Heavy Metal Poisoning

rarediseases.org/rare-diseases/heavy-metal-poisoning/

Synonyms of Heavy Metal Poisoning

Heavy Metal Toxicity

Subdivisions of Heavy Metal Poisoning

Aluminum Poisoning
Antimony Poisoning
Arsenic Poisoning
Barium Poisoning
Bismuth Poisoning
Cadmium Poisoning
Chromium Poisoning
Cobalt Poisoning
Copper Poisoning
Gold Poisoning
Iron Poisoning
Lead Poisoning
Lithium Poisoning
Manganese Poisoning
Mercury Poisoning
Nickel Poisoning
Phosphorous Poisoning
Platinum Poisoning
Selenium Poisoning
Silver Poisoning
Thallium Poisoning
Tin Poisoning
Zinc Poisoning

General Discussion

Heavy metal poisoning is the accumulation of heavy metals, in toxic amounts, in the soft
tissues of the body. Symptoms and physical findings associated with heavy metal
poisoning vary according to the metal accumulated. Many of the heavy metals, such as
zinc, copper, chromium, iron and manganese, are essential to body function in very
small amounts. But, if these metals accumulate in the body in concentrations sufficient
to cause poisoning, then serious damage may occur. The heavy metals most commonly

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associated with poisoning of humans are lead, mercury, arsenic and cadmium. Heavy
metal poisoning may occur as a result of industrial exposure, air or water pollution,
foods, medicines, improperly coated food containers, or the ingestion of lead-based
paints.

Signs & Symptoms

The symptoms of heavy metal poisoning vary according to which type of metal
overexposure is involved. Some specific examples are:

ARSENIC POISONING

Arsenic is used in the manufacture of pesticides. The gas from arsenic also has some
industrial uses. Overexposure may cause headaches, drowsiness, confusion, seizures,
and life-threatening complications. Neurological symptoms include brain damage
(encephalopathy), nerve disease of the extremities (peripheral neuropathy), pericapillary
hemorrhages within the white matter, and loss or deficiency of the fatty coverings
(myelin) around these nerve fibers (demyelination). Skin problems include transverse
white bands on the fingernails (mees’ lines) and excessive accumulation of fluid in the
soft layers of tissue below the skin (edema). Gastrointestinal symptoms include a flu-like
illness (gastroenteritis) that is characterized by vomiting; abdominal pain; fever; and
diarrhea, which, in some cases, may be bloody. Other symptoms include breakdown of
the hemoglobin of red blood cells (hemolysis), a low level of iron in the red blood cells
(anemia), and low blood pressure (hypotension). Some individuals may experience a
garlic-like odor that may be detectable on the breath.

In cases of chronic poisoning, weakness, muscle aches, chills, and fever may develop.
The onset of symptoms in chronic arsenic poisoning is about two to eight weeks after
exposure. Skin and nail symptoms include hardened patches of skin (hyperkeratosis)
with unusually deep creases on the palms of the hands and the soles of the feet, unusual
darkening of certain areas of the skin (hyperpigmentation), transverse white bands on
the fingernails (mees’ lines), and a scale like inflammation of the skin (exfoliative
dermatitis). Other symptoms include inflammation of sensory and motor nerves
(polyneuritis) and the mucose membrane lining the throat.

Inorganic arsenic accumulates in the liver, spleen, kidneys, lungs, and gastrointestinal
tract. It then passes through these sites but leaves a residue in tissues such as skin, hair,
and nails. Symptoms of acute inorganic arsenic poisoning include severe burning of the
mouth and throat, abdominal pain, nausea, vomiting, diarrhea, low blood pressure
(hypotension), and muscle spasms. Individuals with severe inorganic arsenic poisoning
may experience heart problems (cardiomyopathy); accumulation of acid in the tubes of
the kidneys (renal tubular acidosis); breakdown of the hemoglobin of red blood cells
(hemolysis); irregular heart rhythms (ventricular arrhythmias); coma; seizures; bleeding
within the intestines (intestinal hemorrhage); and yellowing of the skin, mucous
membranes, and whites of the eyes (jaundice).

