United States Environmental Protection Agency Environmental Criteria and Assessment Office Research Triangle Park NC 27711 Research and Development EPA/600/S8-83/021F Aug. 1985 &ER& Project Summary Health Assessment Document for Inorganic Arsenic Inorganic arsenic, predominantly the tri- and pentavalent forms, is emitted to the environment principally through primary smelting activity, biocide use, and glass manufacturing. Ambient air monitoring data indicate a concentra- tion equal to or less than 0.1 /tg/m* for most locations. Major routes of absorp- tion of inorganic arsenic in the general population are inhalation and inges- tion. Inhaled inorganic arsenic deposited in the lungs is eventually ab- sorbed. Most ingested soluble in- organic arsenic is absorbed, whereas insoluble forms pass through the gas- trointestinal tract with negligible ab- sorption. Inorganic arsenic metabolism in man is complicated by biotransfor- mation processes which include the methylation and oxidation reduction in- terconversion of inorganic arsenic. Long-term accumulation of inorganic arsenic does not generally occur in physiologically active compartments in the body; renal clearance appears to be the major route of excretion of absorb- ed inorganic arsenic. Acute symptoms of inorganic arsenic poisoning include severe gastrointestinal damage, facial edema, cardiovascular reactions, peripheral nervous system distur- bances, and hematopoietic system ef- fects. General population concerns arising from longterm exposures to moderate levels of inorganic arsenic in- clude respiratory tract cancer, skin cancer, noncancerous skin lesions, peripheral neuropathological effects and cardiovascular effects. There ap- pears to be a nutritional requirement for low levels of inorganic arsenic in certain experimental animals; however, this requirement has not yet been established in man. This Project Summary was devel- oped by EPA's Environmental Criteria and Assessment Office, Research Triangle Park, NC, to announce key findings of the research project that is fully documented in a separate report of the same title (see Project Report ordering information at back). Introduction As a toxic agent, inorganic arsenic possesses several unique properties. The element exists in various chemical states; e.g., tri- and pentavalent inorganic arsenic and methylated organic arsenic, with each having differing toxicological potential. In man, experimental animals, and other organisms, arsenic undergoes a variety of transformations, the full significance and mechanisms of which are, as yet, not well understood. Furthermore, there appears to be a nutritional requirement for low levels of arsenic in certain experimental animals, and this may also be the case for man. All of these factors complicate the analyses of the toxicological effects and the risk for human health associated with environ- mental exposure to arsenic compounds. The following sections summarize these factors which are presented in depth in the document text. Chemical/Physical Aspects of Arsenic Arsenic is encountered as a component of sulfidic ores of metals such as copper, cobalt, and nickel; the smelting of these ores is associated with arsenic release to the environment. Arsenic trioxide, ASjOa, a lexicologically significant form, is a smelter product arising from air roasting of the sulfidic ores. It is only sparingly soluble in water and other solvents which do not pro- mote chemical transformation. This arsenic compound dissolves in acidic or alkaline aqueous media to yield either the free acid or salts, soluble in a number of solvents. The oxide readily sublimes (135°C), a factor important in choosing analytical methods ------- for measuring levels of the compound. The pentavalent arsenic pentoxide, As206, may be prepared by nitric acid oxidation of the trioxide or the element itself. This form has high solubility in water (63 g/100 g water), forming the strongly oxidizing arsenic acid, H3As04 (E° = 0.56V). Stability of the valency forms of arsenic in solution depends on the nature of the medium. Oxygenated media and higher pH favor the pentavalent form, while reducing and/or acidic media favor the trivalent state. The acids of both valency forms of arsenic readily form alkali and alkaline metal salts, with the former being more soluble than the latter. Organic ester derivatives of arsenic are quite labile to hydrolysis, and this chemical behavior has biochemical/ toxicological implications in the postulated role of arsenate ion in interfering with phos- phorylation reactions. Arsine (arsenic trihydride, AsH3) is the most poisonous of the arsenicals, being a strong hemolytic agent; it can be formed under certain restricted conditions, e.g., reduction