Two cases of deliberate elemental arsenic ingestion with no apparent toxicologic consequences.

Introduction: Arsenic is a metalloid that is highly toxic in its inorganic and organic forms. Ingestion of elemental arsenic is rare.

Case reports: A 33-year-old woman ingested elemental arsenic 10 g purchased online. She experienced brief gastrointestinal upset but was otherwise asymptomatic. She underwent chelation with succimer until it became apparent that she had no toxicologic consequences. She remained asymptomatic at 19-day follow-up. Her spot urine inorganic arsenic concentrations were >5,000 µg/L, 109 µg/L, and 87 µg/L at 12 days, 36 days, and 19 days post-ingestion, respectively. A 20-year-old woman similarly ingested elemental arsenic 10 g purchased online. She presented to care 30 min post-ingestion. Abdominal radiography confirmed the presence of multiple radiodensities. She underwent gastrointestinal decontamination without chelation. She developed no apparent signs or symptoms of arsenic poisoning. Her 24 h urine inorganic arsenic concentration (from hospital day 2) was 253 µg/L.

Discussion: The poor water solubility and bioavailability of elemental arsenic may limit its toxicity in acute ingestion.

Conclusions: Elemental arsenic ingestion resulted in no apparent toxicity, despite elevated arsenic concentrations in blood and urine. Elemental arsenic ingestion may not warrant emergent decontamination or chelation.