CADMIUM POISONING

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Cadmium is used for many items, including electroplating, storage batteries, vapor
lamps and in some solders. The onset of symptoms may be delayed for two to four hours
after exposure. Overexposure may cause fatigue, headaches, nausea, vomiting,
abdominal cramps, diarrhea, and fever. In addition, progressive loss of lung function
(emphysema), abnormal buildup of fluid within the lungs (pulmonary edema), and
breathlessness (dyspnea) may also be present. In some cases, affected individuals may
exhibit increased salivation; yellowing of the teeth; an unusually rapid heart beat
(tachycardia); low levels of iron within the red blood cells (anemia); bluish discoloration
(cyanosis) of the skin and mucous membranes due to insufficient oxygen supply to these
tissues; and/or an impaired sense of smell (anosmia). Individuals with cadmium
poisoning may also experience improper functioning of the canals with the kidney (renal
tubular dysfunction) characterized by excretion of abnormally high levels of protein in
the urine (proteinuria), minor changes in liver function, and/or softening of certain
bones (osteomalacia).

CHROMIUM POISONING

Chromium is used in the manufacture of cars, glass, pottery and linoleum. Exposure to
too much chromium may cause lung and respiratory tract cancer as well as kidney
diseases. In addition, overexposure to chromium may also cause gastrointestinal
symptoms, such as diarrhea and vomiting, often with blood. Symptoms may lead to
severe water-electrolyte disorders, increased mild acidity of blood and body tissues
(acidosis), and/or inadequate blood flow to its tissues resulting in shock. Lesions on the
kidneys, liver, and muscular layer of the heart (myocardium) may also develop.

COBALT POISONING

Cobalt, used in making jet engines, may cause nausea, vomiting, lack of appetite
(anorexia), ear ringing (tinnitus), nerve damage, respiratory diseases, an unusually large
thyroid gland (goiter), and/or heart and/or kidney damage.

LEAD POISONING

Lead production workers, battery plant workers, welders and solders may be
overexposed to lead if proper precautions are not taken. Lead is stored in the bone but
may affect any organ system. The effects of lead poisoning varies depending on the age of
the individual and the amount of exposure.

In children, symptoms vary depending upon the degree of exposure to lead. Some
affected individuals may not have any noticeable symptoms. Symptoms usually develop
over a three to six week time period. Lead overexposure may cause children to be less
playful, clumsier, irritable, and sluggish (lethargic). In some cases, symptoms include
headaches, vomiting, abdominal pain, lack of appetite (anorexia), constipation, slurred
speech (dysarthria), changes in kidney function, unusually high amounts of protein in
the blood (hyperproteinemia), and unusually pale skin (pallor) resulting from a low level
of iron in the red blood cells (anemia). Neurological symptoms associated with lead
overexposure include an impaired ability to coordinate voluntary movements (ataxia),

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brain damage (encephalopathy), seizures, convulsions, swelling of the optic nerve
(papilledema), and/or impaired consciousness. Some affected children experience
learning or behavioral problems such as mental retardation and selective deficits in
language, cognitive function, balance, behavior, and school performance. In some cases,
symptoms may be life-threatening.

In adults, overexposure to lead may cause high blood pressure and damage to the
reproductive organs. Additional symptoms may include fever, headaches, fatigue,
sluggishness (letheragy), vomiting, loss of appetite (anorexia), abdominal pain,
constipation, joint pain, loss of recently acquired skills, incoordination, listlessness,
difficulty sleeping (insomnia), irritability, altered consciousness, hallucinations, and/or
seizures. In addition, affected individuals may experience low levels of iron in the red
blood cells (anemia), peripheral neuropathy, and, in some cases, brain damage
(encephalopathy). Some affected individuals experience decreased muscle strength and
endurance; kidney disease; wrist drop; and behavioral changes such as hostility,
depression, and/or anxiety. In some cases, symptoms may be life-threatening.

Lead is excreted in urine and feces. However, it may also appear in hair, nails, sweat,
saliva, and breast milk.