of the oxy compounds in the presence of a strong hydrogen source. Monomethyl and dimethyl arsenic arise by both environmental and in vivo trans- formation processes. In high-temperature processes, arsenic is released as a vapor which is then adsorbed or condensed onto small particles. Such adherence to particles of 1-2 /im or less may result in enhanced health risk from the agent since particles in this size range are inhaled and deposited in the deepest part of the respiratory tract. Arsenic compounds tend to form insolu- ble complexes with soils and sediments. In the case of soils, the interaction occurs with amorphous aluminum or iron oxides. The Environmental Cycling of Arsenic Primary smelting, biocide use, and glass manufacturing are major sources of arsenic in the environment. Of an estimated total release of approximately 10,000 short tons annually in the United States, smelter ac- tivity accounts for 50 percent; use of biocide (pesticide, fungicide, herbicide), 32 percent; and glass production contributes about 7.0 percent; various other sources release the remainder. The atmosphere is a major conduit for arsenic emitted from anthropogenic sources via wet and dry precipitation pro- cesses to the other environmental media. Dry and wet arsenic falling on soils may be followed by movement through soils either into groundwater or surface water. Passage of arsenic into surface waters may be followed by its transfer to sediments. Such cycling is made complex by chemical and biological transformations, which have been reported as occurring in the various environmental compartments. Trivalent arsenic in the atmosphere or in aerated surface waters can undergo oxida- tion to the pentavalent state, while pen- tavalent arsenic in media which are below pH 7.0 and contain oxidizable material can be reduced to the trivalent form. Biological transformations of arsenic have been documented as occurring via both sedimentary bacteria and suspended marine algae. Reduction and mythylation of inorganic arsenic occur only to a limited ex- tent in soils, one report noting a conversion of only 1-2 percent over a period of months. The annual environmental burden of arsenic indicates that approximately 90 per- cent of arsenic is deposited on land, with the atmosphere accounting for eight per- cent and the smallest quantity deposited in waters. Levels of Arsenic in Various Media Available data on levels of arsenic in various media with which man interacts are generally presented as total arsenic, with limited information available for identifying specific chemical forms of arsenic. Levels of Arsenic in Ambient Air Based on the comprehensive data for U.S. air levels of arsenic obtained by the U.S. EPA's National Air Sampling Net- work, air levels of arsenic in the U.S. generally do not exceed 0.1 /*g/m3. Generally, airborne arsenic adheres to particulate matter. Although the immediate areas around smelters may contain some arsenic in the vapor form, available data in- dicate rapid adherence to particulate matter when sampling 2-3 km from these emission sites. The specific chemical form(s) of airborne arsenic is still unclear. Generally, in most urban/suburban areas, arsenic occurs mainly in the form of a mixture of inorganic arsenic in the tri- and pentavalent states. Only in areas where methylated arsenic is used agriculturally, or where biotic trans- formation can occur, has methylated arsenic been found in air samples. Levels of Arsenic in Drinking Water The National Interim Primary Drinking Water Regulations, promulgated under the Safe Drinking Water Act, set the Maximum Contaminant Level (MCL) for arsenic in U.S. public water supplies at 50 general, arsenic is not found in drinkin water at levels exceeding this MCL. W* waters in the western U.S. and Alask; however, may have much higher levels ov ing to geochemical enrichment. In Lar County, Oregon, recent analyses repo levels up to 2.2 ppm (2.2 mg/liter), whi the highest figure in Alaska was 10 ppm (1 mg/liter), representing both natural an mining residue contributions. It is reasonable to assume that the chii chemical form of arsenic in most publ water supplies would be the pentavalent ir organic form, owing to both aeration an chlorination. Similarly, well waters i Alaska and the western U.S. are reporte to mainly contain pentavalent inorgan arsenic. Arsenic in Food The most recent data base for the arson content of foods is the 1975-1976 surve carried out by the U.S. Food and Drug Ac ministration. Shellfish and other marir foods have the highest levels on a foe category basis. Overall, the total dietary it take of arsenic in 1975-1976 was appro: imately 50 fig (elemental arsenic), repn senting an increase from the precedin years. Whether