Substance
Arsenic and arsenic salts

Pathology
Disruption of enzymatic reactions that are essential for cellular metabolism; possible phosphate replacement or interaction with sulfhydryl groups.

Symptoms
Nausea, vomiting, hemorrhagic gastritis, severe watery diarrhea, dehydration, pulmonary edema, hypotension, delirium, encephalopathy, arrhythmias, convulsions, shock, death. Symptoms may have delayed onset.

Emergency Measures
Aggressive fluid replacement, activated charcoal or gastric lavage for larger ingestions, dimercaprol (BAL) 3–5 mg/kg IM every 4–6 hr for symptomatic patients.

Comments
Toxicity depends on the type of arsenic, amount involved, and route of exposure. Systemic toxicity can result from percutaneous absorption. Arsenic is a carcinogen.