Estimation of the body burden of arsenic in a child fatally poisoned by arsenite weedkiller.

A three-year-old child died after ingestion of a mouthful of an estimated 44% sodium arsenite solution. Litigation was initiated based on the quality of emergency treatment at a rural hospital. An issue raised in litigation was whether the child could have survived if he had received an additional dose of BAL (dimercaprol). BAL had been sent for from a neighboring city and arrived approximately 2.0 h after admission. The first 50-mg dose of BAL could have combined with a maximum of 30 mg arsenic; a second dose could have brought the total of chelated arsenic to 60 mg. To determine the total body burden of arsenic in the child, multiple tissues were analyzed. The total body burden was estimated at 113 mg, with 100 mg of this total attributable to the ingested solution. The actual body burden after two doses of BAL therefore would have been at least 40 mg, a fatal level.