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Article
December 15, 1989

Rhabdomyolysis in Fatal Arsenic Trioxide Poisoning

JAMA. 1989;262(23):3271. doi:10.1001/jama.1989.03430230043020
Abstract

To the Editor. —  We report a case of fatal arsenic poisoning with acute renal failure, circulatory collapse, and severe rhabdomyolysis.

Report of Case.—  A 23-year-old man came to our hospital 1 hour after voluntary ingestion of 20 g of arsenic trioxide. On admission he was asymptomatic. He was treated with ipecac syrup, activated charcoal, and dimercaprol (3 mg/kg intramuscularly every 4 hours).Within 8 hours, arterial hypotension (95/50 mm Hg) and anuria ensued. Plasma expanders were perfused and a progressive rise of the central venous pressure, without the reestablishment of diuresis, was observed. Nine hours later, when the creatinine level was 300 μmol/L and the creatine phosphokinase level 1223 U/L, it was decided to carry out hemodialysis followed by a dopamine infusion due to the progressive hypotension.Evolution was characterized by refractory shock, the increase of rhabdomyolysis (creatine phosphokinase level, 31 350 U/L), hepatic dysfunction (aspartate aminotransferase level, 550

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