• Sources of exposure: metal smelting, pesticides, herbicides
• Pathophysiology
  • Has direct toxic effects on endothelial cells
  • Induces oxidative stress, and disrupts ATP production
• Clinical features
  • Acute toxicity
    • Nausea and vomiting
    • Abdominal pain, diarrhea
    • Tachycardia, QT prolongation
    • Garlic-like odor on the breath
    • CNS (coma, seizures)
  • Chronic toxicity
    • Carcinogenic
    • Arsenical keratosis: hyperkeratosis (especially on the soles and palms) → risk of developing squamous cell carcinoma)
    • White bands across the nails (Mees lines)
• Treatment
  • Consider gastric lavage, activated carbon in acute toxicity
  • Dimercaprol, succimer (in children)
    • Chelating agents used to treat metal toxicity