Discuss the events that led to a diagnosis of arsenic poisoning.
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How is arsenic poisoning diagnosed?
The history of the patient is very important as exposures are most often from
industrial accidents so other people (coworkers, rescue personnel) may be
exposed and not realize they may have some risk also. People exposed to toxic
levels of arsenic may have breath and urine that smells like garlic as a clue to
their diagnosis. Most doctors that suspect arsenic (or other metal or metalloid
poisonings) will request lab studies such as
blood cell counts and
serum electrolytes such as calcium and magnesium; if there is evidence of hemolysis
(blood cell destruction), a type and screening for a potential blood transfusion
There are rapid urine "spot" tests available to diagnose elevated
levels of arsenic, but they usually don't distinguish between organic and
inorganic arsenic. The patient's blood and urine will be sent for analysis for
arsenic; a result of > 50 micrograms/L is considered elevated, but acute toxic
exposures may result in levels 5 to 100 times or more than those which are
considered "elevated." A speciation test (determines levels of inorganic versus
organic arsenic) is required in all cases in which total urine arsenic is
elevated since inorganic arsenic is so toxic.
Electrocardiograms (ECG, EKG) and
nerve conduction tests
are often done in any type of suspected arsenic exposure. Tests for other toxins
or toxic overdoses (for example, Tylenol ingestion) may also be done.