MANGANESE POISONING

Manganese is used as a purifying agent in the production of several metals. Symptoms

associated with overexposure to manganese may include damage to the central nervous
system and pneumonia. Additional symptoms and physical findings include weakness,
fatigue, confusion, hallucinations, odd or awkward manner of walking (gait), muscle
spasms (dystonia), rigidity of the trunk, stiffness, awkwardness of the limbs, tremors of
the hands, and psychiatric abnormalities.

MERCURY POISONING

Mercury is used by dental assistants and hygienists, and chemical workers. Mercury can
affect the lungs, kidneys, brain, and/or skin. Symptoms of mercury poisoning include
fatigue, depression, sluggishness (letheragy), irritability, and headaches.

Respiratory symptoms associated with inhalation to mercury vapors include coughing,

breathlessness (dyspnea), tightness or burning pain in the chest, and/or respiratory
distress. Some affected individuals may experience abnormal buildup of fluid in the
lungs (pulmonary edema); pneumonia; and/or abnormal formation of fibrous tissue
(fibrosis).

There may be behavioral and neurological changes associated with overexposure to

mercury poisoning, such as excitability and quick-tempered behavior, lack of
concentration, and loss of memory. Shock and permanent brain damage may also be
result from mercury poisoning. Some affected individuals experience mental confusion.
A progressive cerebellar syndrome with impaired ability to coordinate voluntary
movements (ataxia) of the arms may also be present. Abnormal involuntary movements
of the body such as uncontrolled jerky movements combined with slow, writhing

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movements (choreoathetosis) are common. Additional symptoms include non-
inflammatory degenerative disease of the nerves (polyneuropathy); impaired ability to
coordinate voluntary movements (cerebellar ataxia); tremors of the legs and arms and,
in some cases, of the tongue and lips; seizures; and/or slurred speech (dysarthria).
Changes in mood, behavior, and consciousness may also occur.

In some cases of chronic exposure to inorganic mercury a personality disorder known as

erethism or mad hatter syndrome may occur. Symptoms associated with mad hatter
syndrome include memory loss, excessive shyness, abnormal excitability, and/or
insomnia. This syndrome was described in workers with occupational exposure to
mercury in the felt-hat industry.

Many affected individual experience sensory impairments such as visual problems (e.g.
constriction of visual fields, tunnel vision, and blindness) as well as hearing loss.

Some individuals may experience skin changes such as painful swelling and pink
coloration of the fingers and toes (acrodynia); persistent redness or inflammation of the
skin (erythema); extreme sensitivity (hyperesthesia) of the affected areas; and tingling
and sensory disturbances.

In some cases, other affected individuals may experience stomach and intestinal
disturbances; kidney damage; dehydration; acute renal failure; inflammation of the
gums (gingivitis); severe local irritation of the mouth and pharynx, accompanied by
vomiting; and/or abdominal cramps with bloody diarrhea.

Mercury is mainly excreted through the urine and feces.

PHOSPHORUS POISONING

Symptoms associated with phosphorus poisoning include weakness, headaches,

vomiting, sweating, abdominal cramps, salivation, wheezing secondary to bronchial
spasm, drooping of the upper eyelids (ptosis), contraction of the pupil (miosis), and/or
muscular weakness and twitching. In addition, non-inflammatory degenerative disease
of the sensorimotor nerves (sensorimotor polyneuropathy) may advance to progressive
deterioration (atrophy). In some cases, respiratory paralysis may also occur.

THALLIUM POISONING

Symptoms associated with thallium poisoning include extreme drowsiness

(somnolence), nausea, vomiting, abdominal pain, and bloody vomiting (hematemesis).
Some affected individuals may experience the loss of most or all of their scalp hair
(alopecia); rapidly progressive and painful sensory polyneuropathy; motor neuropathy;
cranial nerve palsies; seizures; impaired ability to coordinate voluntary movements
(cerebellar ataxia); and/or mental retardation. Some individuals may experience eye
symptoms including wasting away (atrophy) of the optic nerve (optic atrophy),
inflammation of the optic nerve (retrobulbar neuritis), and impaired functioning of the

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muscles of the eyes (ophthalmoplegia). In some cases, thallium poisoning may progress
to include renal and cardiac failure, confusion, psychosis, organic brain syndrome,
and/or coma.

