Arsine is the gaseous and the most toxic form of the element, arsenic.
It is a nonirritating gas with a mild odor (odorless at low doses) that
is used in the semiconductor and metals refining industries. Stibine
is a toxic gas that has effects similar to those of arsine, but stibine
is not encountered as frequently as arsine. The most likely route of
exposure to arsine and stibine is inhalation.
Arsine toxicity is different from arsenic toxicity. Arsine causes massive
hemolysis and results in anemia, jaundice, and hemoglobinuric renal failure.
The intensity and length of arsine exposure, and the premorbid condition
of the person exposed, will contribute to the time of onset and the severity
of illness. For example, exposure of a person with underlying coronary
artery disease is likely to result in greater morbidity than exposure
of a healthy person at the same dose.
The following is a more comprehensive list of signs and symptoms that
may be encountered in a person exposed to arsine. Symptoms are not listed
in order of presentation or specificity. Also, partial presentations
(an absence of some of the following signs/symptoms) do not necessarily
imply less severe disease.
- General
- Weakness
- Malaise
- Fatigue
- Fever
- Gastrointestinal signs and symptoms
- Nausea
- Vomiting
- Abdominal
pain
- Liver
injury
- Central
nervous system signs and symptoms
- Headache
- Lethargy
- Convulsions
- Coma
- Peripheral
neuropathy (1–3 weeks after acute exposure)
- Neuropsychological
symptoms (several days after exposure): memory loss, restlessness,
confusion
- Cardiovascular
signs
- Tachycardia
- Hypotension
- ECG changes (repolarization, S-T segment, and T-wave changes)
- Respiratory
signs and symptoms
- Tachypnea
- Dyspnea
- Pulmonary edema
- Genitourinary
signs
- Hemoglobinuria
- Oligouria
- Renal failure
- Laboratory
findings
- Anemia
- Elevated
bilirubin (indirect)
- Hyperkalemia
- Damaged
red blood cells (basophilic stippling, anisocytosis, Heinz-Ehrlich
bodies)
- Low
haptoglobin
- Elevated
plasma-free hemoglobin levels
- Elevated
urinary hemoglobin
- Elevated
BUN and creatinine
- Abnormal
liver function tests
- Thrombocytopenia
- Elevated
blood or spot urine arsenic level
Note: The actual clinical manifestations of arsine exposure may be more
variable than the syndrome described above.
Differential
diagnosis
- Colchicine
- Copper
sulfate
- Envenomations
(snake or spider)
- Dinitrophenols
- Lead
- Naphthalene
- Phosphine
- Thallium
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