Citation

Horn J, Eicher H, Muhlberg W, Platt D. Intensivmedizin und Notfallmedizin 2002; 39(3): 246-253.

Copyright

(Copyright © 2002)

DOI

10.1007/s003900200034

PMID

unavailable

Abstract

We report about a 21-year old man, who tried to commit suicide by swallowing 600 mg arsenic trioxide in the crystal form. Although this amount of poison was swallowed, after 7 hours with no therapy the only symptoms were gastrointestinal (i.e., diarrhea, intestinal colic, vomiting), as well as a small ulcer in the stomach. Because of rapid and high volume intravenous infusion we avoided hypovolemic shock. Thanks to high dosage chelation therapy with DMPS (dimercaptopropane sulfonate), which today is the best known antidote for metal poisoning in Europe, we were able to very quickly and thoroughly eliminate the arsenic by renal clearance (Fig. 2, Tab. 1). After testing the arsenic urinary concentration over a period of more than 8 days, we estimate that the total amount of poison swallowed was more likely to be 1000 mg or over. This is five times over the lethal dosage for one human being. There is no doubt that because of the high dosage of medication given (15.25 g DMPS over 12 days), along with the enormous amounts of fluids (27.5 1 in 5 days, an average of 5.5 liters/day), severe complications were avoided. The huge amounts of intravenous infusions were given for volume substitution and "forced diuresis". It is important to note here that there was no cardiovascular, respiratory, renal, neurological, hematological or muscular damage observed. Perhaps because of slight liver toxicity either for arsenic trioxide or for DMPS, we found a small increase in the transaminases GOT and GPT. This was however completely reversible. The antidote therapy, intravenous at the beginning and then followed orally, was tolerated very well by the patient. There were no severe side effects. After increasing daily nutrition and discussing the patient's welfare and stability with the psychologist, we released him after 12 days into the care of his parents. The report clearly shows the great importance and effectiveness of high dosage chelation therapy with DMPS, in comparison to other chelation therapies (BAL=dimercaprol, DMSA, D-penicillamine), and other secondary elimination treatments such as hemodialysis or continous veno-venous hemofiltration (CVVHF), which are discussed as alternatives in the paper.

Language: de

Keywords

adult; alanine aminotransferase; arsenic poisoning; arsenic trioxide; Arsenic trioxide poisoning; Arsenic urinary concentration; article; aspartate aminotransferase; case report; chelation therapy; Chelation therapy; colic; diarrhea; dimercaprol; Dimercaptopropanesulfonate; disease course; diuresis; drug induced disease; fluid therapy; gastrointestinal symptom; hemodialysis; hemofiltration; human; hypovolemic shock; kidney clearance; liver toxicity; male; penicillamine; stomach ulcer; succimer; Suicide attempt; symptomatology; unithiol; vomiting