Module 3: Toxicology - Section 14: Renal-urinary tract and the kidney
TOX 14.4: Case study: sudden onset of renal failure

Case study: sudden onset of renal failure:

A 45 year old metallurgical assistant in the laboratory of a platinum refinery awoke in the early hours of the morning and noticed sudden onset of haematuria (bloody urine). This was followed by a feeling of being unwell. He sought medical attention that morning and was rapidly admitted to hospital with acute haemolysis (breaking up red blood cells) and renal failure.

He had a difficult course, requiring ICU admission, blood transfusions and haemodialysis, and required three weeks in hospital. He was discharged after three weeks, with persisting signs of kidney dysfunction.

Investigations led also to his job and the following was pieced together. His work in the laboratory required the assay of some of the rarer components of the platinum bearing ore (such as ruthenium) using hydrocholoric acid. This ore was contaminated by arsenic. Arsine gas, which is odourless and non-irritating, is then produced by the following (simplified) reaction:

6HCl + 2As ® 2AsH3

He had suffered acute haemoloysis due to inhalation of arsine gas, with acute renal failure secondary to the haemolysis (pouring of haemoglobin from the ruptured red blood cells through the kidney).

Lessons:

This is a rare occurrence and therefore difficult to predict, but it illustrates:

  1. Insidious nature of poisoning by a gas. (Same applies in other contexts to skin absorption).
  2. How separation of the exposure and the presentation, even for acute disease, may cause one to miss the association.
  3. Need for anticipation in specialised situations, e.g. metallurgy laboratory, of such hazards.



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Postgraduate Diploma in Occupational Health (DOH) - Modules 3: Occupational Medicine & Toxicology (Basic) by Profs Mohamed Jeebhay and Rodney Ehrlich, Health Sciences UCT is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 2.5 South Africa License. Major contributors: Mohamed Jeebhay, Rodney Ehrlich, Jonny Myers, Leslie London, Sophie Kisting, Rajen Naidoo, Saloshni Naidoo. Source available from here. For any updates to the material, or more permissions beyond the scope of this license, please email healthoer@uct.ac.za or visit www.healthedu.uct.ac.za. Last updated Jan 2007.
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