Arsine

CAS RN: 7784-42-1

Treatment Overview

0.4.2 ORAL EXPOSURE
  • A) Arsine is present as a gas at room temperature, so ingestion is unlikely.
0.4.3 INHALATION EXPOSURE
  • A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    • 1) Administer oxygen and intravenous fluids. Monitor for evidence of hemolysis.
  • B) MANAGEMENT OF SEVERE TOXICITY
    • 1) Administer intravenous fluids and, if needed, osmotic diuretics to maintain urine output and reduce the risk of acute renal failure. Type and cross for blood early and perform exchange transfusion in patients with significant hemolysis or developing renal insufficiency. Hemodialysis may be needed. Monitor for and treat hyperkalemia as necessary. Chelation is usually not warranted since the primary concern is hemolysis and not arsenic poisoning.
  • C) DECONTAMINATION
    • 1) PREHOSPITAL: Move patient from the toxic environment to fresh air; administer supplemental oxygen and observe patient clinically. First responders should use self-contained breathing apparatus (SCBA) to protect themselves from any arsine remaining in the environment.
  • D) AIRWAY MANAGEMENT
    • 1) Airway management is rarely necessary, but should be performed in patients with decreased mental status, hemodynamic instability, or severe respiratory distress.
  • E) ANTIDOTE
    • 1) There is no specific effective antidote.
  • F) HEMOLYSIS
    • 1) Provide vigorous intravenous hydration and, if needed, osmotic diuresis with mannitol to maintain urine output and reduce the risk of acute renal failure secondary to hemolysis. Case reports suggest that prompt exchange transfusion with whole blood is a key therapeutic intervention. It should be initiated for plasma or serum hemoglobin levels greater than 1.5 g/dL and/or signs of renal insufficiency or early acute tubular necrosis. Because of the time delay needed to obtain matched blood, the possible need for exchange transfusion in significantly exposed patients should be anticipated soon after they present.
  • G) HYPERKALEMIA
    • 1) Treat as for hyperkalemia of any other etiology. Administer oral kayexalate, intravenous dextrose and insulin, sodium bicarbonate, inhaled beta agonists, or intravenous calcium chloride or calcium gluconate depending on the severity. Hemodialysis may be necessary in severe cases.
  • H) RENAL FAILURE
    • 1) Hemodialysis may be needed to treat progressive renal failure, but is not a substitute for exchange transfusion, which, unlike hemodialysis, removes arsenic-hemoprotein complexes thought to contribute to the ongoing hemolytic state.
  • I) ENHANCED ELIMINATION
    • 1) Prompt exchange transfusion with whole blood is useful in patients with evidence of significant active hemolysis or evolving renal insufficiency. It removes arsenic heme-protein complexes and corrects anemia. Donor blood may be infused through a central line at the same rate of blood removal through a peripheral vein, or techniques using modified hemodialysis circuits can be considered.
  • J) PATIENT DISPOSITION
    • 1) HOME CRITERIA: There is no data to support home management of arsine exposure.
    • 2) OBSERVATION CRITERIA: All patients with potential arsine exposure should be referred to a healthcare facility for evaluation and treatment, and observed for a minimum of 6 hours.
    • 3) ADMISSION CRITERIA: Any patient with evidence of hemolysis should be admitted to an intensive care setting.
    • 4) CONSULT CRITERIA: Consultation with a medical toxicologist and/ or poison center is recommended for any patient with arsine exposure. Contact the blood bank and hematologist regarding exchange transfusion. Consult a nephrologist for hemodialysis in patients with acute renal failure. Follow local emergency management plan and protocols if intentional release of arsine is suspected.
  • K) PITFALLS
    • 1) Primary focus is the treatment of hemolysis and prevention of renal failure, not chelation of arsenic. Evidence of hemolysis may be delayed after moderate exposure.
  • L) TOXICOKINETICS
    • 1) A serious arsine exposure may produce symptoms within 30 to 60 minutes, but may be delayed for hours. Initially, the patient may look and feel relatively well.
  • M) PREDISPOSING CONDITIONS
    • 1) Patients with underlying renal insufficiency, or chronic respiratory or cardiovascular disease may develop more severe toxicity secondary to hemolysis.
  • N) DIFFERENTIAL DIAGNOSIS
    • 1) Methemoglobinemia, naphthalene toxicity, other causes of hemolysis or respiratory symptoms, phosphine toxicity, rhabdomyolysis, smoke inhalation, thallium toxicity, arsenic toxicity, hemolytic uremic syndrome, leptospirosis, cold agglutinin disease, paroxysmal nocturnal hemoglobinuria, stibine gas toxicity
0.4.4 EYE EXPOSURE
  • A) Eye should be flushed with copious amounts of water.
Find more information on this substance at: PubChem, PubMed