heavy metal There are 35 metals that concern us because of occupational or residential exposure; 23 of these are the heavy

elements or "heavy metals": antimony, arsenic, bismuth, cadmium, cerium, chromium, cobalt, copper, gallium, gold, iron, lead, manganese, mercury, nickel, platinum, silver, tellurium, thallium, tin, uranium, vanadium, and zinc. Interestingly, small amounts of these elements are common in our environment and diet and are actually necessary for good health, but large amounts of any of them may cause acute or chronic toxicity (poisoning). The metals may enter the body by Ingestion Inhalation Absorption through the skin or mucous membranes
dusts Dermal contact deposit

Body
Inhalation
Absorption

Air
gaseous

Soil

Intake Leaching

GW
Effluent

DW
Aq uati c

drinking

Intake

SW

Fishes Crop s Food s

Main route Route for consideratio n

Absorption

Pathway of heavy metal poisoning

Heavy metal poisoning in Bangladesh The Ganges-Brahmaputra delta: The Ganges-Brahmaputra delta is the largest delta in the world and the rivers contribute one-third of the global sediment transport to the world oceans. The rivers flow through 10 per cent global population and carry untreated rural, urban, municipal and industrial wastes to the Bay of Bengal. About 6,000 large and medium industries and 24,000 small industries are operating in Bangladesh which discharge effluents directly to the rivers or nearby canal or waterbed without any regard to environment.Over 3000 species of plants and 400 species of fish and other aquatic fauna depend on wetlands for whole or part of their life cycle. Pollution in Buriganga River: The River Buriganga, which runs past Dhaka City, is at present one of the most polluted rivers in Bangladesh. The river is seriously polluted by discharge of industrial effluents into

river water, indiscriminate throwing of household, clinical, pathological & commercial wastes, and discharge of fuel and human excreta. Up to 40,000 tones of tannery waste flows into the river daily along with sewage. Balu River: The River near Tongi receives untreated effluents from industries such as textiles, lead batteries, pulp and paper, pharmaceuticals, paints, detergents, iron and steel, rubber etc. Bhairab/Rupsa Rivers: The principal industries of Khulna are jute mills, oil mills, newsprint mills, cable, shipyards, tobacco, match factories, hardboard and others dispose molasses, starch, oil, sodiumsulphide, ethane, lissapol, soda ash, dye, sulphuric acid, salicylic acid, lime, ammonium sulphide, and chrome etc. Karnaphuli River: The polluting industries of Chittagong, the second largest city of Bangladesh, such as tanneries, textile mills, oil refinery, TSP plant, DDT plant, chemical complexes, fish processing units, urea fertilizer factory, asphalt bitumen plant, steel mill, paper mill, rayon mill complex, cement factories, pesticide manufacturing plants, paint and dye manufacturing plants, several soap and detergent factories and a number of light industrial units directly discharge untreated toxic effluent into Karnaphuli river. Heavy metal poisoning in different area of Bangladesh Heavy Meatal BurigangaSediments sample (mg/kg) 0.40 1.6 70.0 133.8 60.3 105.6 245.0 984.9 52.8 139.6 Patenga to Sitakund coast Water (g/ml) 0.069-0121 0.87-0324 0.185-.500 0186-0.398 0.148-.0860 0.086-0.281 7.23-41.28 0.376-0.672 Karnafuli Water (g/ml) ship breaking area-soil (mg/kg) 573 -1211 4232 -5733 2,929 -5,888 507 - 568 1,792 -2,321 0.076 -0.266 effluent- for irrigation DEPZ, (mg/ L) 0.02 -0.08 1.35 -2.88 0.14 0.30 0.49- 1.69 0.29 - 0.53 0.13 0.29 4.13 -5.53

Cd Cu Pb Zn Cr Ni Fe Mn Hg

0.090-0.217 0.372-0.973 0.405-1.195 0.472-1.186 0.421-0.925 0.356- 865 20.025-42.203 0.498-1.372 -

Major causes of Heavy Metal poisoning in Bangladesh Lack of proper monitoring Lack of accountability and corruption Absence of peoples participation Absence of NGOs involvement Inadequate legal backup Lack of law and order Poor administration Lead Sources of Exposure

Paint chips (Lead Paint) Tetraethyl and tetramethyl lead are still used as additives in gasoline Soil and dust Contaminated water Parents lead-related occupation Traditional Medicines Congenital exposure

