Levinsky, WJ; Smalley, RV; Hillyer, PN; Shindler, RL
HAPAB The arsine poisoning of three male workers is reported. The three male workers entered a chemical evaporating tank containing aqueous sodium arsenite to inspect and repair a malfunctioning paddle. The men used an aluminum ladder to descend to the bottom of the tank. The three men, aged 31, 31 and 41, were exposed to estimated 2, 3, and 15 min, respectively and within 30 min to 3 hr experienced headache, malaise, abdominal pains, coldness, weakness, nausea, vomiting and passage of dark urine. The men were hospitalized the following day. They displayed severe hemolysis, anuria or oliguria and a peculiar skin descoloration. The hemoglobin levels of the three men when admitted was 11.7, 7,8 and 5.9 g, respectively. Immediate supportive therapy included use of dimercaprol. Large quantities of plasma-free hemoglobin and most of the =ghost= cells which had been noted on initial blood smears were removed in the patients by two exchange transfusions within the first 24 hr of treatment. The two anuric patients underwent prompt peritoneal dialysis ( repeated as necessary during the anuric phase which lasted about 20 days ), while the oliguric individual underwent mannitol diuresis. Prolonged anemia necessitated repeated use of blood transfusions. The bone marrow was morphologically normal. The integrity of the erythrocyte sodium- potassium pump mechanism was lost by arsine alteration of the red cell membrane glutathione and resulted in hemoglobin leakage through the swollen membrane. Peripheral neuropathy was seen in the two most exposed patients. All three parients were transferred to the intensive care unit after 4 weeks and all suffered from emaciation, severe weakness and nocturia during their slow convalescene. Seven weeks after treatment, the patients were discharged. The blood urea nitrogen, serum creatinine and electrolyte values and urinalysis were in the normal range. Creatinine clearances continued to show abnormalities in all three cases and in one individual the value ( 65.5 ml/min ) was still abnormal 6 months later. Investigation of the accident revealed that the aliminum ladder, by the evolution of nascent hydrogen, had triggered this case of arsine poisoning. The immediate performance of blood exchange transfusions and the giving of repeated trsnsfusions saved the lives of thse men and is considered a vital step in the treatment of arsine poisoning. EPIDEMIOLOGY AND TREATMENT 70/08/00, 327 1970