Which toxin presents with hyperkeratosis, rice water stools, and garlic breath?

• A. Arsenic
• B. Lead
• C. Mercury
• D. Cyanide

Answer: (A)

Arsenic poisoning shows a distinctive combination of GI toxicity and skin changes. The calcium-rich clue here is the severe watery stools described as rice-water stools, along with a garlic-like breath, which are classic signs of acute arsenic exposure. When exposure is chronic, arsenic leads to hyperkeratosis of the skin, especially on the palms and soles. Putting those clues together—the GI signs with a garlic odor plus the skin thickening from longer exposure—points to arsenic as the toxin. The other options don’t typically produce this specific trio: lead can cause abdominal pain and neuroeffects but not the garlic breath with rice-water stools and hyperkeratosis; mercury causes tremors and kidney/neuro issues; cyanide leads to rapid onset hypoxia and doesn’t feature this skin change pattern.