Arsenic is a naturally occurring element with exposures in various work
settings. Arsenic exposure can occur environmentally, particularly through drinking
contaminated water and ingestion of some foods. The most toxic forms are inorganic
arsenic, iAs (trivalent, pentavalent), and its metabolites, as well as the highly toxic
arsine gas, the latter causing hemolysis. There are also organic arsenicals in food,
particularly seafood, of little or no known toxicity. Inorganic arsenic is well absorbed
through ingestion and respiration and is quickly cleared from the blood, distributed
throughout the body (including across the placenta), metabolized in the liver, and
excreted in the urine with metabolites monomethylarsonic acid (MMA) and
dimethylarsinic acid (DMA). Most of it is excreted with a half-life of days. Inorganic
arsenic disrupts numerous enzyme systems, causes oxidative stress and induces
alterations in gene expression. Acute severe poisoning, rarely seen in occupational
settings, is life-threatening, usually presenting with gastrointestinal symptoms and
severe diarrhea that can progress to cardio-pulmonary collapse, requiring treatment in
intensive care, with chelating medication. Chronic iAs exposure can lead to
characteristic skin lesions, increased cancer risks (particularly skin, lung, bladder), and
other cardiovascular, neurological, endocrine and reproductive adverse health effects.
Assessment involves history, physical exam and urine arsenic (can be a spot sample
corrected for creatinine), speciating the sample for inorganic species. This urine arsenic
biomarker assesses current exposures. Treatment and prevention focus on identifying
and eliminating or decreasing exposure, both in the workplace and environment.
Keywords: Arsenic, Arsine, Arsenobetaine, Arseno sugars, Arseno lipids, Dimethylarsinic acid (DMA), Monomethylarsonic acid (MMA), Inorganic arsenic.