Arsenic Pentoxide: Systemic Agent

White, shapeless (amorphous), crystalline, lumpy solid or powder.

Arsenics, including arsenic pentoxide, naturally exist at low concentrations in the environment and the body. Arsenic pentoxide is used as a solid or as a solution in the manufacturing of arsenates, weed killer, metal adhesives, insecticides, fungicides, wood preservatives, and colored gases and in printing and dyeing. Arsenic pentoxide dissolves and becomes liquid by absorbing moisture from the air (deliquescent) and is odorless. It may be shipped as a concentrated water solution. Arsenic pentoxide has an alternative CAS number of 12044-50-7.

• Indoor Air: Arsenic pentoxide can be released into indoor air as fine particles (aerosol).
• Water: Arsenic pentoxide can be used to contaminate water.
• Food: Arsenic pentoxide can be used to contaminate food.
• Outdoor Air: Arsenic pentoxide can be released into outdoor air as fine particles (aerosol).
• Agricultural: If arsenic pentoxide is released into the air as fine particles (aerosol), it has the potential to contaminate agricultural products.

Arsenic pentoxide is readily absorbed into the body via ingestion, inhalation, and through mucosal membranes. Unless it is mixed with a solvent to enhance absorption, arsenic pentoxide is minimally absorbed through intact skin. Arsenic pentoxide can be absorbed through broken skin. Eye exposure to arsenic pentoxide can cause irritation, but it is not associated with systemic toxicity.

First Responders should use a NIOSH-certified Chemical, Biological, Radiological, Nuclear (CBRN) Self Contained Breathing Apparatus (SCBA) with a Level A protective suit when entering an area with an unknown contaminant or when entering an area where the concentration of the contaminant is unknown. Level A protection should be used until monitoring results confirm the contaminant and the concentration of the contaminant.
NOTE: Safe use of protective clothing and equipment requires specific skills developed through training and experience.

Select when the greatest level of skin, respiratory, and eye protection is required. This is the maximum protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH or greater than the AEGL-2.

• A NIOSH-certified CBRN full-face-piece SCBA operated in a pressure-demand mode or a pressure-demand supplied air hose respirator with an auxiliary escape bottle.
• A Totally-Encapsulating Chemical Protective (TECP) suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Coveralls, long underwear, and a hard hat worn under the TECP suit are optional items.

Select when the highest level of respiratory protection is necessary but a lesser level of skin protection is required. This is the minimum protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH or greater than AEGL-2. It differs from Level A in that it incorporates a non-encapsulating, splash-protective, chemical-resistant splash suit that provides Level A protection against liquids but is not airtight.

• A NIOSH-certified CBRN full-face-piece SCBA operated in a pressure-demand mode or a pressure-demand supplied air hose respirator with an auxiliary escape bottle.
• A hooded chemical-resistant suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Coveralls, long underwear, a hard hat worn under the chemical-resistant suit, and chemical-resistant disposable boot-covers worn over the chemical-resistant suit are optional items.

Select when the contaminant and concentration of the contaminant are known and the respiratory protection criteria factors for using Air Purifying Respirators (APR) or Powered Air Purifying Respirators (PAPR) are met. This level is appropriate when decontaminating patient/victims.

• A NIOSH-certified CBRN tight-fitting APR with a canister-type gas mask or CBRN PAPR for air levels greater than AEGL-2.
• A NIOSH-certified CBRN PAPR with a loose-fitting face-piece, hood, or helmet and a filter or a combination organic vapor, acid gas, and particulate cartridge/filter combination or a continuous flow respirator for air levels greater than AEGL-1.
• A hooded chemical-resistant suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Escape mask, face shield, coveralls, long underwear, a hard hat worn under the chemical-resistant suit, and chemical-resistant disposable boot-covers worn over the chemical-resistant suit are optional items.

Select when the contaminant and concentration of the contaminant are known and the concentration is below the appropriate occupational exposure limit or less than AEGL-1 for the stated duration times.

• Limited to coveralls or other work clothes, boots, and gloves.

• Arsenic pentoxide reacts violently with bromine pentafluoride and reducing agents.
• Arsenic pentoxide is an oxidizer.
• Arsenic pentoxide is a weak acid in water.
• Arsenic pentoxide attacks many metals in the presence of water or moisture.

• Containers may explode when heated.

