Arsine AsHJ(3) CAS 7784.2-1; UN 2188,
Synonyms include arsenic hydride, arsenic trihydride, arseniuretted hydrogen, arsenous hydride, and hydrogen arsenide.
- Arsine presents little risk of secondary contamination to personnel outside the Hot Zone.
- Arsine is a flammable and highly toxic gas with a garlic-like or fishy odor that does not provide adequate warning of dangerous levels.
- Inhalation is the major route of arsine exposure. It has no toxic effects on the skin or eyes, and it is not absorbed through the skin.
Description --
Industrial arsine is a colorless, flammable and highly toxic gas. It has a garlic-like or fishy odor at concentrations of O.5 ppm and above. Because it is nonirritating, persons exposed to dangerous levels may experience no immediate symptoms.
Routes of Exposure --
Inhalation -
Inhalation is the major route of exposure. The odor threshold of arsine is 1O-fold greater than the OSHA permissible exposure limit. Odor is not an adequate indicator of arsine's presence and does not provide reliable warning of dangerous concentrations. Serious exposure can occur even if the garlic-like odor is not smelled. Arsine is heavier than air and may cause asphyxiation in enclosed, poorly ventilated, or low-lying areas.
Skin/Eye Contact -
Arsine has no toxic effects on the skin or eyes, and it is not absorbed through the skin.
Ingestion -
Ingestion of arsine itself is unlikely since it is a gas at room temperature. However, metal arsenides are solids that can react with the gastric mileux and release arsine gas in the stomach.
Sources/Uses --
Arsine gas is formed when arsenic-containing materials react with water or acids. Accidental exposures have occurred during refining of ores (e.g., lead, copper, zinc, iron, and antimony ores) that are contaminated with arsenic. Arsine is used as a dopant in the semiconductor industry and in the manufacture of crystals for fiberoptics and computer chips. It has minor uses in galvanizing, soldering, etching, and lead plating.
Properties of Arsine --
Appearance: Colorless, nonirritating gas at room temperature
Warning properties: Inadequate; garlic-like or fishy odor at 0.5 ppm
OSHA PEL (Permissible Exposure Limit) =0.05 ppm (averaged over an 8-hour workshift)
OSHA Ceiling Limit = 0.002 ppm (15-minute sample)
NIOSH IDLH (Immediately Dangerous to life or Health) = 6 ppm
Molecular weight = 78.0
Boiling point (760 mm Hg) = --80.4 degrees F (-55 degrees C)
Vapor pressure (67.1 degrees F) = >760 mm Hg
Vapor density = 2.7 (air = 1)
Water soluble (20% at 67 degrees F)
Extremely flammable; may be ignited by heat, sparks, or flames. Vapors may travel to a source of ignition and flash back.
Health Effects
- Arsine is a highly toxic gas. Its primary toxic effect after inhalation is massive intravascular hemolysis resulting in acute renal failure.
- Signs and symptoms of acute arsine poisoning are usually delayed for 2 to 24 hours, depending on exposure intensity.
Acute Exposure --
After absorption by the lungs, arsine enters red blood cells and inhibits red cell catalase, which leads to accumulation of hydrogen peroxide. Hydrogen peroxide, in turn, destroys red cell membranes and causes massive intravascular hemolysis. Arsine produces no adverse effects on the skin or eyes, and contact with these organs does not result in systemic toxicity. Gastrointestinal effects from ingestion of arsine are unlikely, but ingestion of metallic arsenides can lead to arsine intoxication.
Respiratory -
Delayed pulmonary edema has been described after massive exposure. Respiratory effects may be secondary to hemolysis hypoxia.
Hematologic -
Acute intravascular hemolysis develops within hours and continues for up to 96 hours. Haptoglobin levels decline rapidly. Plasma free hemoglobin rises, with greater than 2 g/dL reported. Anemia develops; the peripheral smear shows anisocytosis, poikilocytosis, red-cell fragments, basophilic stippling, and ghost cells. The bone marrow usually shows no abnormalities. Coomb's and Ham's tests are negative, and RBC fragility is normal.
Renal -
Renal failure due to acute tubular necrosis is a significant sequela of arsine exposure. Hemoglobinuria is thought to be the major insult, but a direct toxic effect of arsine or deposition of the arsine- hemoglobin- haptoglobin complex may also play a role. Urinalysis shows large amounts of methemoglobin, protein, and hemoglobin without intact RBCs. Urine may be colored (brown, red, orange, etc.) Oliguria or anuria may develop within 24 to 48 hours.
Gastrointestinal -
Nausea, vomiting, and crampy abdominal pain are among the first signs of arsine poisoning. Onset varies from a few minutes to 24 hours after exposure.
Dermal -
The skin bronzing noted with arsine toxicity is not true jaundice due to the presence of bilirubin but is induced by hemolysis.
Neurologic -
Acute encephalopathy can develop several days after severe exposure. Signs include restlessness, memory loss, disorientation, agitation, and psychosis. Some victims suffer peripheral neuropathy beginning 1 to 2 weeks after exposure.
