Repetitive endoscopy and continuous alkaline gastric irrigation in a case of arsenic poisoning

Background: The poor prognosis of patients with persistent gastrointestinal radio-opacities after oral arsenic poisoning supports efficient gastrointe stinal decontamination as critical for survival.(1,2) In a case of massive arsenic ingestion, we performed repetitive gastric endoscopy and a continuo us alkaline irrigation of the stomach over several days. Case Report: A 41- year-old woman was admitted 4 hours after intentional ingestion of trivalen t arsenic powder 5 g, The admission abdominal X-ray confirmed the presence of multiple gastric opacities. Initial treatment was gastric lavage with no rmal saline, dimercaprol chelation, and supportive therapy. Since gastric o pacities persisted on the abdominal X-ray at 34 hours despite repeated gast ric lavage, a gastroscopy was performed showing nonremovable agglomerates. In an attempt to achieve further gastric decontamination, we performed a co ntinuous gastric alkaline irrigation. After 3 days of alkaline irrigation, the abdomen was normal on X-ray but the gastroscopy still showed arsenic co ncretions. Alkaline irrigation was continued for another 3 days until total disappearance of arsenic agglomerates at the gastroscopy, Admission urinar y arsenic was 3663 mu g/L. A total of 46.2 mg of inorganic arsenic, or less than 1% the ingested dose, was extracted from the stomach by this techniqu e. The patient was discharged from the intensive care unit 20 days after ad mission without sequelae.