Facts About Arsine: Arsine or Stibine Poisoning

Facts About Arsine

Interim Document

What arsine is

  • Arsine is a colorless, nonirritating toxic gas with a mild garlic odor. The odor can be detected only at levels greater than those necessary to cause poisoning.
  • Arsine is formed when arsenic comes in contact with an acid.
  • Arsine is similar to a gas called stibine, which is formed when the metal antimony comes in contact with an acid. Stibine has health effects similar to those of arsine, but it is not as widely available, and it has a much more noticeable odor (like rotten eggs).

Where arsine is found and how it is used

  • Although arsine was investigated as a warfare agent during WWII, it was never used on the battlefield.
  • Arsine is most commonly used in the semiconductor and metals refining industries.

How you could be exposed to arsine

  • Most common reports of exposure to arsine have been after accidental formation of arsine in the workplace.
  • Inhalation (breathing in the gas) is the most likely route of exposure after arsine is released into the air.
  • Absorption into the body through the eyes and the skin has not been known to occur.
  • Arsine vapor is heavier than air, so it would be more likely to settle in low-lying areas.

How arsine works

  • The extent of poisoning caused by arsine depends on the amount of arsine to which a person has been exposed and on the length of time of the exposure.
  • Depending on the intensity of exposure to arsine, symptoms may occur 2 to 24 hours after exposure. However, exposure to high doses of arsine can be immediately fatal.
  • After arsine enters the bloodstream, it damages the red blood cells and leads to symptoms as a direct result of this damage.

Signs and symptoms of arsine exposure

At lower doses, people may not know they have been exposed to arsine, because it has no odor. At higher doses, a mild garlic odor has been reported. Stibine, on the other hand, has a strong odor, so people will probably be aware that they may have been exposed to something. People exposed to a low or moderate dose of arsine by inhalation may experience some or all of the following symptoms within 2 to 24 hours of exposure:

  • Weakness
  • Fatigue
  • Headache
  • Drowsiness
  • Confusion
  • Shortness of breath
  • Rapid breathing
  • Nausea, vomiting, and/or abdominal pain
  • Red or dark urine
  • Yellow skin and eyes (jaundice)
  • Muscle cramps

Exposure to a large dose of arsine by any route may result in these additional health effects:

  • Loss of consciousness
  • Convulsions
  • Paralysis
  • Respiratory failure, possibly leading to death
  • Showing these signs and symptoms does not necessarily mean that a person has been exposed to arsine.

Long-term health effects of arsine exposure

Severely exposed people are not likely to survive. If people survive the initial exposure, long-term effects may include kidney damage, numbness and pain in the extremities, and neuropsychological symptoms such as memory loss, confusion, and irritability.

How you can protect yourself, and what to do if you are exposed to arsine

  • Because no antidote exists for arsine exposure, the best thing to do is avoid it. First, get fresh air by leaving the area where the arsine was released. Moving to an area with fresh air is a good way to reduce the possibility of death from exposure to arsine.
    • If the arsine release was outside, move away from the area where the arsine was released.
    • If the arsine release was indoors, get out of the building.
  • If you are near a release of arsine, emergency coordinators may tell you to either evacuate the area or to “shelter in place” inside a building to avoid being exposed to the chemical. For more information on evacuation during a chemical emergency, see “Facts About Evacuation” at http://emergency.cdc.gov/planning/evacuationfacts.asp. For more information on sheltering in place during a chemical emergency, see “Facts About Sheltering in Place” at http://emergency.cdc.gov/planning/Shelteringfacts.asp.
  • If you think you may have been exposed to arsine, you should remove your clothing, rapidly wash your entire body with soap and water, and get medical care as quickly as possible.
  • Removing your clothing:
    • Quickly take off clothing that may have arsine on it. Any clothing that has to be pulled over the head should be cut off the body instead of pulled over the head.
    • If you are helping other people remove their clothing, try to avoid touching any contaminated areas, and remove the clothing as quickly as possible.
  • Washing yourself:
    • As quickly as possible, wash any arsine from your skin with large amounts of soap and water. Washing with soap and water will help protect people from any chemicals on their bodies.
    • If your eyes are burning or your vision is blurred, rinse your eyes with plain water for 10 to 15 minutes. If you wear contacts, remove them and put them with the contaminated clothing. Do not put the contacts back in your eyes (even if they are not disposable contacts). If you wear eyeglasses, wash them with soap and water. You can put your eyeglasses back on after you wash them.
  • Disposing of your clothes:
    • After you have washed yourself, place your clothing inside a plastic bag. Avoid touching contaminated areas of the clothing. If you can’t avoid touching contaminated areas, or you aren’t sure where the contaminated areas are, wear rubber gloves, turn the bag inside out and use it to pick up the clothing, or put the clothing in the bag using tongs, tool handles, sticks, or similar objects. Anything that touches the contaminated clothing should also be placed in the bag. If you wear contacts, put them in the plastic bag, too.
    • Seal the bag, and then seal that bag inside another plastic bag. Disposing of your clothing in this way will help protect you and other people from any chemicals that might be on your clothes.
    • When the local or state health department or emergency personnel arrive, tell them what you did with your clothes. The health department or emergency personnel will arrange for further disposal. Do not handle the plastic bags yourself.
  • For more information about cleaning your body and disposing of your clothes after a chemical release, see “Chemical Agents: Facts About Personal Cleaning and Disposal of Contaminated Clothing” at http://emergency.cdc.gov/planning/personalcleaningfacts.asp.
  • Seek medical attention right away. Dial 911 and explain what has happened.

How arsine exposure is treated

Treatment consists of providing supportive medical care in a hospital setting. Blood transfusions and intravenous fluids (that is, fluids injected directly into a vein) may be needed. Some people may require hemodialysis (artificial kidneys) for kidney failure. No antidotes are available for arsine.

Arsine or Stibine Poisoning

Clinical description

Inhalation of arsine gas causes no immediate symptoms. Signs and symptoms occur 2 to 24 hours after exposure and result from massive hemolysis. These signs and symptoms include generalized weakness, dark urine, jaundice, and dyspnea. Oliguria and renal failure often occur 1 to 3 days after exposure (1-3).

Laboratory criteria for diagnosis

  • Biologic: No specific test is available for arsine exposure; however, exposure to arsine might be indicated by detection of elevated arsenic levels in urine (>50 µg/L for a spot or >50 µg for a 24-hour urine) and signs of hemolysis (e.g., hemoglobinuria, anemia, or low haptoglobin).
  • Environmental: Detection of arsine in environmental samples, as determined by NIOSH.

Case classification

  • Suspected: A case in which a potentially exposed person is being evaluated by health-care workers or public health officials for poisoning by a particular chemical agent, but no specific credible threat exists.
  • Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for arsine exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
  • Confirmed: A clinically compatible case in which laboratory tests have confirmed exposure.

The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or a 100% certainty of the etiology of the agent is known.