Industries with potential exposure to arsine gas:
(1) metal smelting or extractions
(2) metal treatment (galvanizing, etching)
(3) lead plating
(4) electronics (transistors, semiconductors)
(5) production or transport of arsine gas cylinders
The worker will have a history of a brief exposure to arsine gas or having access to arsine gas cylinders. Typically the protective measures taken are absent or inadequate. The person may notice a smell of garlic. The gas is denser than air and will accumulate in tanks.
Presentation:
(1) acute death (sudden death or death within a few hours of exposure)
(2) delayed
Features of delayed presentation:
(1) latent period of 2-24 hours
(2) hemolytic anemia with free plasma hemoglobin
(3) abdominal pain and tenderness, gastrointestinal upset, cramps
(4) nausea and sometimes vomiting
(5) painless hemoglobinuria progressing to renal failure
(6) leukocytosis
(7) persistently high blood and urine arsenic levels
(8) delayed onset (months to years) of neuropsychiatric abnormalities and polyneuropathy
Findings on urinalysis:
(1) hemoglobin positive, with > 3.5 grams per liter indicating a severe hemolytic episode
(2) no red cells or red cell debris
Prompt diuresis with maintenance of hydration can help eliminate arsenic and preserve renal function. Administration of BAL (dimercaprol) appears to have only minor benefit.
Indications for exchange transfusion:
(1) plasma hemoglobin > 1.5 g/dL
(2) significant rise in serum creatinine indicating impending renal failure