this increase represents trend or merely reflects analytical variatic in sampling from year to year is still to t determined. The chemical forms of arsenic in fooc are varied and complex. Crustaceans ar other marine life store arsenic in compk organoarsenical forms which, based on n cent reports, are assimilated by man ar generally excreted intact. Toxicologicall these forms are comparatively inert. Arsenic in Soils Background soil arsenic levels ranc from less than 1 ppm to over 40 ppm, tf latter reflecting agricultural practices < well as air fallout. Soil arsenic is usual bound to clay surfaces, and its mobility is function of soil pH, phosphate levels, ire and aluminum content, and soil type. Tl mobile fraction, usually in the pentavale form, is of concern in terms of moveme to plants and water. Little reducth methylation occurs in most soils. Other Sources of Arsenic Limited data on arsenic content of toba co suggest that more recent values rant from around 1.5 ppm or less, while in tl past (1945), values up to 40 ppm we measured. This decrease reflects reduct use of arsenical biocides in tobacco produ tion. ------- Aggregate Exposure Levels to Arsenic in the U.S. Population Among individuals of the general popula- tion (not occupational^ exposed to arsenic), the main routes of exposure to arsenic are typically via ingestion of food and water, with lesser exposures occurring via inhalation. Representative intake figures are presented in Table 1. Intake by inhala- tion is augmented among smokers in pro- portion to the level of smoking. Assuming a daily ventilation rate of 20 m3, and a national population inhalation average of 0.006 /*g/m3/As, the total daily inhalation exposure for arsenic can be pro- jected to be approximately 0.12 fig. Assum- ing 30 percent absorption, approximately 0.03 /tg of arsenic would be absorbed on a daily average. Contribution of tobacco-borne arsenic to the respiratory burden would depend upon the rate of cigarette smoking. Assuming a mass of 1 gram/cigarette and an average tobacco value of 1.5 ppm, this yields 1.5 fig arsenic/cigarette. With 20 percent of this amount in mainstream smoke, the inhaled amount for each pack of cigarettes would be approximately 6 /*g arsenic, and of this amount, 40 percent would be deposited in the respiratory tract. Assuming an absorp- tion of 75 percent of the deposited fraction, approximately 2 g/pack of cigarettes would be absorbed. This represents a factor of 10 to 100 times greater than intake for nonsmokers in given ambient air settings. The rates of absorption for trivalent and pentavalent arsenic in the respiratory tract are assumed to be equivalent. Since drinking water arsenic is mainly in a soluble form (arsenate or arsenite), vir- tually all of it is absorbed in the Gl tract. Thus, assuming an average daily consump- tion of two liters of water containing at most 10 ing As/liter as an outside high figure, it can be estimated that the total arsenic absorbed from drinking water would be approximately 20 fig/day. Most individuals would, in reality, take in much less than this amount, while those in the Western U.S. with well water supplies much higher in arsenic content would assimilate proportionately more. Food arsenic values taken from the 1976 FDA survey indicate a daily total dietary in- take of approximately 50 /*g elemental arsenic. The major portion (80 percent) of food arsenic would be absorbed, resulting in a net daily food arsenic absorption of 40 lig total. Thus, a nonsmoker would have a total daily absorption from all exposure media of approximately 60 HQ arsenic/day or less. Of this, the diet would be the major con- Table 1. Routes of Daily Human Arsenic Intake Route/Level Rate Total Intake Absorbed Amount Ambient air/ 0.006 ng/m3 (a) Drinking water/ < 10 ng/ liter Food/SO ng daily (elemental As) Cigarettes/ 6 ng in mainstream smoke/ pack le) Total: < 60 fig nonsmokers 20m3 2 liters Vi pack 1 pack 2 pack 0. 12 pg 50 M 3/i9 6119 12 W 0.036 ft 40 it 0.9 n 1.8 p 2.7 f. p!c! g(1) gtt) {a]National Average for 1981. lbl'Assumes 30 percent respiratory absorption. M Assumes total absorption. ldl'Assumes 80 percent absorption. MAssumes 20 percent of cigarette content in inhaled smoke. w Assumes 30 percent absorption of inhaled amount. tributor, assuming levels in water much below 10 /tg/liter. For cigarette smokers, 2 jig/arsenic/pack of cigarettes smoked daily would have to be added. If aggregate intake is viewed not in terms of total arsenic intake but in terms of tox- icologically significant forms of the ele- ment, then much of the dietary fraction, for reasons given earlier, such as complex organoarsenicals being present, becomes relatively less important than the forms in water and air as