EXPERIENCE AND REASON |
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* Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island
Divisions of Emergency Medicine
# Critical Care Medicine
** Nephrology, Children's Hospital, Boston, Massachusetts
Harvard Medical School, Boston, Massachusetts
¶ Department of Emergency Medicine, University of Massachusetts, Worcester, Massachusetts
|| Department of Emergency Medicine, Mount Auburn Hospital, Cambridge, Massachusetts
We report a case series of acute arsenic poisoning of 2 siblings, a 4-month-old male infant and his 2-year-old sister. Each child ingested solubilized inorganic arsenic from an outdated pesticide that was misidentified as spring water. The 4-month-old child ingested a dose of arsenic that was lethal despite extraordinary attempts at arsenic removal, including chelation therapy, extracorporeal membrane oxygenation, exchange transfusion, and hemodialysis. The 2-year-old fared well with conventional therapy.
Key Words: arsenic poisoning toxicokinetics pharmacokinetics British anti-lewisite dimercaprol succimer DMSA DMPS chelation therapy extracorporeal membrane oxygenation ECMO exchange transfusion hemodialysis heavy metal poisoning survival pediatric lethal dose
Abbreviations: DMSA, 2,3-dimercaptosuccinic acid DMPS, 2,3-dimercapto-1-propanesulfonate BAL, British anti-lewisite ECMO, extracorporeal membrane oxygenation