Abstract
Arsenic trioxide is the most prevalent natural inorganic form of arsenic, which is a widely used heavy metal and is ubiquitously distributed in the environment. A 71-year-old man ingested about 10 g of arsenic trioxide powder in an attempted suicide. He developed severe vomiting, watery diarrhea and abdominal pain, and he presented to the emergency room 15 hours after the ingestion. On admission he was slightly drowsy, but shocked. He showed metabolic acidosis, acute renal failure and abnormal electrocardiogram suspecting myocardial infarction. The chest and abdominal X-rays revealed radiopaque materials in the stomach and small bowel. The stomach was irrigated via a nasogastric tube and activated charcoal was given to bind unabsorbed arsenic. The whole bowel irrigation was tried to remove the remained arsenic in the gastrointestinal tract and BAL (British anti-lewisite) was repeatedly administrated. Despite of intensive supporting management with supplemental oxygen, aggressive volume expansion, correction of metabolic disturbances and administration of cardiotonic agents, he developed progressive hypotension and died 42 hours after the ingestion. Random urine arsenic concentration, which was collected at the time of admission, but confirmed after death, was 3,564 $\mu$g/L.
본 환자는 약 10 g 정도로 다량의 비소를 음독한 후 본원 도착까지 15시간 정도 지체된 경우로 내원 즉시 충분한 수액공급과 혈압 상승제 투여, 위세척, 활성탄 투여, 전 장관 세척, 기도확보를 통한 기계호흡 실시, BAL 투여 등의 적극적인 치료를 하였음에도 불구하고 사망하였다. 이로 미루어 볼 때 급성 비소 중독시에는 먼저 철저한 문진을 통해 비소 음독을 빨리 확인하는 것이 중요하다. 또한 음독한 비소의 종류와 형태, 체내에 흡수된 양, 치료 시작 전까지의 시간, 심한 산혈증, 급성신부전 등이 예후에 영향을 줄 뿐만 아니라 적극적인 위 장관 세척, 생체 활력징후의 변화에 대한 적극적인 대처, 신속한 해독제의 투여 등의 치료도 예후와 밀접하게 관여한다고 볼 수 있다.