• Arsenic pentoxide is non-combustible; the substance itself does not burn, but it may decompose upon heating to produce corrosive and/or toxic fumes.
• Fire may produce irritating, corrosive, and/or toxic gases.
• For small fires use dry chemical, CO₂, or water spray.
• For large fires use water spray, fog, or regular foam. Move containers from the fire area if it is possible to do so without risk to personnel. Dike fire control water for later disposal; do not scatter the material. Use water spray or fog; do not use straight streams.
• For fire involving tanks or car/trailer loads, fight the fire from maximum distance or use unmanned hose holders or monitor nozzles. Do not get water inside containers. Cool containers with flooding quantities of water until well after the fire is out. Withdraw immediately in case of rising sound from venting safety devices or discoloration of tanks. Always stay away from tanks engulfed in fire.
• For massive fire, use unmanned hose holders or monitor nozzles; if this is impossible, withdraw from the area and let the fire burn.
• If the situation allows, control and properly dispose of run-off (effluent).

• If a tank, rail car, or tank truck is involved in a fire, isolate it for 0.5 mi (800 m) in all directions; also consider initial evacuation for 0.5 mi (800 m) in all directions.
• This agent is not included in the DOT ERG 2004 Table of Initial Isolation and Protective Action Distances.
• In the DOT ERG 2004 orange-bordered section of the guidebook, there are public safety recommendations to isolate an arsenic (Guide 151) spill or leak area immediately for at least 150 ft (50 m) for liquids and at least 75 ft (25 m) for solids in all directions.

• Not established/determined

• OSHA: ID105
• NIOSH: 7300, 7301, 7303, 9102, 7900

Adverse health effects due to poisoning with arsenic pentoxide occur over a range of time.

• Immediate: garlic or metallic taste, burning feeling of the affected mucous membranes, and cough.
• Within minutes of exposure: thirst, nausea, and vomiting.
• Within minutes to hours: decreased circulating blood volume (hypovolemia), low blood pressure (hypotension), diarrhea, abdominal pain, blood in the urine (hematuria), shortness of breath, chest pain, fluid accumulation in the lungs (pulmonary edema), degenerative disease or dysfunction of the brain (encephalopathy), and seizures.
• Over hours: bloody stools (hematochezia and melena), rice water like stools, and worsening of central nervous system function including confusion and delirium.
• Over hours to days: protein and blood in the urine, kidney failure.
• Over days: fatty degeneration of the liver; central liver necrosis, with yellowing of the skin (jaundice) due to liver damage.
• Over several weeks: decrease in numbers of specific blood cell types, sensory and motor neuropathy, and skin changes.

Within minutes to hours following arsenic pentoxide ingestion the patient/victim may experience nausea, vomiting, abdominal pain, and “rice water” like diarrhea.
Patient/victims suffering from less severe arsenic pentoxide toxicity may experience the following adverse health effects:

• Gastrointestinal: Metallic taste or irritation of the top of the mouth and back of the throat (oropharynx) and inflammation of the pharynx (pharyngitis). Persistent inflammation of the stomach lining (gastroenteritis) with possible ulcerative lesions and bleeding (hemorrhage).
• Dermal: toxic inflammation and redness of the skin (erythroderma) with skin shedding (exfoliative dermatitis) may result from a hypersensitivity reaction to arsenic pentoxide.
• Mild low blood pressure (hypotension).

In addition to the above, patient/victims suffering from severe arsenic pentoxide intoxication may experience the following multisystem adverse health effects:

• Cardiovascular: heart rate disturbances (sinus tachycardia and ventricular dysrhythmias), low blood pressure caused by change in position (orthostatic hypotension), shock, heart (myocardial) dysfunction, false heart attack (mimicked myocardial infarction), and loss of circulating blood volume (hypovolemia) from leaking capillaries.
• Central nervous system: acute degenerative disease or dysfunction of the brain (encephalopathy) may develop and progress over several days, delirium, and confusion. Seizures may be caused by brain swelling (cerebral edema) and brain vessel bleeding (microhemorrhages). Seizures and fainting (syncope) may be caused by heart rate irregularities as opposed to being primarily neurological.
• Respiratory system: accumulation of fluid in the lungs (pulmonary edema), acute respiratory distress syndrome (ARDS), and respiratory failure.
• Liver (hepatic): inflammation of the liver (hepatitis).
• Kidney (renal): acute kidney (renal) failure due to low blood pressure (hypotension), deposition of muscle or blood proteins in the kidneys (tubular deposition of myoglobin or hemoglobin), or direct kidney toxicity.
• Fever.
• Unusual complications: injury to the nerve supply of the diaphragm and larynx (phrenic nerve paralysis), paralysis of muscles on one side of the face (unilateral facial nerve palsy), inflammation of the pancreas (pancreatitis), and inflammation of the lining surrounding the heart and lungs (pericarditis and pleuritis).

• Arsenic pentoxide dust causes eye irritation, itching, burning, mild temporary redness and/or inflammation of the eye membrane (conjunctivitis), watering (lacrimation), temporary double vision (diplopia), abnormal sensitivity to light (photophobia), vision dimness, and other transient eye damage or lesion formation (ulceration).

