Stable isotopes ratios (‰) of Hydrogen (δ²H) and Oxygen (δ¹⁸O) were used to trace the groundwater recharge mechanism and geochemistry of arsenic (As) contamination in groundwater from four selected sites (Larkana, Naudero, Ghari Khuda Buksh and Dokri) of Larkana district. The stable isotope values of δ²H and δ¹⁸O range from 70.78‰ to −56.01‰ and from −10.92‰ to −7.35‰, relative to Vienna Standard for Mean Ocean Water (VSMOW) respectively, in all groundwater samples, thus indicating the recharge source of groundwater from high-salinity older water. The concentrations of As in all groundwater samples were ranged from 2 μg/L to 318 μg/L, with 67% of samples exhibited As levels exceeding than that of World Health Organization (WHO) permissible limit 10 μg/L and 42% of samples expressed the As level exceeding than that of the National Environmental Quality Standard (NEQS) 50 μg/L. The leaching and vertical mixing with return irrigation water are probably the main processes controlling the enrichment of As in groundwater of Larkana, Naudero, Ghari Khuda Buksh and Dokri. The weathering of minerals mostly controlled the overall groundwater chemistry; rock-water interactions and silicate weathering generated yielded solutions that were saturated in calcite and dolomite in two areas while halite dissolution is prominent with high As area.