Mechanisms of Lead Toxicity Lead binds to enzymes that have functional sulfhydryl groups, rendering them nonfunctional and further contributing to impairment in oxidative balance, leading to: Autoimmunity Depletion of glutathione Increased levels of free radicals in tissue Lead Toxicity-Early Symptoms diffuse muscle weakness general fatigue/lethargy attention deficit/ irritability myalgia joint pain/arthritis loss of appetite unusual taste in mouth/change in taste of food Lead Toxicity Symptoms Headache Insomnia Irritability Diminished libido Weight loss of 10 lbs or more without known cause Tremulousness Constipation Loss of libido Motor neuropathy Encephalopathy Cerebral edema Seizures Coma Severe abdominal cramping Epiphyseal lead lines in children (growth arrest) Renal failure Neurotoxicity of Lead in Childhood Mental retardation in severe lead intoxication 5 points in IQ for every 10 g/dl in blood lead level- population based studies Other adverse developmental outcomes: o Aggression o Hyperactivity o Antisocial behaviors

 Learning disability- impairment in memory, auditory processing, and visual-motor integration. The IQ is normal. Treatment 1. Environmental inspection/hazard reduction 2. Nutritional supplementation 3. Chelation therapy 1. Nutritional Supplementation Iron supplementation Calcium supplementation calcium rich foods Phosphorus supplementation Frequent food consumption- regular meals + snacks 2. Chelation Therapy BLL > 70 g/dl or encephalopathy; Hospital admission-Administration of a parenteral chelator BLL > 45 g/dl- oral chelator BLL 25-45 g/dl- if these levels persist despite environmental intervention Arsenic Arsenic is a well-known toxic metal and is present mainly as oxyanion compounds in ground water. The World Health Organizations (WHOs) current provisional guideline for arsenic in drinking water is 10 g/L, but all developing countries affected with contaminated groundwater are still struggling to keep up with the previous WHO guideline value of 50 g/L . Approximately 30-35 million people in Bangladesh are exposed to elevated levels of arsenic in drinking water. About 27% of shallow wells less than 150 m deep have arsenic concentrations >50 g/L , whereas wells greater than 150-200 m deep usually have arsenic concentration <5 g/L. Chemical Description Arsenic rarely occurs in a free state and is found largely in combination with sulfur, oxygen, and iron. In groundwater, arsenic combines with oxygen to form inorganic pentavalent arsenate and trivalent arsenite. The toxicity of different arsenic species varies in the order arsenite> arsenate> monomethylarsonate> dimethylarsinate. One important mechanism through which the groundwater is polluted with arsenic is thereduction of iron oxyhydroxide (FeOOH) by bacteria and subsequent desorption of arsenic from the iron surfaces in the Bengal Basin (part of Bangladesh and West Bengal). Sources Groundwater and surface water Arsenic containing mineral ores Coal mining Industrial processes Metallurgy Glass manufacturing Commercial products Wood preservatives Pesticides Herbicides Fungicides Food- Seafood and fish Others Antiparasitic drugs Soil Pica

Acute exposure May result in death Symptoms Gastrointestinal nausea, emesis, abdominal pain, rice-water diarrhea Bone marrow pancytopenia, anemia, basophilic stippling Cardiovascular EKG changes (torsades de pointes) Central nervous system (CNS) encephalopathy, polyneuropathy Renal renal insufficiency, renal failure Hepatic hepatitis APL differentiation syndrome (APL patients receiving arsenic trioxide treatment) Symptoms include fever, weight gain, pulmonary infiltrates, pleural or pericardial effusions Chronic exposure Dermatologic Mees lines, hyperkeratosis, hyperpigmentation, alopecia Hepatic cirrhosis, hepatomegaly Cardiovascular hypertension, peripheral vascular disease Central nervous system stocking glove neuropathy, tremor Malignancies skin (squamous cell), hepatocellular, bladder, lung, renal Treatment of acute poisoning Gastric lavage Activated charcoal does not bind well inorganic arsenic Whole bowel irrigation with polyethylene glycol Skin decontamination in dermal exposure Supportive care Chelation therapy should be instituted promptly (minutes to hours) BAL (British anti-Lewisite)- IM Succimer (DMSA)- PO DMPS PO, IV D-Penicillamine- less effective Treatments of cronic poisoning Consumption of only arsenic free water Zinc, Selenium, and Vitamin A for repair of the skin Chelation therapy - Not proven to help patients Prevention & control of Arsenic poisoning in drinking water Conventional Arsenic Removal Technologies in Bangladesh The most commonly used conventional technologies for removal of arsenic from water can be grouped into the following four categories: (a) Oxidation and precipitation (b) Coagulation and filtration (c) Sorptive filtration (d) Membrane filtration Alternative Sources of Safe Water in Bangladesh Dug well

