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ACUTE EXPOSURE INFORMATION

1. USES: Arsenic pentoxide is an inorganic pentavalent arsenic compound. It is an odorless, white crystalline amorphous solid which dissolves in water, forming arsenic acid. Arsenic pentoxide is used as an herbicide, wood preservative, metal adhesives, insecticides, fungicide, in dyeing and printing, and in the production of arsenates. Little is known about the effects of arsenic pentoxide. The following review is based on the toxic effects of arsenic and inorganic arsenic compounds, with effects attributed specifically to arsenic pentoxide noted. Please refer to "ARSENIC" document for more information.

2. TOXICOLOGY: Pentavalent arsenic may be transformed to arsenic or substitute for inorganic phosphate in glycolysis, leading to uncoupling of oxidative phosphorylation and loss of ATP formation. Chronically, arsenic may cause DNA damage, mutation in the p-53 suppressor gene, and inhibition of DNA repair mechanisms leading to cancer. Arsenic-containing metals are considered non-toxic due to their low solubility.

3. EPIDEMIOLOGY: Toxicity from arsenic is uncommon and major effects are rare.

4. WITH POISONING/EXPOSURE
   1. The following information is based on the toxic effects of arsenic and inorganic arsenic compounds.
   2. ACUTE OVERDOSE: Arsenic pentoxide is readily absorbed into the body via ingestion, inhalation, and through mucosal membranes, and minimally absorbed through intact skin. Acute arsenic ingestion generally produces signs and symptoms within 30 minutes but symptoms may be delayed for several hours if ingested with food. Many arsenic compounds are severe irritants of the skin, eye, and mucous membranes; some may be corrosive. Contact produces local hyperemia, followed by vesicular or pustular eruptions. Acute inhalation exposures have resulted in irritation of the upper respiratory tract.
   3. MILD TO MODERATE TOXICITY: Gastrointestinal symptoms occur rapidly after acute ingestion. Initial signs and symptoms include burning lips, throat constriction, cough, and dysphagia. Excruciating abdominal pain, severe nausea, vomiting, and profuse "rice water-like" diarrhea that may lead to hypovolemia follows these symptoms. In addition, hypovolemia from capillary leakage (third-spacing of fluids) is a common early effect. QTc prolongation may occur. Muscle cramps, facial edema, bronchitis, dyspnea, chest pain, dehydration, intense thirst, and fluid-electrolyte disturbances are also common following significant exposures. A garlic-like odor of the breath and feces may also develop. Subacute toxicity can produce neuropathies, both motor and sensory, and can progress to a Guillain-Barre like syndrome.
   4. SEVERE TOXICITY: Hypotension and tachycardia are common early signs of severe poisoning. Hypotension may be resistant to fluid resuscitation and multi-organ failure may ensue. Fever and tachypnea may occur. These patients can develop ventricular dysrhythmias including torsade de pointes. Encephalopathy, seizures and coma have been reported. Acute renal failure, hemolytic anemia, rhabdomyolysis, and hepatitis may occur several days after ingestion.
   5. CHRONIC TOXICITY: Inhalation is the most common route of exposure in arsenic workers. The sequence of chronic poisoning involves weakness, anorexia, hepatomegaly, jaundice, and gastrointestinal complaints, followed by conjunctivitis, irritation of the upper respiratory tract, hyperpigmentation, and eczematoid and allergic dermatitis. A hoarse voice and chronic upper respiratory septum is a common result after prolonged inhalation of white arsenic dust or fume. Peripheral nervous system symptoms may include numbness, burning, and tingling of the hands and feet; pain; paresthesias; tenderness; muscle fasciculations; gross tremors; ataxia; discoloration; and mental confusion. Muscular weakness, limb tenderness and difficulty walking may follow. The final phase consists of peripheral sensory neuropathy of the hands and feet. Associated motor neuropathy may occur as well. Certain arsenic compounds are known human carcinogens. Chronic exposure in either occupational settings or by drinking contaminated groundwater can cause poisoning and carries an increased risk of skin, lung, bladder, and possibly liver cancers.
      1. ARSENIC PENTOXIDE: Chronic exposure to arsenic pentoxide was considered to be at least partly responsible for a complex pattern of health effects in one family including: sensory hypesthesias, muscle cramping, recurring pruritic conjunctivitis, otitis media, sinusitis, bronchitis, pneumonia, skin rashes described as "measle-like," reddened and thickened skin on the soles, malaise, decreased sensation in hands and feet, headaches, blackouts, grand mal seizures in the youngest children, epistaxis, easy bruising, alopecia, and premature labor.

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