Basic Pathology & Toxicology

CURRENT STATUS OF ARSENIC POISONING IN BANGLADESH

Submitted to, Submitted by,

Dr. Md. Hasanuzzaman Shohag SUMAIYA ZAMAN PROME
Assistant Professor, ID:1822001649
NORTH SOUTH UNIVERSITY COURSE:225.2
SECTION: 02

June 9, 2020
DEPARTMENT OF PHARMACEUTICAL SCIENCES
CURRENT STATUS OF ARSENIC POISONING IN BANGLADESH
Introduction:
Arsenic is a metallic element forming several poisonous compounds, arsenic is found in the

earth at a low level. It can be found as organic and inorganic substance. Sulfur (S), oxygen

(O) and Chlorin (Cl) compound contains arsenic which is called inorganic arsenic. This

inorganic arsenic binds with the carbon (C) and hydrogen (H) in the animal. When this

arsenic is inhaled or engulf by the mouth or nose above the limit, it causes poisoning.

Inorganic form, it causes less poisoning than the inorganic form. Arsenic poisoning is a

global problem as well as in Bangladesh. According to a statistic done by IAEA (2002),

33million people are at risk of arsenic poisoning in Bangladesh. [1]

Arsenic :

Arsenic is a heavy metal that occurs naturally found mostly in the earth. It can be found at

small amounts in air, water, rock, and plan. Arsenic has no taste, odour and colour. Minerals

which contains Arsenic in nature are Nickel arsenide (NiAs), Arsenic sulfide (As2S3),

Cobaltite (CoAsS), Arsenic trioxide (As2O3) etc.

Figure 1: Arsenite rock

Source of Arsenic:

Arsenic is solubility in underground water depends on Al 2O3 and Fe2O3, the earth 's pH

depends on the arsenic oxidation number. The solubility of arsenic in the earth reduces in the

presence of Fe and Al oxide and when the pH of the earth is poor the solubility of arsenic in

water increases by oxidation cycle.

Arsenic exists in acidic environments as H2ASO4- and arsenic exists as HASO42- in the basic

environment. In the acidic environment, it will transform H 2ASO4- to arsenite. By reaction to

Fe2 + and Al3 + ions, this arsenite transforms into precipitation and remains in the earth. This

As (3) and As (5) are oxidized by aerobic bacteria and converted into methyl arsenic acid and

di-methyl arsenic acid. Ultimately this compound is reduced by anaerobic bacteria and

converted into dimethyl arsine and trimethyl arsine steam. This gas contaminates the soil and

water. [2]

Reaction:

AlAsO4 H2ASO4- O2 di-methyl arsine O2 trimethyl

AsO2-
--

Aerobic Anaerobic
arsenite

Arsenic poisoning:

Arsenic is a toxic substance for any living organism. Consumption of excessive arsenic can

cause verities of abnormalities in the human body. If this arsenic is inhaled or engulfed

beyond the limit by the mouth or nose, it acts as a toxin. According to the World Health
Organization (WHO), the maximum limit of As consumption in the human body is 0.05/L or

0.05 ppm. And water safety value is 0.01mg/L.[3]

Arsenic Exposure:

Arsenic can pass through the skin through absorption, nose through inhalation, and mouth

through ingestion. Most arsenic poisoning occurs because of the consumption of

contaminated drinking water. Crops, plants and animals also carry arsenic but most of them

are in organic form. This arsenic only rises the arsenic range in our body doesn't give much

toxic effect. Organic arsenic can be easily excreted by the out body.[4]

Absorption :

Arsenic mostly absorbs in the small intestine by an electrogenic process. The optimum pH for

arsenic absorption in the medium is 5.0, though in the small intestine the pH is 7 due to the

secretion of bicarbonate from pancreases.[4]

Distribution:

After absorption, inorganic arsenic quickly binds with the haemoglobin in the red blood cell.

