- Mechanism: Inhibits pyruvate dehydrogenase complex by binding to lipoic acid → ↓ ATP.
- Acute Presentation: Garlic breath, severe watery diarrhea (“rice-water stools”), QTc prolongation.
- Chronic Presentation:
- Neuropathy: Painful “stocking-glove” distribution.
- Skin: Hyperpigmentation & hyperkeratosis (palms/soles).
- Nails: Mees’ lines (transverse white lines).
- High-Yield Associations:
- Contaminated well water.
- Pesticides, insecticides, herbicides.
- Cancers: Squamous cell carcinoma of the skin, angiosarcoma of the liver.
- Dx: ↑ urine arsenic level.
- Tx: Chelation therapy (Dimercaprol, Succimer).