KARACHI: No drug for arsenic poisoning available: Hospitals helpless
By Mukhtar Alam
KARACHI, Feb 3: Two members of a family from Sukkur, who were confirmed as “chronic arsenic poisoning” cases were discharged from the Jinnah Postgraduate Medical Centre (JPMC) without giving chelation therapy, a process meant for removal of heavy metals from the human body.
According to senior practitioners at the JPMC, the patients, a father and his son, who were monitored and given supplementary treatment for about two months at the hospital, could not be administered chelating agents as those, were not locally available.
In the absence of the required organic compound at the JPMC, we tried our best to get those from local stores, private and government hospitals, but in vain, and finally allowed the patients to leave for home about a week back, with the instruction that they will be recalled for therapy as soon as the required medicines were made available to us, said Prof Tasnim Ahsan, chief of medical and allied disciplines at the JPMC.
According to experts, chelating agents were introduced in medicine after the use of poison gas based, among others, on arsenic organic compound. The first widely used chelating agent was called British Anti-Lewisite (BAL), a name given to dimercaprol.
Later a group of chelating agents was discovered, which proper bind with metallic ions so that the ion is held by several chemical bonds, thus rendering it much less chemically reactive and allowing the ion to be excreted harmlessly.
The chelating agent may be administered intravenously, intramuscularly, orally, depending on the agent and type of poisoning.
The father and son, both carpenters, were admitted to JPMC on Dec 9, 2005, as doctors failed to handle them at Sukkur.
It was reported that the patients had consumed tube well water carrying arsenic content, which was later confirmed after various laboratory tests of samples of urine, hairs and nails of the two patients and water samples from the source which remained in their use.
After chemical analysis at two laboratories, including the PCSIR, it was found that the body and water samples contained a dangerously high level of arsenic.
Two daughters and a son of the same family had also developed symptoms similar to their father and brother during the last three or four months.
When admitted to the JPMC, the father, 45, and son, 20, had lost almost half of their weights and were bed-ridden due to weakness.
They had greyish brown scaly lesions over palms and soles and hyper pigmentation of skin on the neck and abdomen.
Prof Tasneem said that the patients had been unable to regain a routine life, but on the basis of supportive treatment, change of water they consumed and administration of multivitamins at the hospitals the over all condition of the patients had improved to some extent.
The damage has been done to them in the wake of arsenic consumption and no curative process can help them recover completely. In the absence of extra renal elimination techniques and chelating agents, the arsenic would take a long time to get eliminated from the bodies, Prof Tasneem replied to a question.
She said that the federal and provincial health ministry and departments had also been informed about the non-availability of chelating agents, urging them to make arrangements for those.
She expressed the view that there was an urgent need for surveying water samples and relevant samples from other area of Sukkur.
Dr Tasneem said that the family in question had stopped consuming the contaminated water, but it was necessary in the interest of other residents too to ensure that they were taking safe potable water.
Water Quality Assessment: In the meantime, Dawn has gathered that neither the officials in the Sukkur district health office nor the regional office of SEPA have so far moved on ground for any survey of the water sources, doctors working in the area or families, despite lapse of about one month after surfacing of the chronic arsenic poisoning.
The EDO Health, Sukkur, Dr Hafizur Rehman, told Dawn on Thursday that he had a meeting with his staff on Tuesday on the issue and the required sampling and testing of water would start in a day or two.
A deputy director at the regional office of Sindh Environmental Protection Agency, Sukkur, Viqar Phulpoto, said that he was not aware of any arsenic contamination of water in the area and at present no sampling of water was in progress for the purpose. I have not received any directives for such exercise from my headquarters as well, he replied to a question.
