Arsenic Poisoning (cont.)

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How is arsenic poisoning treated?

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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. Hemodialysis can remove arsenic from the bloodstream, but only before it binds to the tissues so there is only a short time window for this treatment to work. Similarly, arsine binds to and causes rapid destruction of red blood cells, so blood transfusions and exchange transfusions may help the patient. In addition, if the arsenic was ingested, stomach or bowel irrigation may be attempted, but there is no good data to indicate these will be successful. Consultation with a nephrologists and a toxicologist as soon as possible is recommended; other consultants may need to be called (hematologist, psychiatrist, or others).

Chelation therapy (the use of drugs that selectively bind and effectively inactivate substances) is usually begun quickly through an intravenous line. The drug and the bound arsenic is then excreted through the urine. The chelation drug of choice is Dimercaprol (also termed BAL in oil); Succimer (DMSA) has also been used successfully, and Dimerval (DMPS) may also work as a chelator, but it is not readily available in the US.

What is the prognosis (outcome) of arsenic poisoning?

If the patient survives an acute toxic exposure, most will develop some degree of nerve damage to the peripheral nerves (sensory and motor disturbances); many survivors may have cardiac, liver, renal, and skin problems; the prognosis is fair to poor. Chronic poisoning and organic arsenic exposure have better outcomes with fewer and less severe problems.

What foods (rice), products (apple juice) , or liquids (water) is arsenic found in, where it is used, and what are safe limits?

People may be exposed through work in a metal foundry, mining, glass production, the semiconductor industry, in criminal attempts at murder by poisoning, suicide attempts, and as a biological warfare agent.

  • Arsenic has been found to contaminate such common items as wine, glues, and pigments.
  • Arsenic is commonly found in many foods both in its relatively nontoxic organic form, and also in the more toxic inorganic form. Consequently, such foods need to be tested for both inorganic and organic arsenic levels.
  • Such arsenic has been reported in milk and dairy products, beef, pork, poultry, and cereal.
  • Arsenic is also often found in rice, representing a potentially serious source of exposure in certain at-risk populations (especially children).
  • Many water sources in the world have high levels of arsenic in them, both due to normal arsenic leaching out of the ground and from human–caused mining and industrial waste.

Recent examples of concerns about arsenic have surfaced on its presence in apple juice. In most studies, various sources of apple juice tested by government and consumer labs have found that most (over 95% tested) contain a very small amount of arsenic (less than 10 parts per billion) and are safe to drink (in contrast to a TV show that raised alarms about consuming apple juice). However, the FDA qualified their findings by indicating in July 2013, new standards would apply and any juice that contained 10 or more parts per billion (the same level set for safe groundwater) would not be permitted to be sold in the US. This is lower than the previous approved level of less than 23 parts per billion approved in 2008. Nonetheless, other groups suggest that only juice containing less than 3 parts per billion be FDA approved while others advise that only 6 ounces of apple juice per day (about one juice box) be consumed by children because of its high sugar content.

Two other sources of arsenic, especially of some concern for children, is arsenic in groundwater and subsequently, in rice that is grown in such groundwater. Rice is a common food for children but to date, there are no regulations about the levels of arsenic that are considered safe for consumption. The FDA and the EPA are currently collecting data to make a recommendation about safe levels but many groups as pushing the FDA to act soon. The groups claim some private laboratories have detected that a single adult serving of some commercially available rice can give about 1.5 times the amount of permissible arsenic in one liter of water (under 10 parts per billion), so action on permissible arsenic levels should be done quickly. In 2013, the CDC recommends only about 2 cups of cooked rice per individual (adult) per week.

Groundwater around the relatively new method of producing oil and gas has been tested in some sites and found to have increased levels of arsenic. Although further studies are planned and needed, this could be yet a new way to contaminate water supplies. Again, several groups are urging timely FDA studies to investigate this potential problem.


American Cancer Society. Arsenic. Arsenic (Inorganic). Arsenic in your food. Questions & Answers: Arsenic in Rice and Rice Products. How Much Arsenic Is Safe In Apple Juice? FDA Proposes New Rule. Arsenic Toxicity in Emergency Medicine. Neurological Manifestations of Arsenic Intoxication Clinical Presentation. Arsenic.

Medically Reviewed by a Doctor on 10/17/2013

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Arsenic Poisoning - Symptoms Question: Describe the signs and symptoms of arsenic poisoning in a case with which you are familiar.
Arsenic Poisoning - Diagnosis Question: Discuss the events that led to a diagnosis of arsenic poisoning.
Arsenic Poisoning - Treatment Question: Do you know someone who was treated for arsenic poisoning? Please describe the experience.
Arsenic Poisoning - Foods Question: Do you drink apple juice or eat rice on a consistent basis? Are you concerned about the amount of arsenic in these products?