Saturday, 11 September 2010

MRCP revision battle 8.2: Arsenic poisoning

Arsenic poisoning used to be both a favourite method of murder (allegedly involved in the demise of Napoleon) and a substance commonly found in paint and water pipes.  It is now thankfully carefully controlled so it tends to be found mainly in MRCP exam questions...

Arsenic is still used in the glass, smelter and microelectronic industries, and is found in wood preservatives.

Acute poisoning tends to cause features in 30 mins to 2 hours.

Features of acute arsenic poisoning include:
  • severe gastroenteritis
  • garlic ordour
  • hypersalivation
Treatment for acute poisoning is DMPS.

Symptoms of chronic arsenic poisoning present at different times post-exposure; for example, skin symptoms tend to show clinically around 10 years afterwards.  There are multiple, multiple possible complications of chronic arsenic poisoning but a few which may pop up are:
  • keratoses
  • Mees lines (if you don't know what these are you'll find out in the next battle!)
  • hyperpigmentation
  • neuropathy
  • muscle fasciculation and wasting

So on to explore Mees lines...