ADDITIONAL METAL POISONINGS

Additional metals that may cause poisoning include antimony, aluminum, barium,
bismuth, copper, gold, iron, lithium, platinum, silver, tin, and zinc. Common symptoms
of poisoning from these metals may include gastrointestinal, renal, and neurological
symptoms, such as headaches, irritability, psychosis, stupor, coma, and convulsions.

Antimony is used for hardening lead, and in the manufacture of batteries and cables. It
may possibly cause lung disease and skin cancer, especially in those who smoke.

Copper is used in the manufacture of electrical wires. It may cause a flu-like reaction
called metal fume disease and disturbances in the blood.

Lithium is used to make glasses and pharmaceuticals. Lithium may cause diseases of the
stomach, intestinal tract, central nervous system, and kidneys.

Overexposure to silver may cause a gray discoloration of the skin, hair and internal
organs. Additional symptoms may include nausea, vomiting, and diarrhea.

Zinc overexposure may cause the flu-like symptoms of metal fume fever; stomach and
intestinal disturbances; and/or liver dysfunction.

Overexposure to bismuth may cause extreme drowsiness (somnolence) and neurologic

disturbances such as confusion, difficulty in concentration, hallucinations, delusions,
myoclonic jerks, tremors, seizures, an impaired ability to coordinate voluntary
movements (ataxia), and/or inability to stand or walk.

Overexposure to gold (as in treatment of rheumatoid arthritis) may cause skin rashes;
bone marrow depression; stomach and intestinal bleeding; headaches; vomiting; focal or
generalized continuous fine vibrating muscle movements (myokymia); and yellowing of
the skin, mucous membranes, and whites of the eyes (jaundice).

Some cases of overexposure to nickel have been associated an increased risk of lung
cancer.

Overexposure to selenium may cause irritation of the respiratory system, gastrointestinal

tract, and eyes; inflammation of the liver; loss of hair (alopecia); loss of skin color
(depigmentation); and peripheral nerve damage.

Overexposure to tin may damage the nervous system and cause psychomotor
disturbances including tremor, convulsions, hallucinations, and psychotic behavior.

Aluminum containers used in the manufacture and processing of some foods, cosmetics
and medicines, and also for water purification. Overexposure to aluminum may cause
brain damage (encephalopathy).

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Causes

Heavy metal poisoning is a result of the toxic accumulation of certain metals. Such
metals compete with and replace certain essential minerals in the course of which any of
several of the body’s organ systems may be affected.

Arsenic poisoning may be caused by medications including Fowler’s solution (potassium

arsenite) and some topical creams used in the treatment of some skin conditions.
Ingestion of herbicides, insecticides, pesticides, fungicides, or rodenticides containing
arsenic may cause arsenic poisoning. Occupational exposure to arsenic in the
manufacture of paints, enamels, glass, and metals may cause arsenic poisoning. Other
forms of occupational exposure include galvanizing, soldering, etching, lead plating,
smelting, and wood preserving. Arsenic is also found in contaminated water, seafood,
and algae.

Cadmium poisoning may be caused by ingestion of food (e.g. grains, cereals, and leafy
vegetables) and cigarette smoke. Occupational exposure to cadmium in metal plating,
battery, and plastics industries may also occur.

Lead poisoning may be caused by exposure (e.g. chewing or ingestion) to deteriorating

lead paint in older houses. Occupational exposure to lead in painting, smelting, firearms
instruction, automotive repair, brass or cooper foundries, printing, battery
manufacturing, mining, brass foundry, gasoline, glass, and bridge, tunnel and elevated
highway construction may also occur. Another cause of lead poisoning is through the
contamination of water from lead pipes. Additional causes of lead poisoning include
calcium products, progressive hair dyes, kajal, surma, kohl, and foreign digestive
remedies.

Manganese poisoning may be caused by chronic inhalation and ingestion of manganese

particles. Occupational exposure to manganese in mining and separating manganese ore
may also occur.

