Ratnaike R N
Queen Elizabeth Hospital, Woodville, South Australia.
Postgrad Med J. 2003 Jul;79(933):391-6. doi: 10.1136/pmj.79.933.391.
Arsenic toxicity is a global health problem affecting many millions of people. Contamination is caused by arsenic from natural geological sources leaching into aquifers, contaminating drinking water and may also occur from mining and other industrial processes. Arsenic is present as a contaminant in many traditional remedies. Arsenic trioxide is now used to treat acute promyelocytic leukaemia. Absorption occurs predominantly from ingestion from the small intestine, though minimal absorption occurs from skin contact and inhalation. Arsenic exerts its toxicity by inactivating up to 200 enzymes, especially those involved in cellular energy pathways and DNA synthesis and repair. Acute arsenic poisoning is associated initially with nausea, vomiting, abdominal pain, and severe diarrhoea. Encephalopathy and peripheral neuropathy are reported. Chronic arsenic toxicity results in multisystem disease. Arsenic is a well documented human carcinogen affecting numerous organs. There are no evidence based treatment regimens to treat chronic arsenic poisoning but antioxidants have been advocated, though benefit is not proven. The focus of management is to reduce arsenic ingestion from drinking water and there is increasing emphasis on using alternative supplies of water.
砷中毒是一个影响数百万人的全球健康问题。污染是由天然地质来源的砷渗入含水层、污染饮用水所致，也可能源于采矿和其他工业过程。砷在许多传统药物中作为污染物存在。三氧化二砷目前用于治疗急性早幼粒细胞白血病。吸收主要通过小肠摄入发生，不过皮肤接触和吸入也会有少量吸收。砷通过使多达200种酶失活发挥其毒性作用，尤其是那些参与细胞能量途径以及DNA合成与修复的酶。急性砷中毒最初伴有恶心、呕吐、腹痛和严重腹泻。还会出现脑病和周围神经病变的报告。慢性砷中毒会导致多系统疾病。砷是一种有充分文献记载的人类致癌物，会影响多个器官。目前尚无基于证据的治疗慢性砷中毒的方案，但有人主张使用抗氧化剂，不过其益处尚未得到证实。管理的重点是减少饮用水中的砷摄入量，并且越来越强调使用替代水源。
