In animal models, the efficacy of chelation therapy generally declines as the time elapsed since exposure increases.Īll known chelating agents have adverse side effects and should be used with caution.
These are more water soluble than BAL, and can be administered orally with lower toxicity. The currently recommended treatment is 2-3-dimercapto-1-propanesulfonate (DMPS) or meso 2, 3-dimer-captosuccinic acid (DMSA). Hemodialysis may be beneficial in a patient with concomitant renal failure.Ĭhelating agents administered within hours of arsenic absorption may successfully prevent the full effects of arsenic toxicity.ĭimercaprol (2, 3 dimercaptopropanol, also known as British anti Lewisite or BAL), was previously the most frequently recommended chelating agent for arsenic.If profuse diarrhea is present, cathartics should be withheld.The efficacy of activated charcoal is controversial, but its administration together with a cathartic (such as sorbitol) is frequently recommended.Gastric lavage may be useful soon after an acute ingestion to prevent further absorption.Aggressive intravenous fluid replacement therapy may be life–saving in severe poisoning.
Patients with suspected acute arsenic poisoning generally require rapid stabilization with fluid and electrolyte replacement in an intensive care setting. Gut decontamination and hemodynamic stabilization are key factors in the initial management of acute arsenic intoxication.
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