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Potentially life-threatening emergency
Arsenic poisoning - Nail and Distal Digit
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Potentially life-threatening emergency

Arsenic poisoning - Nail and Distal Digit

See also in: Overview
Print Images (8)
Contributors: Bertrand Richert MD, Robert Baran MD
Other Resources UpToDate PubMed

Synopsis

Arsenic is a ubiquitous natural element and is the most common source of heavy metal poisoning in the world. It lacks odor, taste, and color and can result in both acute and chronic toxicity in humans accidentally, intentionally (suicide or crime), environmentally, or occupationally. Intoxication may result from ingestion or inhalation.

Environmental intoxication occurs mostly in rural settings. Pesticides, fungicides, and insecticides may contain arsenic (copper acetoarsenite, calcium, or lead arsenite). Surface soils and ground drinking water can contain high levels of arsenic. The use of plywood containing a chromium-copper-arsenate treatment could lead to intoxication. Occupational exposure is seen in workers in the mining, smelting, and glassmaking industries.

Transverse white bands across nails are called Mees' lines. They occur approximately 2–3 weeks after acute arsenic poisoning and are located above the lunulae. The Mees' lines form due to the deposition of arsenic in the nails. The presence of Mees' lines in chronic arsenic poisoning is less common.

Systemic signs and symptoms of acute poisoning (more likely accidental/intentional ingestion) include mucosal erosions, nausea, vomiting, abdominal pain, diarrhea, seizures, dermatitis (often exfoliative), edema of the face and eyelids associated with pruritus, hair loss, hyperpyrexia, jaundice, dark urine, acute renal failure, and coma. Death may occur. Signs and symptoms of chronic poisoning (more likely environmental / occupational ingestion) include nausea, vomiting, anorexia, weight loss, "raindrop" hypomelanosis, hyperkeratosis punctata (arsenical keratoses of the palms and soles), cutaneous neoplasms (basal cell carcinomas, Bowen's disease – often multiple and commonly in areas of the skin without sun exposure), sensory motor distal neuropathy, liver failure, renal failure, and encephalopathy.

The use of "exotic medicines" (Chinese herbal medicine, aphrodisiacs) is a risk factor for arsenic poisoning. Acute arsenic poisoning may occur over a period of days to weeks. Chronic arsenic poisoning may occur over a period of months to years. Arsenic poisoning is most common in adults. Accidental and environmental exposure occurs equally in both sexes; however, occupational exposure is more common in men.

Codes

ICD10CM:
T57.0X1A – Toxic effect of arsenic and its compounds, accidental (unintentional), initial encounter

SNOMEDCT:
81844008 – Arsenic poisoning

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 10/07/2019
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Potentially life-threatening emergency
Arsenic poisoning - Nail and Distal Digit
See also in: Overview
Print 8 Images
View all Images (8)
(with subscription)
Arsenic poisoning (Chronic) : Nausea/vomiting, Arsenic compound exposure, Hyperpigmented patch, Mees lines, Neuropathy peripheral, WBC decreased, RBC decreased
Clinical image of Arsenic poisoning
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