succimer and Drug-Overdose

Topics: Adolescent; Antidotes; Arsenic; Arsenic Poisoning; Arsenicals; Child, Preschool; Digitaria; Drug Overdose; Female; Gastric Lavage; Herbicides; Humans; Male; Succimer; Suicide, Attempted; Treatment Outcome

Arsenic is a traditional poison that has a history extending back into ancient times, as a medicinal agent, a homicidal poison and more recently in deliberate and unintentional self-poisoning. We report two cases of acute poisoning with an unwettable formulation of arsenic trioxide. Both patients had early gastrointestinal toxicity and were treated with early whole bowel irrigation (WBI). Chelation therapy with dimercaptosuccinic acid (dimercaptosuccinate, DMSA) was commenced within 24 hours and serial blood and urine arsenic concentrations were measured. Neither patient suffered any adverse outcome in spite of very high blood and urine concentrations of arsenic. Arsenic quantification in blood, urine and faeces suggested that enhanced gastrointestinal decontamination was minimally effective for decontamination and that DMSA for at least two weeks was required.

Topics: Acute Disease; Adult; Antidotes; Arsenic Poisoning; Arsenic Trioxide; Arsenicals; Drug Overdose; Feces; Humans; Male; Oxides; Powders; Succimer; Suicide, Attempted; Time Factors

Topics: Adult; Animals; Arsenic Poisoning; Arsenic Trioxide; Arsenicals; Chelating Agents; Drug Overdose; Humans; Male; Mice; Oxides; Rats; Succimer; Suicide, Attempted

Alkane arsenate herbicides are available commercially, and their acute toxicity has been well documented in previous studies. Animal studies have indicated that dimercaptosuccinic acid (DMSA) can be used as an oral chelating agent. A 20-y-old white male cocaine addict attempted suicide by drinking approximately 500 ml of a 16% monosodium methanearsenate solution. He vomited 10 or more times and was admitted to the intensive care unit with impending shock and early liver and renal involvement. Four 5-day courses of 30 mg DMSA/kg/24 h were given. This brought the serum arsenic level from 2,871 micrograms/L to 6 micrograms/L, and his urine arsenic level from 78,920 micrograms/L to 21 micrograms/L in 30 d. Renal function tests returned to normal, with normal renal creatinine clearance, normal blood urea nitrogen and serum creatinine. However liver functions were abnormal, with elevation of serum transaminases, which later proved secondary to chronic hepatitis. No side effects of DMSA was encountered during the therapy. DMSA was successfully used to detoxify acute organoarsenate poisoning in a clinical setting, supporting experimental reports in the literature.

Topics: Administration, Oral; Adult; Arsenic; Arsenic Poisoning; Arsenicals; Blood Cell Count; Blood Chemical Analysis; Blood Gas Analysis; Chelating Agents; Cocaine; Drug Overdose; Herbicides; Humans; Kidney; Liver; Liver Function Tests; Male; Substance-Related Disorders; Succimer; Suicide, Attempted; Urine