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