Arsenic

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Arsenic

Prepared By Dr.Anees AlSaadi

Community Medicine Resident. Nov. 2012

Poisoning

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Napoléon Bonaparte.15 August 1769 – 5 May 1821

Jane Austen16 December 1775 – 18 July 1817

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Simón José Antonio de la Santísima Trinidad Bolívar y Palacios Ponte y Blanco(24 July 1783 – 17 December 1830)

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KING OF POISONS AND

POISON OF KINGS

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OBJECTIVES • What Is Arsenic …? The Chemical And Physical

Properties.

• Where It Is Found ….?

• Burden of Arsenic Poisoning.

• Effect On The Health.

• Limits And Standards.

• Control And Prevention.

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What Is ARSENIC …?

Arsenic (Metal)

Inorganic

Arsenic

Toxic

Environmental

Arsenate & Arsenite

Organic Arsenic

Non Toxic.

Sea Food

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ARSENIC• Arsenic is typically

considered a heavy metal.

• Ubiquitous in the environment .

• ③allotropic forms:– Alpha or yellow.– Beta or black.– Gamma or grey.

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Where It Is Found ….?

• Natural Activities.

• Soil, Air, Water, Food.

• Human Activities.

20th

14th

12th

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Where It Is Found ….?

Fruit sprays Sheep-dips

Weed-killers

Rat poisons

Fly papers

Calico printing

TaxidermyPreserving timber against white ants

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Where It Is Found ….?

Ground Water.

Antifungal wood Preservatives.

Cigarettes Smoking.

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Burden of Arsenic Poisoning.

• United States– (AAPCC) & (NPDS) in 2010:• 927 human exposures.

• The majority of the pesticide exposures occurred in children younger than 5 years (43 [65%] of 67).

Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Dart RC. 2010 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th Annual Report. Clin Toxicol (Phila). Dec 2011;49(10):910-41.

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Burden of Arsenic Poisoning.

• International–100 million people are at risk.

– In Bangladesh 95% of the water supply is arsenic contaminated.

Ng JC, Moore MR. Arsenic in drinking water: a natural killer in Bangladesh and beyond. An urgent alternative watershed management strategy is needed. Med J Aust. Dec 5-19 2005;183(11-12):562-3.

13http://www.who.int/ipcs/assessment/public_health/arsenic/en/index.html

Nepal

Bhutan

BangladeshBurma

Thailand

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Burden of Arsenic Poisoning.

• Mortality/Morbidity– (AAPCC) & (NPDS), 6 individuals suffered major

effects and 3 died from exposure to nonpesticide arsenic exposure in 2011.

Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Dart RC. 2010 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th Annual Report. Clin Toxicol (Phila). Dec 2011;49(10):910-41.

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Burden of Arsenic Poisoning.

• WHO estimated that arsenic contaminated drinking water in Bangladesh alone was attributed 9,100 deaths and 125000 (DALYs) in 2001.

WHO. Arsenic. Geneva , world health organization press; 2010: available from: http://www.who.int/ipcs/assessment/public_health/arsenic/en/index.html

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Risk Factors

• Sex.

• Age– Pesticides V.S Nonpesticide Arsenic Exposure.

• Occupation.

• Nutritional Deficiencies.

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Effect On Health.

History :• Killing: Suicidal, Homicidal,

Malicious …ect. • Occupational History.

History :• Dietary, Nutritional Habits,

Alcohol. • Ayurvedic Medicine

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Effect On Health.

Acute:

Shock like Picture.

Acute:

Cholera- like GE.

Acute:

Garlic smell.

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CHRONIC• Classical Dermatitis.– Hyperkeratosis.– Dew drops on a dusty road.

• Mees lines on fingernails.

• Acute Hemolytic Anemia.

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CHRONIC • Peripheral neuropathy.

• Cardiac arrhythmias:– Prolonged QT and VF.

• Hepatic and Renal Damage.

• Black foot disease.

• Cancers.

• Pregnancy.

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Limits And Standards.

10 μg/ L

10 μg/m3

http://www.who.int/ipcs/assessment/public_health/arsenic/en/index.html

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Limits And Standards.

5μg/m3

http://www.who.int/ipcs/assessment/public_health/arsenic/en/index.html

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Limits And Standards.

3.0 μg/kg

http://www.who.int/ipcs/assessment/public_health/arsenic/en/index.html

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Limits And Standards.WHO

WHO

Tolerable intake level

3.0 μg/kg body weight

per day

Drinking Water 10 μg/ L

Air Can not be Established

EPA & OSHA

OSHA

Water 10 μg/L

Air ( PEL) 10 μg/m3

Action level 5μg/m3

http://www.who.int/ipcs/assessment/public_health/arsenic/en/index.html

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10024

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Action Level (5 µg/m3) at least 30 days/year:

Medical Examination. Protective Clothing And EquipmentHygiene Facilities And PracticesSigns And LabelsObservation Of Monitoring Access To RecordsTraining And Notification

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10024

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Control And Prevention. Emergency

• Pond –sand filter.

• Dug wells.

• Deep hand tube wells.

• Rainwater harvesting.

http://www.who.int/water_sanitation_health/dwq/wsh0306/en/index3.html

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Control And PreventionLong term

• Drinking water arsenic concentration below 10μg/L.– Rain water collection.– Regular testing of water.– Installing arsenic removal system.

• Occupational exposure to low level.

• Public awareness and education.

• Monitor high risk population for early signs. http://www.who.int/water_sanitation_health/dwq/wsh0306/en/index3.html

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• The Major Source Of Arsenic Is:–Ground Water.–Cigarettes Smoking.–Pesticides. –Volcanic eruptions.

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• The Major Source Of Arsenic Is:–Ground Water.–Cigarettes Smoking.–Pesticides. –Volcanic eruptions.

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• The following is the most common human health effect of Arsenic:

–Hepatocellular Carcinoma. –Skin Squamous Cell Carcinoma.– Skin Melanoses and Keratosis.–Black foot Disease.

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• The following is the most common human health effect of Arsenic:

–Hepatocellular Carcinoma. –Skin Squamous Cell Carcinoma.– Skin Melanoses and Keratosis.–Black foot Disease.

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Summary• Inorganic Arsenic is the toxic form.

• Underground Drinking water is the major source.

• Acute and Chronic health Effect mainly on the skin, respiratory and CNS.

• Known Carcinogenic.

• 10μg/L level in drinking water.

• Prevention and Control.

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