A missed case of poisoning with arsenic

Christine, a 40-year-old white woman, suffered from acute gastrointestinal pain, diarrhea, malaise, and fatigue shortly after receiving oral herbal treatment and drank eight glasses of clear liquid in a clinic in California. On October 19, 2004 between 1540 and 1730, she was given Uro-well herbal supplement prescribed by her physician as a kidney-cleansing agent. Christine was transported by ambulance to the Stanford Emergency Department (SED) at approximately 1930. She was treated with activated charcoal orally and N-saline by IV. An electrocardiogram test showed that she developed sinus tachycardia. Christine’s blood test was negative for alcohol and her urine test was negative for the use of illicit drugs. The treating physicians did not order screening tests for the presence of heavy metals and arsenic in blood and urine, even though, she stated that a poison might be the cause of her symptoms. Christine was released from SED after ten hours of admission. However, she continued to suffer from abdominal pain, fatigue, vomiting, and diarrhea for several weeks. A 24 hour-urine sample was collected and analyzed for arsenic on day 26 post-her hospitalization on October 19. It revealed a significantly high level of arsenic (270 μg arsenic per 24 hour urine collection). Christine’s arsenic background level in urine was 18 μg arsenic per day. Furthermore, analysis of the Uro-well herbal supplement revealed arsenic level of 25 ppm, which is five-time, the maximum permissible level of arsenic (5 ppm) in herbs set by the American National Institute of Standards and Technology. My investigation revealed that the exposure to a toxic level of arsenic by ingestion is the likely cause for Christine’s acute symptoms developed on October 19. © Copyright 2007 Pearblossom Private School, Inc.–Publishing Division. All rights reserved.