Renal damage from industrial arsine poisoning

Uldall, P. R., Khan, H. A., Ennis, J. E., McCallum, R. I., and Grimson, T. A. (1970).Brit. J. industr. Med.,27, 372-377. Renal damage from industrial arsine poisoning. An incident is reported in which three men were accidentally poisoned by arsine (A_s H₃) in an industrial chemical plant. Two mildly affected individuals recovered quickly-without treatment but the third, who was severely poisoned, developed oliguric renal failure. Though this patient recovered after repeated peritoneal dialysis he was left with a legacy of chronic renal insufficiency and hypertension. This severe case drew attention to a previous incident in the same factory involving three other men, the cause of which had not hitherto been suspected.

The previous reports of arsine-induced renal failure treated by dialysis have been reviewed and certain common features are apparent. Dangerous uraemia may persist long after the onset of the diuretic phase. Dialysis provides a high chance for recovery in what was previously a universally fatal condition, but permanent renal interstitial damage is a likely sequel. There are strong reasons for the prompt use of exchange transfusion in the severely affected patient with oliguria.

Mild arsine poisoning unaccompanied by oliguria may remain unrecognized and should therefore be considered in the differential diagnosis of any patient presenting with haematuria or jaundice, particularly if his occupation brings him in contact with acids and metals.