• The classic presentation of arsenic pentoxide toxicity revolves around the gastrointestinal symptoms described in Signs/Symptoms, General. Other signs and symptoms include fluid in the lungs (pulmonary edema), adult respiratory distress (ARS), toxic delirium, pain in the extremities and muscles, absence of urination (anuria), blood and protein in the urine (hematuria and proteinuria), tissue swelling in the extremities (peripheral edema), headache, loss of appetite (anorexia), and vertigo. Skin findings are uncommon but may include flushing and sweating (diaphoresis). Severe toxicity may cause respiratory failure, kidney damage and failure, cellular liver damage (hepatocellular damage), and mania.
• See also Inhalation.

• Inhalation of arsenic pentoxide may cause respiratory tract irritation, cough, sore throat, shortness of breath, chest pain, fluid in the lungs (pulmonary edema, headache, dizziness, and weakness).
• See also Ingestion.

• Skin contact with arsenic pentoxide may cause redness from capillary dilation (erythema), burning sensation, pain, itchy rash, swelling, and eruptions. These effects may be increased in the presence of humid environments, moisture, or perspiration on the skin.

The purpose of decontamination is to make an individual and/or their equipment safe by physically removing toxic substances quickly and effectively. Care should be taken during decontamination, because absorbed agent can be released from clothing and skin as a gas. Your Incident Commander will provide you with decontaminants specific for the agent released or the agent believed to have been released.

The following are recommendations to protect the first responders from the release area:

• Position the decontamination corridor upwind and uphill of the hot zone. The warm zone should include two decontamination corridors. One decontamination corridor is used to enter the warm zone and the other for exiting the warm zone into the cold zone. The decontamination zone for exiting should be upwind and uphill from the zone used to enter.
• Decontamination area workers should wear appropriate PPE. See the PPE section of this card for detailed information.
• A solution of detergent and water (which should have a pH value of at least 8 but should not exceed a pH value of 10.5) should be available for use in decontamination procedures. Soft brushes should be available to remove contamination from the PPE. Labeled, durable 6-mil polyethylene bags should be available for disposal of contaminated PPE.

The following methods can be used to decontaminate an individual:

• Decontamination of First Responder:
  • Begin washing PPE of the first responder using soap and water solution and a soft brush. Always move in a downward motion (from head to toe). Make sure to get into all areas, especially folds in the clothing. Wash and rinse (using cold or warm water) until the contaminant is thoroughly removed.
  • Remove PPE by rolling downward (from head to toe) and avoid pulling PPE off over the head. Remove the SCBA after other PPE has been removed.
  • Place all PPE in labeled durable 6-mil polyethylene bags.
• Decontamination of Patient/Victim:
  • Remove the patient/victim from the contaminated area and into the decontamination corridor.
  • Remove all clothing (at least down to their undergarments) and place the clothing in a labeled durable 6-mil polyethylene bag.
  • Thoroughly wash and rinse (using cold or warm water) the contaminated skin of the patient/victim using a soap and water solution. Be careful not to break the patient/victim’s skin during the decontamination process, and cover all open wounds.
  • Cover the patient/victim to prevent shock and loss of body heat.
  • Move the patient/victim to an area where emergency medical treatment can be provided.

Initial treatment is primarily supportive.

British Anti-Lewisite (BAL; dimercaprol) binds to arsenic to decrease the toxicity of this agent. BAL is given by intramuscular (IM) injection as an antidote for whole-body (systemic) health effects of arsenic. Side effects from BAL are known; administration of BAL should only occur in a hospital setting. Note: BAL should not be administered to persons with a peanut allergy.
Dimercaptosuccinic acid (DMSA; succimer) is another chelating agent that can be used in the treatment of exposure to arsenic and arsenic compounds. It is administered by mouth and may be used when the patient/victim can tolerate oral medication.

• Immediately remove the patient/victim from the source of exposure.
• Immediately wash eyes with large amounts of tepid water for at least 15 minutes.
• If irritation is severe or persists, prolonged irrigation is advised.
• Seek medical attention immediately.

• Immediately remove the patient/victim from the source of exposure.
• Ensure that the patient/victim has an unobstructed airway.
• Do not induce vomiting (emesis).
• If evidence of shock or low blood pressure (hypotension) is observed, begin intravenous (IV) fluid administration.
• Gastric lavage and whole bowl irrigation is recommended.
• Seek medical attention immediately.

• Immediately remove the patient/victim from the source of exposure.
• Evaluate respiratory function and pulse.
• Ensure that the patient/victim has an unobstructed airway.
• If shortness of breath occurs or breathing is difficult (dyspnea), administer oxygen.
• Assist ventilation as required. Always use a barrier or bag-valve-mask device.
• If breathing has ceased (apnea), provide artificial respiration.
• Seek medical attention immediately.

• Immediately remove the patient/victim from the source of exposure.
• See Decontamination (Human): Procedures for patient/victim decontamination.
• Seek medical attention immediately.