Within a day this arsenic substance is distributed to liver, kidneys, heart, lungs, etc.[6]

Metabolism and Excretion :

Absorbed arsenic goes to the liver and undergo hepatic biomethylation process. By the

process, it converts into monomethylarsonic acid and di-methyalarsinic ascid. These are less

toxic compound and more than 50% is excreted by the urine within 3-5 days. 60-70% of di-

methyarsinic acid can be excreted faster than other organic arsenic. A small amount of

arsenic also excreted by the urine.[6]

Mechanism of Arsenic in the body:

One of two key cells depends on its oxidative state arsenic poisonous cells mechanism. The

trivalent attachment of sulfhydryl groups to essential enzymes, Arsenite depletes lipoate

which is involved in core intermediate synthesis in the Krebs cycle. The effect of lipoate

depletion is inhibition of the Krebs cycle and oxidative phosphorylation resulting in depletion

of ATP. In contrast, pentavalent arsenate can replace the stable phosphate ATP ester bond

with a rapid hydrolyzing arsenate ester bond (arsenolysis) uncoupling and depleting ATP

stores of oxidative phosphorylation.[6]

Toxic effect of Arsenic on human:

Arsenite, a trivalent form As (3) of inorganic arsenic 60-fold more toxic than Arsenate As(5).

Arsenic can inactivate 200 enzymes in the human body. These enzymes are usually involved

in the replication and repair of cellular energy pathways and DNA and are replaced by

phosphate in high energy molecules including for example ATP. Also, unbound arsenic

exerts its toxicity by producing reactive intermediates in oxygen during their redox cycle and

metabolic activation processes. Which cause the peroxidation of lipids and DNA damage.

Example, thiol or sulfhydryl binds as Arsenic trivalent groups in liver, lung, kidney,

gastrointestinal mucous membranes, and tissues which are rich in keratin substances.[4]

there are two types of toxic effect given by the arsenic.

Arsenic
poisoning

Acute chronic
poisoining poisoning
Acute poisoning:

Acute arsenic poisoning occurs when insecticides or pesticides are ingested accidentally or

intentionally. Consumption of less than 5mg can induce vomiting and diarrhoea and possibly

the patient can recover within 12 hours. A lethal dose of arsenic in acute toxicity varies from

100 mg to 300 mg. The Risk Assessment Information System database states “The acute

lethal dose of inorganic arsenic to humans has been estimated to be about 0.6 mg/kg/day”.

abdominal pain, diarrhoea, rash, salivary secretion, seizure, vomiting, nausea can be sign and

symptoms of acute arsenic poisoning.

Management:

The cause of toxicity will be eliminated first, to prevent severe arsenic poisoning. The arsenic

may be absorbed mainly through vomiting. If it doesn't work, washing the gastrointestinal

with the assistance of good absorbent charcoal should work.

Chronic poisoning:

Chronic poisoning happens when a person is consuming a toxic substance for a while.

Arsenic contaminated water or foods can be the reason for chronic arsenic poisoning. It

causes many fatal diseases, among them the most dangerous one is malignancy. Other major

diseases are mentioned below;

DNA damage:

There is growing proof that arsenic is gene-toxic. Various types of DNA damage result from

exposure of this are carcinogenic. The promotion of chromosomal aberrations was reported;

exchange sister chromatids, and induce hyper DNA for hypomethylation. Arsenic effect on

DNA Methyltransferases which result in tumour suppressor inactivation of genes by

hypermethylation with DNA.[7] Inactivation of tumour suppressor can lead to the formation of

tumour and then mature as cancer.

Skin:
Many skin disease can be caused by arsenic exposure. Hyperpigmentation takes place as

deep, dark brown spots, or less discrete, intermittent skin darkening, or characteristic

appearance of "raindrop". Associated arsenic skin cancer is an unusual form of Bowen 's

disease in Asians, maybe due to the high content of skin melanin and increased ultraviolet

radiation exposure; Arsenic in a skin pigmented with non-melanin may develop a basal cell

carcinoma. Another skin disease, keratosis can appear as discrete nodules.[4]

Gastrointestinal system:

Diarrhoea occurs in chronic toxicity in recurring bouts and probably linked to vomiting.

Arsenic ingestion should be suspected when other symptoms such as skin changes and

neuropathy occur.