well as in cigarette smoke. Arsenic forms in such media include pen- tavalent arsenic in most water supplies, variable mixtures of tri- and pentavalent arsenic in ambient air, and probably an arsenic oxide in cigarette smoke. From this viewpoint, utilizing the examples already given above, nonsmokers would absorb 20 fig or less daily of lexicologically significant arsenic. Heavy smokers having otherwise very low air and water exposure, con- ceivably could receive their major exposure via cigarettes. Significant Human Health Effects Associated With Ambient Exposure Acute Exposure Effects Serious acute effects and late sequelae from exposure to arsenic will appear after single or short-term respiratory or oral ex- posures to large amounts of arsenic. Available data indicate that inorganic trivalent compounds of arsenic are general- ly more acutely toxic than inorganic pen- tavalent compounds, which in turn are more toxic than organic arsenic com- pounds. Serious effects will also appear after long-term exposure to respiratory or oral doses of arsenic. The acute symptoms following oral ex- posure consist of gastrointestinal disturb- ances, which may be so severe that secon- dary cardiovascular effects and shock may result and cause death. Also, direct toxic effects on the liver, blood-forming organs, the central and pheripheral nervous systems, and the cardiovascular system may appear. Some symptoms, especially those from the nervous system, may ap- pear a long time after exposure has ceased and may not be reversible, whereas the other effects seem to be reversible. Infants and young children especially are suscepti- ble with regard to effects on the central ner- vous system. A Japanese study on milk poisoned with arsenic showed that per- sisting damage, especially mental retarda- tion and epilepsy, is a late sequela in children of short-term oral exposure to large doses of inorganic arsenic. Among adults, the central nervous system is not as susceptible, but peripheral neuropathy has been a common finding. Both in adults and children, acute oral exposure has resulted in dermal changes, especially hyperpigmentation and kera- tosis, as a late sequela. Acute inhalation exposures have also resulted in irritation of the upper respiratory tract, even leading to nasal perforations. Direct dermal exposure to arsenic may lead to dermal changes; allergic reactions may also be involved. Chronic Exposure Effects Both carcinogenic and non-carcinogenic effects are associated with long-term ex- posures, which do not cause any obvious immediate effects. Chronic effects ger- mane to the general population can be ranked as follows: 1. Respiratory tract cancer 2. Skin cancer 3. Non-cancerous skin lesions 4. Peripheral neuropathological effects 5. Cardiovascular changes ------- Cancer of the respiratory system is clearly associated with exposure to ar- senic via inhalation. This association has been especially noted among smelter workers where there is a consistency of findings across different studies in dif- ferent countries, high relative risk, and dose-response by length and intensity of exposure. Excess risk of lung cancer has also been found among arsenical pesti- cide manufacturing workers. Based on this information, the Carcinogen Assess- ment Group (CAG) of the U.S. Environ- mental Protection Agency has concluded that there is sufficient evidence that inorganic arsenic compounds are lung carcinogens in humans. Cancer of the skin was found to have a dose-related effect in a population in Taiwan who had lifetime exposure to arsenic in well water. Cancer of the skin has also been found among people treated with large doses of arsenite for skin disorders. The CAG has concluded that there is sufficient evidence that inorganic arsenic compounds are skin carcinogens in humans. Hyperkeratosis and hyperpigmentation, sometimes with precancerous changes, have been a common finding in persons in- gesting arsenic. These skin lesions, as well as the manifest cancer, develop on skin sur- faces usually unexposed to sunlight. In studies in the United States, an association between skin lesions or skin cancer has not been demonstrated. These studies have been limited, however, by sample sizes too small to be able to detect the dose response seen in studies outside the U.S. The effects on the peripheral nervous system range from sensory disturbances to motor weakness and even paralysis. The more severe signs have been noted in subacute poisonings, but more subtle changes after long-term low-level exposure have been found by using electromy- ography or measuring nerve conduction velocity. These subclinical effects are slow in recovery and may persist for years after cessation of exposure. In a study in