Musculoskeletal -
Skeletal muscle injury has been reported in some patients. Findings include severe myalgia, myoglobinuria, and elevated serum CPK and aldolase levels.
Chronic Exposure --
Chronic exposure to arsine can result in gastrointestinal distress and anemia. Repeated exposure may cause damage to lungs, kidneys, liver, nervous system, heart, and blood and blood-forming organs.
Arsine has been associated with skin and lung cancers. IARC states that sufficient evidence exists to conclude that arsine is a human carcinogen.
Arsine should be treated as a potential teratogenic agent. Although the reproductive effects of acute or chronic exposure to arsine are unknown, some related inorganic arsenicals produce a broad spectrum of adverse developmental effects in animals.
Prehospital Management
- Even if arsine's odor is not detected by persons at the scene, victims could have received a serious exposure. All exposure victims should be evaluated at a medical facility.
- Signs of hemolysis and pulmonary edema may be delayed 2 to 24 hours.
- There is no specific antidote for arsine poisoning. Treatment is supportive.
Potential for Secondary Contamination. Although small amounts of arsine gas can be trapped in the victim's clothing or hair after an overwhelming exposure, these quantifies are not likely to create a hazard for response personnel outside the Hot Zone.
Hot Zone --
Rescuers should be trained and appropriately attired before entering the Hot Zone. If the proper equipment is not available, or if rescuers have not been trained to use it, call for assistance from a local or regional hazmat team or other properly equipped response organization.
Rescuer Protection -
Rescuers in the Hot Zone should wear self-contained breathing apparatus (SCBA). Chemical-protective clothing is not required.
ABCs -
Quickly establish a patent airway. Stabilize the cervical spine with a collar if trauma is suspected. Administer supplemental oxygen and assist ventilation with a bag-valve-mask device if necessary.
Victim Removal -
If victims can walk, lead them out of the Hot Zone to the Decontamination Zone. If a victim is unable to walk, remove him or her on a backboard or gurney. If there is no means of transport, carefully drag the victim out. Decontamination Zone --
Victims with exposure to only arsine gas do not need decontamination. They may be transferred immediately to the Support Zone.
Support Zone --
Support Zone personnel require no specialized protective gear if the patient has been exposed to only arsine.
ABCs -
Establish a patent airway. Stabilize the cervical spine with a collar if trauma is suspected. Administer supplemental oxygen and assist ventilation with a bag-valve-mask device if necessary. Evaluate the need for an intravenous line, cardiac monitor, and life support.
Advanced Treatment --
Intubate the trachea if indicated (respiratory distress or apnea). If massive exposure is suspected or if the patient is hypotensive, infuse intravenous saline or lactated Ringer's solution (adult dose: 500 to 1000 mL).
Transport to Medical Facility -
Report to the base station and receiving medical facility the condition of the patient, treatment given, and estimated time of arrival at the medical facility.
Multiple Casualty Triage --
If possible, consult with the base station physician or regional poison control center for advice regarding triage of multiple victims.
It is difficult to determine at the scene which patients have had the most serious exposure and are likely to develop severe hemolysis; therefore, all patients with potential exposure should be evaluated at a medical facility.
Patients whose history indicates massive exposure and those who have smelled a garlic- or fish-like odor should be transported first.
Emergency Department Management
- Arsine poisoning causes acute intravascular hemolysis, which may lead to renal failure. Arsine gas does not produce arsenic intoxication.
- Even if arsine's odor was not detected by persons at the scene, victims could have had a serious exposure. All exposure victims should be evaluated and observed.
- There is no specific antidote for arsine poisoning. Treatment is supportive.
Potential for Secondary Contamination. Although small amounts of arsine gas can be trapped in the victim's clothing or hair after an overwhelming exposure, these quantities are not likely to create a hazard for hospital personnel.
Critical Care Area --
Patients with exposure to only arsine gas do not need decontamination.
ABCs -
Evaluate and support airway, breathing, and circulation. Monitor cardiac rhythm.
Observe inhalation patients for up to 24 hours. Follow-up as clinically indicated.
Treatment for Hemolysis -
If hemolysis develops, initiate urinary alkalinization. Add 50 to 100 mEq of sodium bicarbonate to one liter of 5% dextrose in 0.25 normal saline and administer intravenously at a rate that maintains urine output at 2 to 3 mL/kg/hr. Maintain alkaline urine (i.e., pH>7.5) until urine is hemoglobin free. Closely monitor serum electrolytes, calcium, BUN, and creatinine.
Antidotes and Other Treatments -
Although BAL (dimercaprol) and other chelating agents are useful in arsenic poisoning, they are not effective antidotes for arsine poisoning. Consider hemodialysis if renal failure is severe. (Although hemodialysis will assist the patient with renal failure, it will not effectively remove the arsine-hemoglobin or arsine-haptoglobin complexes deposited in the renal tubules.)
Blood transfusions may be necessary if hemolysis causes severe anemia.
Laboratory Tests -
If significant exposure is a possibility and transfusion may be necessary, immediately obtain blood type and screen (cross match, if needed). Laboratory tests to determine hemolysis include CBC with peripheral smear, urinalysis with hemoglobin quantitation, and plasma free hemoglobin and haptoglobin analyses. Other useful tests include renal function tests (BUN, creatinine), Serum electrolytes, and unconjugated bilirubin levels.
