binds trivalent arsenic |
| Succimer | Oral capsule | Binds pentavalent and trivalent arsenic |
| DMPS | Intravenous or oral | Arsenic and mercury chelator |
| DMSA | Oral | Binds and removes arsenic |
Table 2. Some chelating agents used to treat acute arsenic poisoning by enhancing urinary arsenic elimination.
Chelation side effects can include nausea, headache, liver changes, and mineral imbalances from depletion of essential metals. Treatment typically continues for 1-4 weeks along with medication to manage symptoms.
Long Term Health Effects of Arsenic Poisoning
Surviving an acute arsenic poisoning can still result in chronic health problems down the road even after arsenic elimination from the body. Long term effects of significant arsenic exposure may include:
– Peripheral neuropathy – numbness and pain from nerve damage in hands and feet
– Vascular disease – hypertension, strokes, heart attacks, blood vessel damage
– Kidney and liver dysfunction – inability to filter wastes and toxins
– Diabetes mellitus – reduced insulin production and sensitivity
– Reproductive effects – infertility, spontaneous abortions, stillbirths
– Neurologic effects – cognitive deficits, mood disorders, memory loss
– Various cancers – bladder, kidney, lung, liver, prostate, skin
Ongoing nutritional support, antioxidants, physical therapy, and symptom management may help improve long term well-being. But some impairments like cancer or neurologic deficits may be irreversible.
Prevention of Arsenic Poisoning
Since arsenic contamination is still a major health issue in certain parts of the world from environmental sources, here are some tips to avoid chronic arsenic poisoning:
– Avoid drinking, cooking or watering crops with well water that may have high arsenic levels. Testing water annually is recommended.
– Eat a varied diet and avoid food items unusually high in arsenic, like certain types of seafood, rice, or juices.
– Take antioxidant supplements to boost cellular defense against arsenic damage.
– Stop smoking and reduce secondhand smoke exposure which contains some arsenic.
– Use proper protective equipment if working in occupations like mining, metal processing, pesticide application, wood treatment that have arsenic contamination risks.
– Avoid traditional medicines, especially herbal remedies from certain Asian and Latin American countries that may contain toxic arsenic compounds.
If you have any known arsenic exposure, consult a doctor promptly for testing and treatment if indicated. Periodic testing for arsenic through urine, hair, or nails may be beneficial even with low dose exposures to ensure levels remain below toxic thresholds.
Conclusion
Arsenic is an extremely toxic compound that throughout history has been used to poison countless people both deliberately and inadvertently. Acute lethal doses of arsenic can certainly be fatal if untreated. But the outcomes of arsenic poisoning are complex and depend on the chemical form, dosage, route, and duration of exposure as well as age, genetics, and general health of the victim. Prompt chelation treatment can be effective at reducing arsenic levels following acute poisoning and may prevent death in some cases. However, chronic low dose arsenic exposure still carries serious risks of debilitating neurological, cardiovascular, kidney, liver and cancer effects that may only arise years later even if the poisoning does not immediately cause death. While arsenic remains an insidious poison, being aware of potential sources of exposure, not delaying treatment if poisoning is suspected, and implementing preventive strategies can help ward off this toxic metalloid that has taken so many lives over the centuries.