Chronic Arsenic Poisoning

The most common early signs of chronic arsenic poisoning are muscle weakness and aching, skin pigmentation (especially of the neck, eyelids, nipples, and axillae), hyperkeratosis, and edema. GI involvement is less prominent in long-term exposures. Other signs and symptoms that should arouse suspicion of arsenic poisoning include garlic odor of the breath and perspiration, excessive salivation and sweating, stomatitis, generalized itching, sore throat, coryza, lacrimation, numbness, burning or tingling of the extremities, dermatitis, vitiligo, and alopecia. Poisoning may begin insidiously with symptoms of weakness, languor, anorexia, occasional nausea and vomiting, and diarrhea or constipation. Subsequent symptoms may simulate acute coryza. Dermatitis and keratosis of the palms and soles are common features. Mee's lines are found characteristically in the fingernails (white transverse lines of deposited arsenic that usually appear 6 weeks after exposure). Desquamation and scaling of the skin may initiate an exfoliative process involving many epithelial structures of the body. The liver may enlarge, and obstruction of the bile ducts may result in jaundice. Eventually, cirrhosis may occur from the hepatotoxic action. Renal dysfunction also may be encountered. As intoxication advances, encephalopathy may develop. Peripheral neuritis results in motor and sensory paralysis of the extremities; in contrast to lead palsy, the legs usually are more severely affected than the arms. The bone marrow is seriously damaged by arsenic, and all hematological elements may be affected with severe exposure.

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