Cases reported "Arsenic Poisoning"

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1/12. The nail and hair in forensic science.

    Drugs, chemicals, and biological substances accumulate and are stored in hair and nails where they can be detected and measured. Advantages of analyzing hair and nail samples also include their easy and non-invasive collection, the small sample size required for analysis, and their easy storage at room temperature. We report 3 examples of heavy metal poisoning diagnosed because of the hair or nail symptoms. Drugs and toxins that can be detected in hair and nails are reviewed and the application of hair/nail analysis in general and in forensic medicine is discussed.
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keywords = heavy metal, metal
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2/12. Torsade de pointes and T-U wave alternans associated with arsenic poisoning.

    Arsenic intoxication is a common form of heavy metal poisoning. Although arsenic-induced circulatory collapse, seizures, and syncope are well known, the potential for serious ventricular arrhythmias is less well recognized. Reported in this study are two cases of arsenic poisoning causing torsade de pointes. Furthermore, marked prolongation of the QT-U interval and the rarely observed phenomenon of T-U wave alternans are demonstrated. Thus, arsenic intoxication may be complicated by prolongation of the QT-U interval and torsade de pointes. T-U wave alternans occurs in the presence of a long QT-U interval and may be an electrocardiographic warning sign of torsade de pointes.
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keywords = heavy metal, metal
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3/12. Arsenic intoxication presenting as a myelodysplastic syndrome: a case report.

    A case of arsenic intoxication presenting as a myelodysplastic syndrome is reported. A 41-year-old woman with a 6-month history of gastrointestinal and neurological symptoms was noted to be pancytopenic at presentation. A bone marrow aspirate revealed dysmyelopoietic changes involving all three marrow cell lines. Subsequent analysis of urine for heavy metals demonstrated very high levels of arsenic. Treatment with British anti-Lewisite (BAL) resulted in the resolution of gastrointestinal symptoms and hematological abnormalities although the neurological complications progressed. This case emphasizes that heavy metal intoxication should be considered in the differential diagnosis of any individual presenting with the hematological features of myelodysplasia especially when accompanied by clinical features considered atypical for primary or secondary myelodysplasia.
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keywords = heavy metal, metal
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4/12. Acute arsenic intoxication from environmental arsenic exposure.

    Reports of acute arsenic poisoning arising from environmental exposure are rare. Two cases of acute arsenic intoxication resulting from ingestion of contaminated well water are described. These patients experienced a variety of problems: acute gastrointestinal symptoms, central and peripheral neurotoxicity, bone marrow suppression, hepatic toxicity, and mild mucous membrane and cutaneous changes. Although located adjacent to an abandoned mine, the well water had been tested for microorganisms only and was found to be "safe." Regulations for testing of water from private wells for fitness to drink are frequently nonexistent, or only mandate biologic tests for microorganisms. Well water, particularly in areas near mining activity, should be tested for metals.
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keywords = metal
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5/12. arsenic poisoning. Ongoing diagnostic and social problem.

    Arsenic, commonly found in insecticides, herbicides, and industrial materials, is involved in the majority of heavy metal poisonings reported in the united states. Accidental poisoning appears to be most common in the pediatric age-group, whereas intentional and covert poisonings predominate in adults. Diagnosis is often difficult. The clinical presentations of arsenic poisoning, both acute and chronic types, represent a wide spectrum, largely dependent on route of exposure, chemical form, and dose. Because the patient or others providing the history may suppress information on exposure and because toxic levels of arsenic in the system drop rapidly in the first 24 hours, swift administration of diagnostic tests is important. Physician follow-up is determined by the route of exposure to arsenic and may involve referral to a social service network or a mental health facility.
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keywords = heavy metal, metal
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6/12. Sources of error in the diagnosis of guillain-barre syndrome.

    A careful monitoring of the accuracy of diagnosis in six cases of Guillain-Barre syndrome has shown that a substantial proportion of these patients initially diagnosed as having guillain-barre syndrome on the basis of characteristic clinical findings and an elevated level of protein in the spinal fluid had a neuropathy caused by another etiology. The pitfalls in the laboratory and clinical diagnosis of disorders that were confused with guillain-barre syndrome were several: the pattern of neurological dysfunction in the guillain-barre syndrome was not unique to that disorder; no specific laboratory test existed to confirm the diagnosis of guillain-barre syndrome; and the laboratory diagnosis of other causes of similar neurological disorders (especially heavy metal intoxication) depended upon tests that are very unreliable.
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keywords = heavy metal, metal
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7/12. Erythroid karyorrhexis in the peripheral blood smear in severe arsenic poisoning: a comparison with lead poisoning.

    Three men with severe arsenic poisoning were hospitalized with working diagnoses, respectively, of peptic ulcer, pancreatitis, and viral gastroenteritis. In the first two patients, correct diagnosis was delayed until the return of heavy-metal screening tests ordered because of painful peripheral neuropathy in one and sudden flaccid paralysis, resembling guillain-barre syndrome, in the other. Both patients had coarsely stippled red blood cells with markedly abnormal nuclei in their peripheral blood smears. These distinctive hematologic features led to an early diagnosis in the third patient. The author's review of past cases of lead poisoning showed that red blood cell karyorrhexis also tends to occur in patients who consume illicit whiskey ("moonshine"). Karyorrhexis or marked dyserythropoiesis in the peripheral smear, not heretofore described in arsenic or lead poisoning, may indeed be a unique hematologic clue. Scrutiny of the peripheral blood and/or buffy coat smear in patients with perplexing gastrointestinal or neurologic symptoms may enable earlier diagnosis and better therapy of arsenic poisoning.
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ranking = 0.00070081786769579
keywords = metal
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8/12. Variegate porphyria and heavy metal poisoning from ingestion of "moonshine".

    A patient with cavitary tuberculosis, hepatic cirrhosis, bullous skin lesions over sun-exposed surfaces, disorientation, and a chronic, as well as recent, history of illicit alcohol consumption was found to have acute variegate porphyria by characteristic fecal and urinary porphyrin studies. Elevated levels of lead and arsenic were found in serum and urine without evidence of heavy metal storage in hair and liver. We suspect that the variegate porphyria was precipitated by the ingestion of heavy metals contained in illicit alcohol. In a patient with disorientation, bullous skin lesions, and a history of illicit alcohol ingestion, one must consider heavy metal intoxication and secondary porphyrin abnormalities.
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keywords = heavy metal, metal
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9/12. Arsenic intoxication associated with tubulointerstitial nephritis.

    arsenic poisoning is an often unrecognized cause of renal insufficiency. We report a case of tubulointerstitial nephritis associated with an elevated urinary arsenic concentration. Removal of the putative source of arsenic resulted in symptomatic improvement, resolution of abnormal abdominal radiographs, and stabilization of renal function. This case emphasizes the importance of heavy metal screening in patients with multisystem complaints and tubulointerstitial nephritis.
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keywords = heavy metal, metal
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10/12. Simultaneous exposure to lead, arsenic and mercury from Indian ethnic remedies.

    We report the case of an Asian woman who was exposed to toxic levels of lead, arsenic and mercury through the use of Indian ethnic remedies, and who suffered symptomatic lead poisoning. We know of no other case of exposure to such a combination of heavy metals from this source. We believe that control of the dispensing of these compounds is essential.
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keywords = heavy metal, metal
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