Toxicology

Q: 52 year old mining worker is admitted to ICU with episodes of torsades de pointes after an exposure to large amount of fumes. Patient c/o abdominal cramps, watery diarrhea and a garlic odor of the breath and stool. Toxicity of which element should be suspected? 


Answer: Arsenic

Acute arsenic poisoning has some distinct characteristics like abdominal symptoms but with severe watery diarrhea, a garlic odor of the breath and stool, QTc prolongation with or without torsades de pointes, acute respiratory distress syndrome, acute encephalopathy with or without seizures, proteinuria, hematuria, and acute tubular necrosis. This list continues and involves almost every body system.

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References:

1. Mundy SW. Arsenic. In: Goldfrank's Toxicologic Emergencies, 10th ed, Hoffman RS, Lewin NA, Howland MA, et al (Eds), Mcgraw-Hill Education, New York 2015. p.1169. 

2.  Agency for Toxic Substances and Disease Registry. Toxicological Profile for Arsenic. U.S. Department of Health & Human Services, Public Health Service 2007. Available at: www.atsdr.cdc.gov/toxprofiles/tp.asp?id=22&tid=3 (Accessed on July 25, 2019).

3. Chhuttani P, Chopra J. Arsenic Poisoning. In: Handbook of Clinical Neurology: Intoxication of the Nervous System, part I, Vinken P, Bruyn G (Eds), North Holland, Amsterdam 1979. Vol 36, p.199.