Canada, electromyographic (EMG) changes were noted when water concen- trations of arsenic exceeded 0.05 mg/l. Cardiovascular effects have been noted especially in Taiwan, where Blackfoot disease (peripheral vasculopathy) occurred after long-term exposure to arsenic in well water. However, the presence of ergota- mine-like compounds raises the possibility of vascular effects from these agents. Peripheral vascular changes were also found among German vintners who were exposed both occupationally, by spraying arsenic-containing pesticides, and orally. by drinking wine with elevated arsenic levels. Studies on occupationally exposed persons have been inconclusive in showing that arsenic causes an increase in mortality from cardiac disease. Dose-Effect/Dose-Response Relationships The general question of how to define and employ a dose factor in attempts at quantitative assessments of human health risk for any toxicant is highly dependent upon: 1) the available information on the body's ability to metabolize the agent, and 2) the assessment of the relative utility of various internal indices of exposure. The time period over which a given total intake occurs is highly important. For ex- ample, intake of one gram of arsenic over a period of years would be quite different pathophysiologically from assimilating this amount at one time, the latter probably having a lethal outcome. This time- dependent behavior is related in part to the relative ability of the body to detoxify in- organic arsenic by methylation as a func- tion of both dose and time. In cases of acute and subacute exposure, indicators of internal exposure such as blood or urine arsenic levels are probably appropriate for assessing the intensity of exposure. With chronic, low-level exposure, how- ever, the available data would indicate that the total amount assimilated is probably more important than an indicator concen- tration without knowledge of the total ex- posure period. An added problem is the background level of arsenic found in these indicators due to dietary habits. For exam- ple, in acute exposures, levels in blood or urine would be greatly elevated over background values while low-level chronic exposures would only result in moderate in- creases over background. In regard to hair arsenic levels as an in- dicator of internal arsenic exposure, no reliable methods exist for distinguishing ex- ternal contamination levels from those ac- cumulated via absorption and metabolic distribution. Hair arsenic levels cannot, therefore, be employed as reliable in- dicators of either current or cumulative long-term exposures for individual subjects, but rather may provide only a rough overall indication of group exposure situations. Given the above considerations and limitations concerning the use of blood, urinary, or hair arsenic concentrations as in- ternal indices of cumulative, long-term low- level arsenic exposures of concern here, the dose-effect/dose-response relationships summarized below are done so mainly in terms of external arsenic exposure levels v either inhalation or ingestion. It is difficult to define a precise acul lethal dose of arsenic for man, becaus such exposure situations rarely allow a< curate determination of the effectiv amounts. However, for trivalent arsenii the figure is believed to range from 70 1 180 milligrams. For subacute exposure, it appears thi for children, about one gram assimilate over a period of 3-4 weeks will induce deal with severe effects in survivors, while f< adults, that dose will occasion significar clinical effects. In one poisoning episodi intake of approximately 50 milligrams over period as short as two weeks resulted i clinically demonstrable effects in adults. From available data, the Carcinoge Assessment Group (CAG) has estimate carcinogenic unit risks for both air an water exposures to arsenic. The quar titative aspect of carcinogen risk asses: ment is included here because it may be c use in setting regulatory priorities evaluating the adequacy of technology based controls, and other aspects of th regulatory decision-making process However, the imprecision of present available technology for estimating canct risks to humans at low levels of exposui should be recognized. At best, the line; extrapolation model used provides a roug but plausible estimate of the upper limit c risk—that is, with this model it is not like that the true risk would be much more tha the estimated risk, but it could be cor siderably lower. The risk estimate presented below should not be regardec therefore, as accurate representations < true cancer risks even when the exposure involved are accurately defined. Th estimates presented may, however, be fai tored into regulatory decisions to the exter