Arsenic, Elemental

CAS RN:7440-38-2

Laboratory

A) Testing must be correlated with the time of exposure and care must be taken to eliminate possible confounding factors such as food-derived arsenic (fish) or accumulated arsenic in those with chronic renal failure.
B) Diagnosis is based on elevated urinary arsenic levels. A spot urine may be done as a screen prior to chelation but arsenic excretion is intermittent, therefore a 24-hour urine arsenic collection is necessary for definitive diagnosis. A 24-hour urinary arsenic collection exceeding 100 mcg is usually abnormal, even after chelation.
C) Monitor CBC, serum electrolytes, liver enzymes, renal function tests, and a blood arsenic concentration in symptomatic patients.
D) Serial ECGs should be obtained to follow the QTc interval and continuous cardiac monitoring should be instituted in symptomatic patients.
E) Most arsenic compounds are radio-opaque, therefore abdominal X-rays may confirm acute ingestions and guide decontamination.
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