Abstract
Arsenic poisoning may occur from sources other than drinking water such as rice, seafood, or insecticides. Symptoms and signs can be insidious, non-specific, atypical, and easily overlooked. We present a 39-year-old woman with celiac disease who was on gluten-free diet for 8 years and presented with diarrhea, headache, insomnia, loss of appetite, abnormal taste, and impaired short-term memory and concentration, but with no skin lesions. Arsenic concentration in her 24-hour urine was 682.77 micro g/g creatinine (normal < 15). She responded very well to chelation therapy with dimercaptosuccinic acid given orally and recovered within 2 weeks. The suspected source of arsenic poisoning was rice, as drink.ing contaminated ground water is not known in Saudi Arabia and she had not taken seafood. Therefore, arsenic poisoning should be suspected based on the meticulous medical history in cases of patients with celiac disease whose main food is rice and who present with unusual symptoms.
References
Oct 1, 1979·Environmental Research·J L ValentineG Spivey
Aug 1, 1977·Environmental Health Perspectives·K Tsuchiya
Nov 1, 1992·British Journal of Cancer·C J ChenT L Kuo
Jan 1, 1991·Archives of Environmental Contamination and Toxicology·P WeisL M Coohill
May 1, 1986·Archives of Environmental Health·A A AbdelghaniF Mather
Dec 1, 1967·Gut·H J BinderH M Spiro
Mar 1, 1995·The Analyst·J AasethE Wickstrøm
May 2, 2001·The Oncologist·K H Antman
Dec 14, 2002·Lancet·Munjoo BaeRyutaro Ohtsuka
Mar 15, 2003·Journal of Environmental Science and Health. Part A, Toxic/hazardous Substances & Environmental Engineering·D N Guha Mazumder
Aug 5, 2003·Postgraduate Medical Journal·R N Ratnaike
Oct 22, 2003·Journal of Hazardous Materials·Kim D Jones, Wi Hao Huang
Jan 7, 2004·Journal of Toxicology. Clinical Toxicology·Dipankar ChakrabortiMrinal Kumar Sengupta
Jul 9, 2004·Environmental Health Perspectives·Soma R MitraAllan H Smith
Sep 17, 2004·Journal of Toxicology and Environmental Health. Part a·Chih-Ching ChangChun-Yuh Yang
Nov 10, 2006·Regulatory Toxicology and Pharmacology : RTP·Jonathan Borak, H Dean Hosgood
Apr 19, 2007·Environmental Science & Technology·P N WilliamsA A Meharg
Oct 2, 2007·Food Additives & Contaminants. Part A, Chemistry, Analysis, Control, Exposure & Risk Assessment·L JorhemK Petersson Grawé
May 9, 2008·The Journal of Pharmacology and Experimental Therapeutics·Jie LiuMichael P Waalkes
Oct 23, 2008·Environmental Science & Technology·Guo-Xin SunAndrew A Meharg
May 5, 2009·Human & Experimental Toxicology·Y YilmazE Dolar
Aug 25, 2009·QJM : Monthly Journal of the Association of Physicians·S BradberryA Vale
Jul 22, 2010·Lancet·Maria ArgosHabibul Ahsan
Jul 14, 2011·Toxicological Sciences : an Official Journal of the Society of Toxicology·Michael F HughesDavid J Thomas
Sep 9, 2011·The Science of the Total Environment·M Azizur Rahman, H Hasegawa
Jan 17, 2013·Current Treatment Options in Oncology·Harry J Iland, John F Seymour