that the concept of upper-risk limits found to be useful. The air estimates were based on dal obtained in five separate studies involvin three independently exposed worker pop ulations. Both linear and quadratic absc lute risk and relative risk models wer fitted to the data. It was found that for th models that fit the data at the p = 0.01 c better level, the corresponding unit ris estimates ranged from 1.05x10~4to1.3 x 10~2. Linear models were found to f better than quadratic models, and absc lute risk models better than relative ris models. Restricting their unit risk esi imates to those obtained from linee absolute risk models gave a range of 1.2 x 10"3to 7.6 x 10"3. A weighted average c the five estimates in this range gave composite estimate of 4.3 x 10~3. ------- The unit risk estimates for water were based on an extensive drinking water study which was conducted in a rural area of Taiwan. An association between arsenic in well water and skin cancer was observed in the study population. Using the male population, who appeared to be more susceptible, the CAG estimated that the unit risk associated with drinking water contaminated with 1 yug/l of arsenic was 4.3 x 10'4 To compare the air and water unit risks, the CAG converted the exposure units in both cases to mg/kg/day absorbed doses, which resulted in unit risk estimates of 50.1 and 15.0, respectively. The potency of arsenic compared to other carcinogens was evaluated by noting that an arsenic potency of 2.25 x 10*3 (mMol/kg/day)"' lies in the first quartile of the 52 suspect carcinogens that have been evaluated by the CAG. The U.S. EPA is presently examining in- formation from studies on both patient and general populations which have been ex- posed to arsenic via medicinals or drinking water, respectively, in order to determine whether quantitative dose-response rela- tionships can be established for non- cancerous skin lesions. While the qualitative evidence for peripheral neurological effects and car- diovascular changes in arsenic-exposed populations is well established, the data are insufficient for determining quantitative dose-response relationships at the present time. Populations at Special Risk to Health Effects of Arsenic From a Japanese study, which reported on the poisoning of children exposed to arsenic in infant milk formula, young children may be considered at risk for acute exposure to arsenic. From the clinical reports published at the time of the mass poisoning, as well as those from follow-up studies, a number of signs of central ner- vous system involvement were noted at both the time of the episode and much later, with the follow-up studies showing behavioral problems, abnormal brain wave patterns, marked cognitive deficits, and severe hearing loss. Because children consume more water per unit body weight than do adults, the daily intake of arsenic via drinking water per kilogram body weight would be greater in children. This might have implications regarding chronic exposure effects in children. However, it should be noted that serious health effects due to chronic ex- posure of arsenic in drinking water have not been found at a greater frequency in children than adults. Individuals residing in the vicinity of cer- tain arsenic-emitting sources, e.g., certain types of smelters, may be at risk for in- creased arsenic intake because of both direct exposure to arsenic in air and indirect exposure via arsenic secondarily deposited from air onto soil or other human exposure media. The relative contribution from such indirect exposures to increased risk would be difficult to define, however. A less defined group at risk would be cigarette smokers due to some arsenic in tobacco, but it is not clear just what the quantitative increase in risk would be. ^U.S.GOVERNMENTPRINTINGOFFia 1985/559-111/20661 ------- This Project Summary was prepared by staff of Environmental Criteria and Assessment Office, U.S. Environmental Protection Agency, Research Triangle Park, NC 27711. Donna J. Sivulka is the EPA Project Officer (see below). The complete report, entitled "Health Assessment Document for Inorganic Arsenic," (Order No. PB 84-190 891; Cost: $23.50, subject to change) will be available only from: National Technical Information Service 5285 Port Royal Road Springfield. VA 22161 Telephone: 703-487-4650 The EPA Project Officer can be contacted at: Environmental Criteria and Assessment Office U.S. Environmental Protection Agency Research Triangle Park, NC27711 United States Environmental Protection Agency Center for Environmental Research Information Cincinnati OH 45268 i -OP 3 r i V!ET- .! Official Business Penalty for Private Use $300 EPA/600/S8-83/021F 0000329 PS U S ENVIR PROTECTION AGENCY CHICAGO ------- |