Published online July 1, 2005
PEDIATRICS Vol. 116 No. 1 July 2005, pp. 249-257 (doi:10.1542/peds.2004-1957)
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EXPERIENCE AND REASON

Acute Arsenic Poisoning in Two Siblings

Melisa W Lai, MD*,{ddagger},§,||, Edward W Boyer, MD, PhD*,§,¶, Monica E Kleinman, MD§,#, Nancy M Rodig, MD§,** and Michele Burns Ewald, MD*,{ddagger},§,||

* Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island
{ddagger} 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 Each child ingested solubilized inorganic arsenic from an outdated pesticide that was misidentified as spring water.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

Accepted Nov 8, 2004.