Cardiovascular system:

Cardiovascular diseases can be increased in e arsenic exposure. Arsenic specifically induces

myocardial damage, cardiac arrhythmias and cardiac attack. Black foot disease has a unique

peripheral character vascular disease which causes foot gangrene

Neurological system:

The neurological system is the principal target for the toxic metal. The most common finding

is that of peripheral neuropathy which is similar to Guillain-Barré syndrome results

electromyographic. The original neuropathy is glove tactile and stock anaesthesia. The

toxicity effects also include behavioural changes, cognitive deficiency and attention failure.

The mental function returned to normal after the retirement arsenic source.

Malignant disease:

It is one of the most dangerous diseases caused by arsenic. It is the reason for skin, intestinal,

brain cancer. it also can cause stone formation in the bladder. Though not fully determined,

the mechanisms may because of the adverse effects on DNA repair, methylation of the DNA

and increased free radical formation. Arsenic may act as a tumour, , creator or progressor of
tumours and it may also act as a carcinogen in other conditions. Large amounts of the arsenic

in livestock are teratogenic.

Management :

Chronic arsenic poisoning symptoms can get better if the consumption of arsenic is stopped.

further treatment for the specific diseases can improve inpatient health.

Roles of Arsenic:

Arsenic has a toxic effect on our body. But it also important for the body. Even though in

very low amount. Deficiency of it in animals can increased mortality rate; decrease fertility,

higher spontaneous abortion rate, the low birth weight of the infant, and damage to red blood

cells in offspring.[6]

History of arsenic:

Arsenic is known as the "king of the poison". It is because, in the Renaissance era, arsenic

was used as a poison to kill the enemy. The Borgia and Medici family in Italy are a

practitioner of this poison. It was known as the most dangerous poison as it does not have any

odour, colour or taste.[10]

Arsenic a global issue:

Arsenic poisoning is considered a global environmental disease. Arsenic is label as most

carcinogen compound according to WHO,2008. Some countries around the world suffering

more from the disease because of their geographical structure and availability of arsenic

compound. In Bangladesh, India, Pakistan, Taiwan people are at great risk of arsenic

poisoning. More than 100million people around the world at risk of arsenic poisoning.

Arsenic in Bangladesh:

Arsenic poisoning by drinking contaminated water is a global public health issue that is

especially debilitating in Bangladesh. Reason can be either underground arsenic or industrial

heavy metal waste which is thrown out in water. Survey result of 2000 to 2010, about 35 to
77 million citizens in the country have been systematically exposed to arsenic in their

drinking water, which has been described as the largest mass poisoning in history.

Unfortunately, in rural areas, a mass population that is highly exposed to arsenic but has

limited means to find safe and contamination-free water. [3]

The first arsenic was found in underwater in1993 in Bangladesh. As most people in

Bangladesh (around 90%) is dependent on underground water, the chance of drinking

contaminated water is very high. Geography in Bangladesh is partly responsible for arsenic

contamination since arsenic is the removal of alluvial and deltaic sediments by aquifers. In

Bangladesh, arsenic pollutes shallow groundwater. If calculated against International Health

Criteria Organization (WHO), the arsenic content in water is significantly above the WHO

suggested average standard of 10 micrograms per litre. In most of the affected areas of

Bangladesh arsenic concentration in water is above 50 micrograms per litre. [5]

Figure 2: According to the UNICEF, arsenic contamination area in Bangladesh

Within 12 years of the first discovery of arsenic pollution, it was clear that groundwater

arsenic toxicity was occurring in 62 of 64 districts in Bangladesh. A countrywide screening

for arsenic contamination in tube well water was initiated in 1996, regarding sporadic

detection and reporting of groundwater arsenic contamination. [8] in 1999, more than 51000

tube wells water are tasted arsenic contamination found in 211 out of 460 upazillas, 51% tube

well water contains >0.01 ppm, 35% tube wells water contains >0.05 ppm and 14% of water

contains > 0.1-1.0 ppm arsenic is found. In 2003, the Bangladesh Arsenic Mitigation Water

Supply Project (BAMWSP) done a nationwide survey covering 57,482 villages in 271

upazillas, with 1,44 million tube wells stated to be polluted out of 4,95 million tube wells for

arsenic pollution. In Jashor districts, sharsha thana most arsenic-contaminated water was

found. Also in golapgonj,cumilla, jhosor ,munishigonj, shoriyetpur etc district people are

suffering from “backfoot” disease.

