Emergency Medicine Book

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Heavy Metal Poisoning

Aka: Heavy Metal Poisoning, Heavy Metal Toxicity, Heavy Metal
  1. See Also
    1. Unknown Ingestion
  2. 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
  3. Types: Heavy Metal Poisonings
    1. Aluminum Poisoning
    2. Arsenic Poisoning
    3. Chromium Poisoning
    4. Copper Poisoning
      1. See Wilson Disease
    5. Iron Poisoning
    6. Lead Poisoning
    7. Mercury Poisoning
    8. Nickel Poisoning
  4. 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)
  5. Diagnosis
    1. Heavy Metal Studies (from blood, hair, urine)
      1. Typically sent to reference labs and are not immediately available
  6. 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
  7. References
    1. Kinker and Glauser (2021) Crit Dec Emerg Med 35(9): 19-27

Toxic effect of heavy metal (C0274869)

Definition (CSP) acute or chronic disease due to exposure to a metal or its salts.
Concepts Injury or Poisoning (T037)
MSH C535854
ICD9 985
ICD10 T56.8, T56, T56.89, T56.891
SnomedCT 212850007, 212843008, 157694007, 212849007, 157696009, 213693002, 85866007, 67181005
LNC LA10470-5
English Toxic effect of other metals, Tox effect of other metals, [X]Tox effect of other metals, [X]Toxic effect of other metals, Metals - toxic effect NOS, Metals causing toxic effect NOS, Other metals, Other metals - toxic effect, Other metals causing toxic effect, Other metals causing toxic effect NOS, Other metals-toxic effect NOS, poisoning by heavy metals, poisoning by heavy metals (diagnosis), Toxic effects of other metals, Toxic effects of other metals NOS, Toxic effect of metals, Chronic heavy metal poisoning, Heavy Metal Toxicity, heavy metal poison, metal poison, metal poisoning, heavy metal poisonings, metal poisons, toxic effect of heavy metal, heavy metal poisons, heavy metals poisoning, Metals causing toxic effect NOS (disorder), Other metals causing toxic effect (disorder), Metal causing toxic effect (disorder), Other metals causing toxic effect NOS (disorder), [X]Toxic effect of other metals (disorder), Heavy metal poisoning, Metal causing toxic effect, Metal poisoning, Heavy metal toxicosis, Toxic effect of heavy metal (disorder), Toxic effect of metal (disorder), Toxic effect of metal, Toxic effect of other metal, Toxic effect of heavy metal, Heavy metal poisoning, NOS, Toxic effect of heavy metal, NOS, Toxic effect of other metal, NOS, Metal poisoning, NOS
Italian Avvelenamento da metallo, Effetti tossici di altri metalli, Avvelenamento da metallo pesante
Dutch toxisch gevolg van andere metalen, zware metalenvergiftiging, Overige gespecificeerde metalen, metaalvergiftiging, Toxisch gevolg van metalen
French Intoxication à un métal lourd, Effet toxique d'autres métaux, Intoxication par des métaux
German toxischer Effekt sonstiger Metalle, Toxische Wirkung von Metallen, Toxische Wirkung: Sonstige Metalle, Schwermetallvergiftung
Portuguese Efeito tóxico de outros metais, Intoxicação por metal pesado, Intoxicação por metais
Spanish Intoxicación por metales pesados, Efecto tóxico de otros metales, otros metales que producen efecto tóxico, SAI, metales que producen efecto tóxico, SAI (trastorno), metales que producen efecto tóxico, SAI, otros metales que producen efecto tóxico (trastorno), [X]efecto tóxico de otros metales (trastorno), Metals causing toxic effect NOS, otros metales que producen efecto tóxico, SAI (trastorno), [X]efecto tóxico de otros metales, otros metales que producen efecto tóxico, efecto tóxico del metal (trastorno), efecto tóxico del metal pesado, efecto tóxico del metal, intoxicación por metal pesado (trastorno), intoxicación por metal pesado, intoxicación por metales, intoxicación por otro metal, Intoxicación por metales
Japanese 重金属中毒, 金属中毒, ジュウキンゾクチュウドク, キンゾクチュウドク
Czech Toxický účinek jiných kovů, Otrava těžkými kovy, Otrava kovem
Korean 금속의 중독작용, 기타 금속의 중독작용
Hungarian Nehézfémmérgezés, Egyéb fémek toxikus hatása, Fémmérgezés
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury) (C3702063)

Concepts Laboratory Procedure (T059)
CPT 1011477
English Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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