Disposition and Follow-up --
Decisions to admit or discharge a patient should be based on exposure history, physical examination, and test results.
Delayed Effects -
All patients with suspected arsine exposure should be carefully observed for 24 hours, including hourly urine monitoring to assure absence of hemolysis. Onset of hemolysis may be delayed up to 24 hours, and acute renal failure may not become evident for as long as 72 hours after exposure.
Patient Release -
Patients with no signs of hemolysis may be discharged after 24 hours of observation with instructions to return to the ED if symptoms of toxicity develop (see the reverse side of Arsine--Patient Information Sheet). Released patients should be instructed to rest and to drink plenty of fluids.
Follow-up -
All patients should receive repeat laboratory tests in 12 to 24 hours.
Reporting --
If a work-related incident has occurred, you may be legally required to file a report; contact your state or local health department.
Other persons may still be at risk in the setting where this incident occurred. OSHA may be contacted for assistance in evaluating workplace conditions, or an appropriate public agency can be notified if a public health risk exists. If appropriate, inform patients that they may request an evaluation of their workplace from the Hazard Evaluation Division at NIOSH. See Appendix XX for a list of these and other agencies that may be of assistance.
Arsine Patient Information Sheet
This handout provides information and follow-up instructions for persons who may have been exposed to arsine gas.
What is arsine?
Arsine is a colorless gas that does not burn the eyes, nose, or throat like some other dangerous gases. It has a garlic-like or fishy smell, but only at relatively high concentrations. A person can be exposed to a high concentration of arsine and not be able to smell it.
Certain ores or metals may contain traces of arsenic. If water or acid contacts these ores or metals, they may release small amounts of arsine gas. Arsine is widely used in manufacturing of fiberoptic equipment and computer microchips. It is sometimes used in galvanizing, soldering, etching, and lead plating.
What immediate health effects may result from arsine exposure? Besides the odor, there may be no other immediate sign that a person is breathing arsine. Its main effect is to destroy red blood cells, causing anemia (destruction of red blood cells) and kidney damage (from red blood cell debris). Within hours after a serious exposure, the victim may develop dark red or brown urine, back pain or belly pain, weakness, or shortness of breath. The skin or eyes may become yellow or bronze in color. Although arsine is related to arsenic, it does not produce the usual signs of arsenic poisoning.
What is the treatment for arsine poisoning?
There is no antidote for arsine poisoning, but its effects can be treated. The doctor may give the exposed patient fluids through a vein to protect the kidneys from damage. For severe poisoning, blood transfusions and cleansing of the blood (hemodialysis) may be needed.
Are any future health effects likely to occur?
After a serious exposure, symptoms usually begin within 2 to 24 hours. People who have no signs of poisoning during this time probably have not breathed a large amount of arsine and may be sent home with instructions for follow-up medical care (see the reverse side of this page). Most people do not have long term effects from a single, small exposure to arsine. In rare cases, permanent kidney damage or nerve damage has developed after a severe exposure.
Repeated exposure to arsine may cause skin and lung cancer.
What tests can be done if a person has been exposed to arsine? The are no specific tests for arsine exposure. However, blood, urine and other tests may show if there has been any serious injury to the lungs, blood cells, kidneys, or nerves.
Where can more information about arsine be obtained?
More information about arsine may be obtained from your regional poison control center; your state, county, or local health department; the Agency for Toxic Substances and Disease Registry (ATSDR); your doctor; or a clinic in your area that specializes in occupational and environmental health. If the exposure happened at work, you may wish to contact the Occupational Safety and Health Administration (OSHA) or the National Institute for Occupational Safety and Health (NIOSH). Ask the doctor who gave you this form for help in locating these telephone numbers.
Arsine Follow-up Instructions --
( ) Call your doctor or the Emergency Department if you develop any of the following symptoms within the next 24 hours: * unusual fatigue or weakness * shortness of breath * abnormal urine color (red, brown, etc.) * belly pain or tenderness ( ) No follow-up appointment is necessary unless you develop any of the symptoms described above. ( ) Call for an appointment with Dr. __________ in the practice of ________ When you call for your appointment, please tell the receptionist/nurse that you were treated in the Emergency Department at __________________ Hospital by __________ and were advised to be seen again in ___ days. ( ) Return to the Emergency Department/__________ Clinic on (date) ________ at AM/PM for a follow-up examination. ( ) Do not perform vigorous physical activities for __ days. ( ) You may resume everyday activities including driving and operating machinery. ( ) Do not return to work for__ days. ( ) You may return to work on a limited basis. See instructions below. ( ) Avoid exposure to cigarette smoke for 24 hours since smoke may worsen injury to your lungs. ( ) You may continue taking the following medication(s) that your doctor(s) prescribed for you: ___________________________________________________ _______________________________________________________________________ ( ) Other instructions: ___________________________________________________ _______________________________________________________________________ Signature of patient ___________________________ Date _____________________ Signature of physician _________________________ Date _____________________
Above courtesy of C.D.C.
