Heavy Metal Poisoning


Heavy Metal Poisoning, Heavy Metal Toxicity, Heavy Metal

  • Pathophysiology
  1. Poisoning may be intentional ingestion (Suicide) or unintentional
  2. Exposure to contaminated air, water or soil
  3. Common mechanisms (specific toxicity varies by specific substance)
    1. Oxidative Stress
    2. Cellular Protein dysregulation
    3. DNA damage
  4. Toxicity is impacted by multiple factors
    1. Bioavailability
    2. Water Solubility
  • Labs
  1. See Unknown Ingestion
  2. Comprehensive Metabolic Panel
    1. Evaluate for multiorgan dysfunction, renal dysfunction, Electrolyte abnormalities
  3. Serum Creatine Phosphokinase (CPK)
  4. Complete Blood Count
  5. Coagulation studies (INR, PTT)
  6. Venous Blood Gas (or Arterial Blood Gas)
  • Diagnosis
  1. Heavy Metal Studies (from blood, hair, urine)
    1. Typically sent to reference labs and are not immediately available
  • Management
  1. See Unknown Ingestion
  2. Consult poison control and toxiclogy experts
  3. Common strategies
    1. Decontamination
      1. Activated Charcoal is NOT effective at absorbing Heavy Metals
      2. Consider Whole Bowel Irrigation
    2. ABC Management
    3. Adjuvant antioxidant therapy
      1. Consider N-Acetylcysteine (NAC) to reduce oxidative stress
      2. Consider Ascorbic Acid (Vitamin C) if early in course
    4. Chelation (consult poison control)
      1. Arsenic Poisoning (DMSA, DMPS)
      2. Copper Poisoning (Penicillamine, Trientine)
      3. Iron Poisoning (Deferoxamine)
      4. Lead Poisoning (Dimercaprol, DMSA, DMPS, EDTA)
      5. Mercury Poisoning (Dimercaprol, DMSA, DMPS)
      6. Chromium does not respond to chelation
    5. Other measures
      1. Heavy Metals are NOT typically dialyzable
        1. However, Dialysis may be indicated for associated Acute Renal Failure or Electrolyte abnormalities
  • References
  1. Kinker and Glauser (2021) Crit Dec Emerg Med 35(9): 19-27