A 58-year-old male presented to the emergen- cy department (ED) with nausea and vomiting one hour after committing suicide by ingestion of arsenic trioxide. Vital signs in triage revealed a respiratory rate of 22 breaths per minute, heart rate of 100 beats per minute, and blood pressure of 99/51 mmHg. The physical examination showed clear consciousness and soft abdomen without tenderness nor rebound pain. The laboratory evaluation disclosed elevated blood creatinine 1.4 mg/dL (normal: 0.64–1.27 mg/ dL) and alanine transaminase 103 U/L (normal: < 36 U/L). The other basic biochemistry blood examina- tions were unremarkable. The chest X-ray revealed hyperdense lesion in the left upper quadrant of abdo- men (Fig. 1, arrowheads). Nasogastric tube irrigation was performed for decontamination. Intravenous 2,3-dimercapto-1-propanesulfonic acid (DMPS) was prescribed. Acute kidney injury, metabolic acidosis, acute respiratory failure, and shock occurred 6 hours after ingestion. His clinical condition deteriorated de- spite fluid resuscitation and inotropic agents use. The patient deceased 11 hours after ingestion. Blood arse- nic ultimately revealed 730 μg/L (normal: < 20 μg/L). Discussion The initial presentation of acute arsenic intox- ication includes nausea, vomiting, diarrhea, and ab- dominal pain, followed by renal failure, respiratory failure, and shock.1 These symptoms and signs are non-specific. Hence, there is no specific toxidrome for clinical diagnosis.
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