From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Connolly, Grainne
Sent: Wednesday, July 04, 2018 9:22 AM
To: [log in to unmask]
Subject: Re: urine arsenic

Thanks to all of you who have replied so far.
The child has a normal diet and there has been no history of ingestion or magic putty.

Grainne



Sent from my Windows Phone

Dear all,

 

I would be grateful for any thoughts on the case below.

 

5 year old boy presented with D+V illness, rash, fall in GCS, encephalopathy, ataxia, weakness and required ventilation in PICU (due to the severity of his neurological condition).

Nerve conduction studies showed predominantly axonal loss peripheral neuropathy. CSF total protein 6g/l. MRI brain nil significant.

He was treated as a possible Gullian Barre variant and was given IV immunoglobulin and steroids. Clinically he improved with this treatment.

 

Urine arsenic requested shortly after admission was 223 nmol/mmol creat (0-12.9 nmol/mmol creat).

A repeat sample was sent (about 4 weeks into his hospital admission) and although he was clinically much improved his urine arsenic had increased to 730 nmol/mmol creat. 

A further urine arsenic sample 1 week later was 40 nmol/mmol creat and urine cobalt (which had been normal) had increased 5.9 (0-2.0) nmol/mmol creat.

Mother and sibling urine arsenics are normal.

 

Public Health have not identified a source for the elevated urinary arsenic. He has a normal diet.

 

We are having some difficulty piecing this all together, so would be grateful if anyone has any ideas.

 

Many thanks,

 

Grainne

 

Consultant Chemical Pathologist

Belfast Trust