5 - Heavy metals

b. mercury poisoning

1. Minamata Disease refers to

   a. copper toxicity

   b. mercury poisoning

   c. manganese toxicity

   d. aluminum toxicity

c. iron

2. Deferoxamine is most useful in the treatment of poisoning caused by:

   a. arsenic

   b. mercury

   c. iron

   d. lead

d. both a & b

3. Pinicillamine use

   a. tx of rheumatoid arthritis

   b. treatment of copper toxicity

   c. tx of g(+) infections

   d. both a & b

d. iron; cd ; Se

4. BAL is used in chelating the ff heavy metals, except

   a. arsenic

   b. mercury

   c. lead

   d. iron; cd ; Se

a. Zinc poisoning

5. Metal Fume fever

   a. Zinc poisoning

   b. Iron poisoning

   c. Cadmium poisoning

   d. Mercury poisoning

a. Manganese

6. Parkinson like symptoms

   a. Manganese

   b. magnesium

   c. Aluminum

   d. Zinc

a. Aluminum Toxicity

7. Shaver’s disease

   a. Aluminum Toxicity

   b. Mercury Toxicity

   c. Cadmium toxicity

   d. Chromium toxicity

Lead

Sources: *Paint, Old Pipes, Lead Contaminated, Soil & Dust (Old Building), Jewelry & Toys, Drinking Water

Plumbism or Saturnism (Archaic)

Lead Poisoning:

Acute Lead Poisoning

Children – acute abdominal colic and CNS change

Chronic Lead Poisoning

• Plumbism

• Result of gradual accumulation

• Peripheral neuropathy (wrist drop)

• Anorexia

• Anemia

• Weight Loss, Tremor

Oral Succimer (children)

Antidote for Mild Lead Poisoning

EDTA & (+) BAL (if encephalitis is present)

Antidote for Severe Lead Poisoning

Cadmium

Sources: Smokes and “Stink Bomb”

Itai-Itai

Toxicity of Cadmium:

• EDTA (+glutathione)

• BAL IS NOT RECOMMENDED

Treatment for Cadmium Toxicity

• Elemental Hg

• Amalgam

• HgCl (calomel)

• HgCl2 (corrosive sublimate)

Inorganic forms for Mercury Toxicity

• Alkyl Mercury (Methyl Hg)

• Thimerosal (old antiseptic | NEW: Benzalkonium

organic forms for Mercury Toxicity

• Minamata Disease – acute alkyl mercury toxicity (methyl mercury)

• Erethism – aka Mad Hatter Disease | affects the neurological & behavioural of the px

• Acrodymia – aka Pink Disease | In children: pink & painful extremities (palms & toe)

Toxicity of Mercury:

Minamata Disease

acute alkyl mercury toxicity (methyl mercury)

Erethism

• aka Mad Hatter Disease

• affects the neurological & behavioural of the px

Acrodymia

• aka Pink Disease

• In children: pink & painful extremities (palms & toe)

• NOT recommended for BAL – it may redistribute mercury in the CNS

• Na Formaldehyde Sulfoxylate – PACOP; antidote

Treatment for Mercury Toxicity

Lewsite Metal

Arsenic is also known as

Arsenic

• KING OF ALL POISONS – colorless, odourless, tasteless

• SAVIOR OF SYPHILIS – Salvarsan, Compound606, Arsphenamine ~ 1^st effect treatment of syphilis

• colorless

• odourless

• tasteless

Arsenic is called the king of all poisons because of its characteristics:

• Salvarsan,

• Compound 606,

• Arsphenamine

1st effect treatment of syphilis:

• Melarsoprol –  African sleeping sickness

• Paris Queen – copper acetoarsenite

• Fowler’s Solution – K arsenite

• Arsphenamine –

• (+) heat or acid → AsH3 (Arsine Gas) = highly irritating, massive hemolysis, renal failure

Arsenic is present in:

Arsine gas

when arsenic is reacted w/ heat or acid, it produces:

• Aldrich – Mee’s Line

• Garlic Odor of Breath

• Luminous vomitus

• Black line gums

• Alopecia

Signs and symptoms of Arsenic poisoning:

• BAL (Dimercaprol)

• + Penicillamine (if severe)

Treatment for Arsenic poisoning

Aluminum

• 3^rd most abundant element & most abundant metal on Earth

• Uses: Antacid, Astringent

Deferoxamine

Treatment for aluminum toxicity

Aluminosis or Shaver’s Disease

Aluminum Poisoning is called:

Zinc

Used in galvanizing iron & container for battery cells

Parakeratosis

Zinc deficiency is called:

Metal Fume Fever

Zinc toxicity is called:

• Bed Rest,

• NSAIDs (ASA)

Zinc toxicity treatment:

Iron acute toxicity

• Lethal dose: 200-300 mg/kg

• Toxic dose: >60 mg/kg

Iron chronic toxicity

• Hemosiderosis: iron overload, tissue damage

• Hemochromatosis – iron overload has no tissue damage

Lethal dose

ingestion of FeSO4 tablets w/ 200-300 mg/kg is considered as:

Toxic dose

ingestion of FeSO4 tablets w/ >60 mg/kg is considered as:

Hemochromatosis

iron overload, tissue damage

Hemosiderosis

iron overload, has no tissue damage

Stage 1

What stage of Iron Poisoning?

• GI Phases

• GI irritation

• Nausea, Diarrhea, GI upset

Stage 2

What stage of Iron Poisoning?

• Latent Phase

• GI improvement

Stage 3

What stage of Iron Poisoning?

• Metabolic & CV phase | most patients die

• Cardiotoxicity

• CNS problem (coma)

Stage 4

What stage of Iron Poisoning?

• Hepatic phase

• Liver Failure

• Hypoglycemia

Stage 5

What stage of Iron Poisoning?

• Delayed phase

• Scarring of healing GI tract

• Bowel obstruction

• Deferoxamine (parenteral/IV)

• Deferasirox (orally)

Antidote for Iron Poisoning

Copper

Essential trace element

• IUD (intraurine device) – Copper Oil; prevent pregnancy

• Copper Cookware (uncoated) + acid à leaching

Copper can be found in:

• Copperiedus

• *Wilson’s Disease: genetic disorder in which excess copper builds up in the body

Copper toxicity:

Wilson’s Disease

genetic disorder in which excess copper builds up in the body

Chromosome #13

Wilson’s disease gene; a transport protein that transfers copper → liver

Penicillamine

Treatment for copper toxicity

Chromium

Glucose tolerance factor

DM like

Chromium Deficiency:

Acute Chromium Ingestion Toxicity

• GIT corrosion

• Multiple Organ Damage

• Often Fatal (regardless of therapy used)

Chronic Chromium Ingestion Toxicity

• Respiratory tract irritation

• Most Serious: Lung Cancer

• Manganism,

• Permanent neurological disorder

• Parkinson’s Like

Manganese Toxicity is called:

• EDTA (poor enter to the brain)

• PAS (neuroprotectant)

• *Levodopa (parkinson’s disease) = poor clinical response

Manganese antidotes: