Arsenic and Heavy Metal Poisoning

A 32-year-old man from rural Maharashtra presents to the emergency department with acute onset vomiting, profuse watery diarrhoea, and severe abdominal pain 2 hours after consuming contaminated groundwater. On examination, he is hypotensive (BP 90/60 mmHg), tachycardic (HR 120/min), and has signs of dehydration. His wife, who drank the same water, is asymptomatic. Serum electrolytes show hypokalaemia and hyponatraemia. What is the most appropriate immediate next step in management?

A 28-year-old man is brought to the hospital with a 6-hour history of sudden onset severe abdominal pain, persistent vomiting, and bloody diarrhea. He works in a small jewelry workshop and admits to accidentally ingesting a solution used for metal plating. On examination, he is severely dehydrated with a blood pressure of 70/40 mmHg and a heart rate of 130/min. His mucous membranes show a characteristic garlic odor on his breath. Cardiac auscultation reveals an irregular rhythm. ECG shows prolonged QT interval and multiple ectopic beats. Serum electrolytes show severe hypokalemia (K^+^ 2.1 mEq/L) and hypomagnesemia. What is the most appropriate immediate management?

Which of the following is the most characteristic cutaneous finding in chronic arsenic poisoning?

Arsenic exerts its toxic effect primarily by which mechanism?

A 42-year-old woman from rural Maharashtra presents to the emergency department with a 3-day history of severe abdominal pain, profuse watery diarrhea, and vomiting. Her husband reports she consumed water from a hand pump near an old pesticide storage site. On examination, she is hypotensive (BP 80/50), tachycardic (HR 118/min), and has signs of severe dehydration. Her skin shows diffuse hyperpigmentation and hyperkeratosis on the palms and soles. Laboratory investigations reveal: hemoglobin 16 g/dL, WBC 12,000/μL, serum creatinine 2.8 mg/dL, and elevated liver enzymes. Urine shows dark brown discoloration. What is the most likely diagnosis?