Nickel Carbonyl

Aka: Nickel Carbonyl, Nickel tetracarbonyl, Nickel Carbonyl Toxicity, Nickel Carbonyl Poisoning

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II. Mechanism

  1. Background
    1. Nickel Carbonyl is a colorless and highly flammable inorganic compound
    2. Volatile liquid (gas at 43 C, 109 F)
    3. Musty or sooty odor that emits toxic Carbon Monoxide fumes when heated
  2. Sources
    1. Nickel coating in manufacturing
    2. High-purity nickel powder production
    3. Refining of nickel-sulfide ore
    4. Chemical reagent (carbonylation)
    5. Catalyst used in petroleum, plastics, Rubber
  3. Exposures
    1. Pulmonary absorption at high Temperature
    2. Lipophilic with widespread distribution (after pulmonary absorption) to brain, Kidneys and liver
  4. Toxicity
    1. Direct pulmonary toxicity in inhalation
    2. Increases free oxygen radicals
    3. Inhibits RNA synthesis

III. Pharmacokinetics

  1. Exposure to concentrations >100 mg/m3 are lethal after 20 minutes
  2. Immediate toxicity with morbidity and mortality risk when >=2 ppm

IV. Adverse Effects

  1. Lung toxicity (most common toxicity)
    1. Interstitial Pneumonitis
    2. Acute Respiratory Distress Syndrome
  2. Skin exposure
    1. Severe dermatitis
  3. Cardiovascular toxicity
    1. Myocarditis
  4. Central Nervous System (CNS) toxicity
    1. Encephalopathy
  5. Known carcinogen
    1. Lung Cancer
    2. Nasal cancer

V. Findings: Acute Poisoning

  1. Onset of symptoms with hours to one week of exposure
  2. Constitutional (early)
    1. Nausea
    2. Headache
    3. Dizziness
  3. Cardiopulmonary
    1. Early with Interstitial Pneumonitis
      1. Chest Pain
      2. Shortness of Breath
    2. Later
      1. Acute Respiratory Distress Syndrome
      2. Pulmonary Hemorrhage
      3. Myocarditis with Dysrhythmias
  4. Neurologic
    1. Encephalopathy
    2. Seizures
    3. Respiratory depression

VI. Labs: Acute Poisoning

  1. See Acute Poisoning
  2. Complete Blood Count
    1. Leukocytosis
  3. Comprehensive Metabolic Panel
    1. Liver Transaminitis (AST, ALT)
  4. Urine Nickel Level (collected over 8 hours)
    1. Levels >500 mcg/L are associated with severe toxicity

VII. Diagnostics

  1. Electrocardiogram
    1. QT Prolongation
    2. ST Change
    3. T Wave Change

VIII. Imaging

  1. Chest XRay
    1. Interstitial Pneumonitis
    2. Acute Respiratory Distress Syndrome
  2. CT Head
    1. Cerebral edema may accompany encephalopathy

IX. Management

  1. ABC Management
    1. Focus on airway, oxygenation, ventilation
  2. Skin Decontamination
    1. Remove all clothing
    2. Wash skin with soap and water
  3. Chelation therapy
    1. Sodium Diethyldithiocarbamate (DDC, preferred if available)
    2. Disulfiram (alternative to DDC)
      1. Day 1: Dose 750 mg orally every 8 hours
      2. Subsequent days: 250 mg every 8 hours
  4. Disposition
    1. ICU admission
      1. Persistent findings (pulmonary, neurologic, cardiovascular)
    2. Concerning exposure (nonspecific symptoms may be present)
      1. Observe for 8 hours
      2. Collect 8 hour urine nickel level and use level to determine risk and disposition
    3. Asymptomatic with only brief or limited exposure
      1. Discharge with return precautions

X. Resources

  1. Nickel Carbonyl 1 Acute Exposure Guideline Levels
    1. https://www.ncbi.nlm.nih.gov/books/NBK207867/
  2. Gates (2023) Nickel Toxicology, StatPearls
    1. https://www.ncbi.nlm.nih.gov/books/NBK592400/

XI. References

  1. Carroll and Yakey (2026) Crit Dec Emerg Med 40(3): 42

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