623 Acute intoxication with arsine gas, a case report

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IntroductionArsine gas is an arsenic compound conjugated with the hydrogen ion generated from several chemical reactions. The arsine gas poisoning is infrequent and usually generated on unexpected reactions from industrial process. Once it`s absorbed into de body, inhibits many enzymatic systems lowing the intracellular glutathione concentration, this causes a oxidative stress damage and hematic, renal, mucosa and erythrocytes cellulary death. Clinically manifests itself with the triad of abdominal pain, oliguria and jaundice, secondary to massive intravascular haemolysis, renal acute injury, hepatic damage and central nervous system injury.MethodsWe presented a clinical curse of a patient part of a outbreak of workers exposed to an incidental formation of arsine gas while performance a cadmium extraction process after adding metallic zinc. After a few hours the patient suffered headache, epistaxis, fatigue, mucus dark diarrhoea, vomiting and red urine.ResultsThe patient evolved to hematuria with posterior oliguria, Generalised muscle weakness, dyspnoea and anasarca. Laboratory test showed urine blood test positive, with blood haemoglobin of 6.6 g/dL, and an haematocrit of 19.3%, Lactic dehydrogenase of 1469 U/L, blood creatinine: 14.7 mg/dL, total urinary arsenic on 10th day: 8.6 µg/L, with the diagnosis of: massive intravascular haemolysis with acute pre renal injury secondary to arsine gas poisoning. The treatment consisted in daily haemodialysis and blood transfusions until stabilisation of the concentration of red blood cells and complementary sustainability management. The patient where stabilised, however, the renal function where no fully recovered.ConclusionAlthough this pathology has a high mortality, the patient showed a favourable response to treatment, he was the only survivor of the three workers exposed directly to the gas arsine formation after adding zinc.

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