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1597393 
Journal Article 
Abstract 
Case report: Poisoning with elemental (metallic) arsenic 
Pfab, R; Eyer, F; Stich, R; Romanek, K; Stenzel, J; Roider, G; Einwaechter, H 
2013 
1 
Clinical Toxicology
ISSN: 1556-3650
EISSN: 1556-9519 
51 
4 
358 
English 
WOS:000317938600248 
Background: From literature nothing is known about the acute effects after ingestion of elemental arsenic, As(0). With its virtual insolubility in non oxidizing aqueous media one should expect only minor adverse effects after a single ingestion.

Case report: A 56 y male chemistry teacher ingested > 5 g elemental As(0) deliberately at h0. Twelve hours later, (h12) he went to a hospital reporting diarrhoea and respiratory distress. Anticipating a severe intoxication with As2O3 he was intubated, mechanically ventilated and transferred to our hospital. At h14 he received DMPS iv, 500 mg bolus, 83 mg/h continuously. Abdominal computed tomography (CT) scan revealed densities throughout the GI-tract, predominantly in the stomach and duodenum. Gastroscopic lavage with 4 litres of water retrieved 2.2 g metallic-black grains of As(0). At h205 a further 3 g As(0) were recovered by colonoscopic lavage. Serum-creatinine at h12 was 3.3 mg/dL and normalized after fluid replacement. No toxic organ failure was seen. However, extubation at h106 failed due to extreme agitation with delirium requiring deep sedation and re-intubation. A ventilator-associated pneumonia necessitated further mechanical ventilation. After extubation at h205 the patient was still delirious and complained about pain throughout the body without objective findings. The patient recovered within one further week and was transferred to psychiatry without any sequelae of the intoxication at h516.

Results: Arsenic concentration in blood [AsB] at h12 was 454 μg/L, at h14: 420 μg/L. With gastroscopic lavage (h16) [AsB] rose to 550 μg/L. From h18-h41 [AsB] declined to 76 μg/L with a half-life of 9.3 h. From h65 to h270 [AsB] fell to 3.6 μg/L with half-life 73 h. Arsenic concentration in urine [AsU] at h12 was 16 mg/L, with DMPS at h29 45 mg/L. [AsU] was 0.9 mg/L when DMPS was stopped at h132. Readministration of DMPS did not increase As-elimination: at h206: [AsU] was 0.2 mg/L. Total arsenic excretion in urine was ≥ 113 mg.

Conclusion: Ingestion of elemental, metallic arsenic(0) causes an intoxication less severe than would be expected with the same amount of As2O3. DMPS enhances As elimination in the first few days without further increase after 5 days. 
XXXIII International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 
Copenhagen, Denmark 
May 28-31, 2013