Mercury poisoning may be caused by exposure to large amounts of mercury in the

manufacturing of thermometers, mirrors, incandescent lights, x-ray machines, and
vacuum pumps. Another cause of mercury poisoning is contaminated water and fish.
Children often are exposed to mercury through paint, calomel, teething powder, and
mercuric fungicide used in washing diapers. Additional causes of mercury poisoning is
exposure to mercury in thermometers, dental amalgams, and some batteries.

Phosphorus poisoning may be caused by insecticides such as tetraethylpyrophosphate.

Thallium poisoning may be caused by ingestion of rodenticides containing thallium.

Thallium in pesticides, insecticides, metal alloys, and fireworks can be absorbed through
skin as well as through ingestion and inhalation.

Affected Populations

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Heavy metal poisoning can affect males and females in equal numbers, depending on
exposure. Outbreaks of this type of poisoning have occurred in the United States during
the past several years from imported plates and cookware that were not properly coated
to prevent heavy metals from contaminating food.

In the United States, lead poisoning most often affects children between one and three
years old.

Lead poisoning affects adults less often than children. In the last 20 years, statistics
show the number of children with potentially harmful blood lead levels has dropped 85
percent.

Mercury poisoning is unusual in children. There have been large outbreaks in Australia
and France of bismuth poisoning.

Related Disorders

Symptoms of the following disorders can be similar to those of heavy metal poisoning.
Comparisons may be useful for a differential diagnosis:

Metal fume fever includes a variety of symptoms, such as a general feeling of ill health
(malaise), chills, and fever. Affected individuals may have excessive thirst and a metallic
taste in their mouth. Symptoms usually subside spontaneously in six to 12 hours. A
classic case would occur when galvanized steel is welded in a poorly ventilated area.

The following disorders may be associated with heavy metal poisoning as secondary
characteristics. They are not necessary for a differential diagnosis.

Fanconi’s anemia is a blood disorder, which is a familial form of aplastic anemia.

Children with this disorder bruise easily and experience nosebleeds. It may be caused by
genetic and environmental interactions. Fanconi’s syndrome can be acquired instead of
inherited due to acute lead poisoning. (For more information on this disorder, choose
“Fanconi’s Anemia” as your search term in the Rare Disease Database.)

Wilson’s disease is a genetic disorder characterized by excess storage of copper in the

body’s tissues, particularly in the liver, brain and corneas of the eyes. The disorder
occurs without overexposure to copper and is due to a metabolic defect. (For more
information on this disorder, choose “Wilson Disease” as your search term in the Rare
Disease Database.)

Diagnosis

The diagnosis of arsenic poisoning can be confirmed by discovering increased levels of

arsenic in the hair, nails, and urine. An x-ray of abdomen may show ingested arsenic
which is not penetrable by x-rays (radiopaque).

The diagnosis of lead poisoning may be suspected based upon appreciation of the
causative factors, a high index of suspicion, and certain laboratory tests for levels of lead
in the blood. Other indicators of lead poisoning include an elevation of free erthrocytic

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protoporphyrins, inhibition of ALA-D activity, elevated lead in the hair, increased lead
content of deciduous teeth, estimation of urinary coproporphytins, zinc protoporphyrin
levels. A spinal tap may also be helpful in the diagnosis of lead poisoning. The
LEADCARE In Office Test System has been approved by the FDA as a portable blood
lead screening kit for health professionals' use to test for lead poisoning.

Standard Therapies

Treatment

The main treatment of heavy metal poisoning is termination of exposure to the metal.
Treatment also consists of the use of various chelating agents that cause the toxic
(poison) element to bind with the drug and be excreted in the urine. Three common
drugs for treatment of metal poisoning are: BA. (Dimercaprol), Calcium EDTA (Calcium
Disodium Versenate) and Penicillamine. Each of these work by binding actions that
permit the metals to be eliminated from the body through the urine.

Treatment should also be symptomatic and supportive. In some cases, pumping of the
stomach (gastric lavage) will remove some ingested metals. In the case of inhaled
poisons, affected individuals should be removed from the contaminated environment
and their respiration supported.

Occupational exposure to heavy metals requires prevention through the use of masks
and protective clothing.

In cases of swelling of the brain (cerebral edema), treatment with a diuretic called
Mannitol, and corticosteroid drugs, along with intracranial monitoring, is required.