According to the FAO report if the arsenic-containing water is used in the crop during

cultivation it can contain a high level of arsenic in it. This food can also increase the

consumption level of As in the human body and give a harmful effect in the body potentially.

Steps which are taken to prevent arsenic poisoning:

As Bangladesh has the most arsenic affected population to decrease the rate of contamination

Bangladesh government decided to run free tube well water test around the country. A group

of specialists go to the affected area and test the water. If the water contains arsenic they put

the red mark on the tube wells. These waters can be ingested but other housework like

dishwashing, cloth cleaning can be done by this water. If the water does not contain any

arsenic in it or consumable level of arsenic they put green colour on the tube well which

means it is safe to use as drinking water. They also run the test in ponds and other

underground water sources. If a village has only arsenic-contaminated water government

migrate the safe water from the nearest village and the cities.

Industries near the rivers are moved to stop the further arsenic or any metal contamination.
People who are suffering from arsenic-contaminated diseases are getting treated in hospitals,

clinic and health centre for free. Government raising the awareness of people by using

attractive advertisement, health show and documentary.

According to the Bangladesh government, the contamination level has decreased within 10

years. Where in 2010 the suffers from arsenic contamination are more than 65% in 2020 it

became 15%. Which explained the peoples rising awareness and decrease of the

contamination.

Conclusion:

Arsenic poisoning is a global problem. Increase level of arsenic may change the pH of soil

also. Water contamination can be alarming. To ensure the safe water the further

contamination of water should be stopped. Arsenic exposure could be eliminated by 2030 if

the government invests a small fraction of its annual GDP growth in providing arsenic-safe

water supply and improving the monitoring and surveillance activities of water quality.

Reductions in arsenic-related mortality would be noted within approximately 40 years, as

suggested by observations in similarly exposed populations in Chile and Taiwan (China),

where arsenic-related cancer mortality gradually declined about 20 or 25 years after

exposure.[3]
References:

1. Islam, M.S., Islam, F. and IWA, W.W., 2010. Arsenic contamination in groundwater in

Bangladesh: an environmental and social disaster. IWA Water Wiki.

2. Hazari, S., 2017. chemistry 2nd pepar. 2nd ed. Bangladesh: Hasan book house.

3. WHO | World Health Organization. 2020. WHO | World Health Organization. [ONLINE]

Available at https://www.who.int/. [Accessed 09 June 2020].

4. Ratnaike, R.N., 2003. Acute and chronic arsenic toxicity. Postgraduate medical journal,

79(933), pp.391-396.

5. Alam, I., Arsenic poisoning in Bangladesh.

6. Ibrahim, D., Froberg, B., Wolf, A. and Rusyniak, D.E., 2006. Heavy metal poisoning:

clinical presentations and pathophysiology. Clinics in laboratory medicine, 26(1), pp.67-97.

7. Shi, H., Shi, X. and Liu, K.J., 2004. Oxidative mechanism of arsenic toxicity and

carcinogenesis. Molecular and cellular biochemistry, 255(1-2), pp.67-78

8. Ahmad, S.A., Khan, M.H. and Haque, M., 2018. Arsenic contamination in groundwater in

Bangladesh: implications and challenges for healthcare policy. Risk management and

healthcare policy, 11, p.251.

9. Flanagan, S.V., Johnston, R.B. and Zheng, Y., 2012. Arsenic in tube well water in

Bangladesh: health and economic impacts and implications for arsenic mitigation. Bulletin of

the World Health Organization, 90, pp.839-846.

10. Kumar, Abbas, V., 2015. Pathologic basis of disease. 9th ed. Canada: Elsevier.