Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
Clinical Ecotoxicology (Diagnostic & Research) Facility, All India Institute of Medical Sciences, New Delhi, India.
Drug Discov Ther. 2022;16(1):49-51. doi: 10.5582/ddt.2021.01110.
Arsenic has widespread use in agriculture, in alternative medicine and in treatment of certain malignancies, therefore it is vital to timely recognize and treat arsenic toxicity in a suspected patient. Hemodialysis conventionally is thought to play only a supportive role in managing arsenic toxicity but it can be life-saving when chelation is not possible or available. A middle-aged female with a history of non-dialysis-dependent chronic kidney disease (CKD) was brought to the emergency with altered sensorium. On presentation, she was hemodynamically stable with pallor and exfoliating lesions on palms, hyperkeratotic lesions on soles and hyperpigmented macules on the trunk. Investigations revealed pancytopenia and deranged kidney function tests. In view of skin lesions, the toxicological analysis was sent which revealed high levels of Arsenic (594 and 2,553 mcg/L in blood and urine respectively). Thus, a diagnosis of metabolic encephalopathy with the underlying cause being uremic or/and arsenic intoxication was made. Considering renal failure, she was managed with thrice-weekly hemodialysis. Chelation was not possible due to unavailability of agents during lockdown in Coronavirus disease (COVID-19) pandemic. Following dialysis, there was a significant improvement in sensorium, skin lesions, and pancytopenia depicting the utility of hemodialysis in such cases. Thus, hemodialysis is an effective and perhaps underutilized modality in the treatment of arsenic intoxication with impaired renal function.
砷在农业、替代医学和某些恶性肿瘤的治疗中被广泛应用，因此及时识别和治疗疑似患者的砷中毒至关重要。传统上认为血液透析在管理砷中毒中仅起支持作用，但在无法或无法进行螯合时，它可以挽救生命。一名中年女性患有非透析依赖性慢性肾脏病（CKD），因意识改变被送往急诊。就诊时，她血流动力学稳定，手掌有苍白和脱皮病变，足底有角化过度病变，躯干有色素沉着斑。检查显示全血细胞减少和肾功能检查异常。鉴于皮肤病变，进行了毒理学分析，结果显示砷含量很高（血液和尿液中的砷含量分别为 594 和 2553 mcg/L）。因此，诊断为代谢性脑病，其根本原因是尿毒症和/或砷中毒。考虑到肾功能衰竭，她接受了每周三次的血液透析治疗。由于在冠状病毒病（COVID-19）大流行期间无法获得药物，因此无法进行螯合。透析后，意识、皮肤病变和全血细胞减少均有显著改善，表明血液透析在这种情况下有效。因此，血液透析是治疗肾功能受损的砷中毒的一种有效且可能未充分利用的方法。
