Survival after massive arsenic poisoning self-treated by high fluid intake

A 23-year-old male pharmacist ingested 1040 mg arsenic trioxide (788 mg trivalent arsenic, 13 mg/kg). After 7 asymptomatic hours, frequent vomiting and diarrhea occurred. Fearing death from shock, he drank 5 L of water over 5 hours. When he was brought to our hospital with chief complaint of constricted vision about 20 hours after ingestion, the major abdominal symptoms had already subsided. Despite a lethal plasma arsenic on admission, all toxic symptoms including hepatic dysfunction, erythematous dermal eruption, and peripheral neuropathy improved during his hospital stay with no treatment except for dimercaptopropanol.