Kidney failure may call for hemodialysis and/or other special treatment.

In 1991 the FDA approved the drug succimer (Chemet) for the treatment of children with
severe lead poisoning. Chemet is manufactured by Johnson & Johnson Co.

There is no proven effective therapy for the treatment of cadmium poisoning.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov.

All studies receiving U.S. government funding, and some supported by private industry,
are posted on this government website.

For information about clinical trials being conducted at the National Institutes of Health
(NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: [email protected]

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For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

Two orphan drugs are being tested for the treatment of heavy metal poisoning.

In the treatment of iron poisoning, the drug Bio-Rescue (40SD02 and 25SD04) is being
developed by Biomedical Frontiers, Inc. of Minneapolis, MN, in alliance with Hemosol.

Mercury poisoning is being treated by the drug, Chemet (Succimer), which is being
developed by McNeil Consumer Products, Co., Ft. Washington, PA.

Supporting Organizations

Food and Drug Administration (FDA) Consumer Nutrition and Health Information
10903 New Hampshire Ave
Silver Spring, MD 20993-0002
Phone: (301) 575-0156
Toll-free: (888) 463-6332
Website:
http://www.fda.gov/Food/LabelingNutrition/ConsumerInformation/default.
htm
Genetic and Rare Diseases (GARD) Information Center
PO Box 8126
Gaithersburg, MD 20898-8126
Phone: (301) 251-4925
Toll-free: (888) 205-2311
Website: http://rarediseases.info.nih.gov/GARD/
Human Ecology Action League, Inc. (HEAL)
10 Wilson RD
Ste 4
Stockbridge, GA 30281
Phone: (770) 389-4519
Email: HEALNatnl @aol.com
Website: http://www.healnatl.org/index.php
National Institute for Occupational Safety and Health
395 E Street, S.W. Suite 9200
Patriots Plaza Building
Washington, DC 20201
Phone: (513) 533-8328
Toll-free: (800) 232-4636
Email: [email protected]
Website: http://www.cdc.gov/niosh/

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 National Safety Council/Environmental Health Center
1121 Spring Lake Dr.
Itasca, IL 60143-3201
Phone: (630) 285-1121
Toll-free: (800) 621-7615
Email: [email protected]
Website: http://www.nsc.org/Pages/Home.aspx

References

TEXTBOOKS

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck
Research Laboratories; 1999:1881-82.

Rowland LP, ed. Merritt’s Neurology. 10th ed. Lippincott Williams & Wilkins.
Philadelphia, PA. 2000:940-44.

Menkes JH, Pine Jr JW, et al., eds. Textbook of Child Neurology. 5th ed. Williams &
Wilkins. Baltimore, MD; 1995:598-603.

REVIEW ARTICLES

Chaney RL, Angle JS, McIntosh MS, et al. Using hyperaccumulator plants to
phytoextract soild Ni and Cd. Z Naturforsch [C]. 2005;60:190-98.

Bhan A, Sarkar NN. Mercury in the environment: effect on health and reproduction. Rev
Environ Health. 2005;20:39-56.

Peter AL, Viraraghavan T. Thallium: a review of public health and environmental

concerns. Environ Int. 2005;31:493-501.

Eicher T, Avery E. Toxic encephalopathies. Neurol Clin. 2005;31:353-76.

Kazantzis G. Cadmium, osteoporosis and calcium metabolism. Biometals. 2004;17:493-

98.

Crossgrove J, Zheng W. Manganese toxicity upon overexposure. NMR Biomed.

2004;17:544-53.

Nuttall KL. Interpreting mercury on blood and urine of individual patients. Ann Clin Lab
Sci. 2004;34:235-50.

Kwong WT, Friello P, Semba RD. Interactions between iron deficiency and lead
poisoning: Idemiology and pathogenesis. Sci Total Environ. 2004;330:21-37.

FROM THE INTERNET

Ferner DJ. Toxicity, Heavy Metals. emedicine. Last Updated: June 20, 2005. 11pp.

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www.emedicine.com/emerg/topic237.htm

Years Published

1989, 1991, 1998, 2006

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