 Surface Water Treatment: (a) Pond Sand Filter, (b) Large-scale Surface Water Treatment Rainwater Harvesting System Deep Tubewell Piped Water supply System Treatment of Arsenic Contaminated Groundwater in Bangladesh 1. Sono 3-Kolshi Filter 2. Granet Home-made Filter 3. Chari Filter 4. Adarsha Filter 5. Shafi Filter 6. Bijoypur Clay /Processed Cellulose Filter 7. Household Bucket Filter Cadmium Sources: Leather tanning indutries Rechargeable Ni-Cd batteries Solar cells Solder alloys Paint and plastic production Engraving Cadmium vapor lamps Parasite treatment in farm animals Old television tubes Electroplate other metals coal or tobacco is burned Fish & Shellfish Toxicity Respiratory Effects Acute inhalation may mimic metal fume fever: Fever, chills & decreases in FVC and FEV1 Initial symptoms: flu-like symptoms Later: chest pain, cough, dyspnea, Bronchospasm and hemoptysis may occur Chronic inhalation MAY result in impairment of pulmonary function with reduction in ventilatory capacity Renal Effects May cause tubular and glomerular damage with resultant proteinuria Latency period of ~10 yrs Nephropathy is progressive & irreversible Chronic exposure progressive renal tubular dysfunction Critical renal concentration Decreased GFR Chronic renal failure Kidney stones more common Skeletal Effects Pseudofractures

Other effects of osteomalacia and osteoporosis Appear to be secondary to increased urinary calcium and phosphorus losses

Treatment Cadmium poisoning is not reversible. It stays in the system for a very long time and will be excreted along with metallothionein slowly. Hemodialysis has been used before to get rid of cadmium that has not been absorbed from the bloodstream yet and sometimes EDTA chelation can help increase the productivity of the proced. Mercury Sources Elemental mercury (Hg0) medical and environmental measuring devises disc batteries fluorescent light bulbs dental amalgam burning fossil fuels manufacturing, processing, and mining Inorganic mercury (Hg1+ & Hg2+) disinfectant antibacterial antiparasitic cathartic diuretic teething powder, cholera Organic mercury (methyl-, ethyl-, or phenylmercury) Methylmercury: used as a crop fungicide, ubiquitous in environment since microorganisms methylate elemental mercury Ethylmercury: thimerosal used as an antiseptic and vaccine preservative Phenylmercury: fungicide in latex paints

Toxicity At high concentrations, vapor inhalation produces acute necrotizing bronchitis, pneumonitis, and death. Long term exposure affects CNS. Early: insomnia, forgetfulness, anorexia, mild tremor Late: progressive tremor and erethism Salivation, excessive sweating, renal toxicity (proteinuria, or nephrotic syndrome) Gastrointestinal ulceration or perforation and hemorrhage are rapidly produced, followed by circulatory collapse. Breakdown of mucosal barriers leads to increased absorption and distribution to kidneys (proximal tubular necrosis and anuria). Acrodynia (Pink disease) usually from dermal exposure maculopapular rash, swollen and painful extremities, peripheral neuropathy, hypertension, and renal tubular dysfunction. Children and fetuses exceptionally vulnerable o seizures o psychomotor retardation o visual and auditory impairment

Treatment The most important and effective treatment is to identify the source and end the exposure Chelating agents (DMSA) may enhance inorganic mercury elimination. Dimercaprol may increase mercury concentration in the brain. Elemental mercury spills- Roll onto a sheet of paper and place in airtight container Consultation with environmental cleaning company is advised with large spills. Conclusion If diagnosed early, most cases of heavy metal poisoning can be cured, chronic exposure is difficult to cure. As with all poisonings, prevention is the key. With the gradual development of industry, intensive use of pesticides and discharge of untreated domestic sewage may further exacerbate the situation in coming years. To prevent heavy metal poisoning following step may improve current situation proper monitoring & accountability peoples participation NGOs involvement Proper law and order