Fluid and electrolyte balance should be monitored and restored if abnormal. Heart, kidney (renal), and liver function should be monitored. In symptomatic patient/victims, initiation of therapy with a chelating agent should be promptly considered. See Antidote for additional information. Adequate hydration and urine output should be maintained. Because arsenic interferes with the enzymes that help stabilize red blood cells against damage, breakdown of red blood cells can occur. Urine alkalinization may prevent red blood cell breakdown products from being deposited in the kidney tubules. Consider hemodialysis if the patient/victim stops producing urine (oliguria) or kidney failure develops.

Arsenic may lead to whole-body (systemic) collapse days to weeks following exposure. Nervous system effects include: restlessness and irritability, headache, confusion, decreased memory, personality change, hallucinations, delirium, seizures, coma, and death. Bilateral hearing loss has been reported. Degeneration of certain nerves (peripheral neuropathy) may occur 1 to 3 weeks after acute poisoning, with sensory symptoms; e.g., “pins and needles” or electrical shock-like pains in the lower extremities, followed by numbness and motor weakness. Physical findings may include diminished to absent pain, touch, temperature, and deep-tendon reflexes in a “stocking-glove” distribution. A light touch of the extremities may cause severe or deep-aching pains. Gastrointestinal symptoms may persist; weight loss and loss of appetite (anorexia) may occur. Blood (hematologic) effects include low white blood cell counts and, less commonly, low red blood cell and platelet counts. Skin effects may include loss of hair (alopecia) in patches, mouth blisters, itchy red rash, peeling skin, and Mees lines (1 to 2 mm wide, horizontal white nail bands). Pulmonary effects include cough, coughing up blood, chest pain, and fluid accumulation in the lungs (pulmonary edema); respiratory failure may develop in severe cases. Cardiovascular effects include abnormal heart rhythms and severe low blood pressure (hypotension). Kidney damage may occur. Inorganic arsenic crosses the placenta and may result in miscarriage or stillbirth. Early chelation with BAL may not prevent the occurrence of delayed adverse health effects.

Chronic low-level exposure to arsenic typically occurs from occupational or environmental sources. Chronic exposure to arsenic carries an increased risk of skin, lung, bladder, and possibly liver cancers. Exposure to arsenic (organic) does not cause reproductive or developmental toxicity but has been associated with degeneration of certain nerves (peripheral sensorimotor neuropathy) and peripheral vascular disease. The sequence of chronic arsenic poisoning is as follows: weakness (malaise); appetite loss (anorexia); liver enlargement (hepatomegaly); yellowish coloration of the skin and tissues (jaundice); and gastrointestinal complaints. Inhalation exposure can lead to inflammation of the membranes of the eyes (conjunctivitis), irritation of the throat and respiratory tract, and perforation of the nasal septum. Skin changes include inflammation (dermatitis), darkening, pigmentation changes, and hyperkeratosis (thickening of the outer layer of the skin, especially the palms and soles); these changes can take 3 to 7 years to appear. Eye effects of chronic arsenic exposure include tear production (lacrimation) and pigment spots in certain eye tissues (corneal and conjunctival epithelium).

• Consult with the Incident Commander regarding the agent dispersed, dissemination method, level of PPE required, location, geographic complications (if any), and the approximate number of remains.
• Coordinate responsibilities and prepare to enter the scene as part of the evaluation team along with the FBI HazMat Technician, local law enforcement evidence technician, and other relevant personnel.
• Begin tracking remains using waterproof tags.

• Wear PPE until all remains are deemed free of contamination.
• Establish a preliminary (holding) morgue.
• Gather evidence, and place it in a clearly labeled impervious container. Hand any evidence over to the FBI.
• Remove and tag personal effects.
• Perform a thorough external evaluation and a preliminary identification check.
• See the Decontamination section for decontamination procedures.
• Decontaminate remains before they are removed from the incident site.

The following methods can be used to decontaminate the environment/spillage disposal:

• Do not touch or walk through the spilled agent if at all possible. However, if you must, personnel should wear the appropriate PPE during environmental decontamination. See the PPE section of this card for detailed information.
• Keep combustibles (e.g., wood, paper, and oil) away from the spilled agent. Use water spray to reduce vapors or divert vapor cloud drift. Avoid allowing water runoff to contact the spilled agent.
• Do not direct water at the spill or the source of the leak.
• Stop the leak if it is possible to do so without risk to personnel, and turn leaking containers so that gas rather than liquid escapes.
• Prevent entry into waterways, sewers, basements, or confined areas.
• Isolate the area until gas has dispersed.
• Ventilate the area.

Agents can seep into the crevices of equipment making it dangerous to handle. The following methods can be used to decontaminate equipment:

• Not established/determined