Archives for May 1, 2003

Arsenic poisoining

According to the WMTW website:

Maine State police said Thursday that they’re treating the arsenic poisoning death of a church elder as a homicide investigation.

Steve McCausland of the Maine Public Safety Department says the source of the arsenic that killed Walter Morrill and sickened more than a dozen others was the brewed coffee served after church.

McCausland says tests done on the tap water, the sugar and the unbrewed coffee from the can are all negative for arsenic. He says the investigation has produced no evidence that supports a conclusion that arsenic was introduced into the brewed coffee accidentally.

The state medical examiner’s office has now ruled that 78-year-old Walter Morrill died from acute arsenic poisoning. Two other victims remain in critical condition today at the Eastern Maine Medical Center in Bangor.

This highlighted to me that I needed to refresh my memory on arsenic poisoinings. Guess what? It looks like a ton of other stuff.

Acute poisoinings (like the case above) start with some difficulty swallowing and a ‘metallic’ taste in the mouth, and depending on the dose can quickly progress to nausea, vomiting, abdominal pain and watery diarrhea. Seizures with coma can follow a severe ingestion, followed by brain and kidney damage if you live that long.

I see that presentation about once a shift in the ED (though none have progressed to seizures and coma), and as far as I know, none so far have been arsenic overdoses. Even more insidious are those with a chronic toxicity, being quite difficult to diagnose.

Taking a thorough history wouldn’t help in the case above, in fact, it would seem to be a cluster of food poisoning (sick people after church – potato salad!), not arsenic poisoining, unless the patients were alert enough to do some of the epidemiology history (what, exactly, did you eat/drink, and when), which is one of the things state health departments and the CDC usually do well. The trick is to suspect it, and that would be hard (it looks like everything else).

Whoever made the diagnosis no doubt saved the lived of those still left alive, and should be congratulated.