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Heavy Metals - Dr.Kopec

12/2/2016

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Picture
ARSENIC
  • ​Acute arsenic toxicity can present wiht abdominal pain, vomiting, fluid shifts, hemolysis and prolonged QTc.
  • Chronic arsenic toxicity leads to peripheral sensory neuropathy, skin hyperpigmentation, Mee's lines and alopecia.
  • Arsenic toxicity is associated with lung and skin cancer. 
  • Testing for arsenic needs a 24 hour urine sample that is speciated and no ingestion of seafood 72 hours prior to testing. 
  • Treatment is with BAL or succimer. 
  • Arsine gas classic triad is: abdominal pain, hemolysis and bronze skin.

MERCURY
  • Elemental mercury is found in thermometers and is not absorbed by the GI tract, however it is very toxic if it is vaporized.
  • Inorganic mercury is associated with renal failure. 
  • Inorganic mercury has been associated with Pink's disease (acrodynia) with is a maculopapular rash with desquamation and swollen painful extremities. 
  • Danbury shakes were from mercury used in the felt hat industry leading to chronic toxicity and is where the term "mad as a hatter" comes from.
  • Organic mercury crosses the BBB and placenta. It is teratogenic and highly fatal, with neurological demise. Classic finding is constricted visual fields. 
  • To diagnosis organic mercury toxicity you check a whole blood mercury level.
  • To diagnosis inorganic mercury toxicity you check a 24 hour urine mercury level. 
  • Treatment for inorganic mercury is succimer or BAL. 

LEAD
  • Lead inhibits multiple steps in the heme pathway. 
  • Children are more susptible to lead toxicity than adults. 
  • Lead toxicity can present with a range of symptoms from: constipation, irritability, abdominal pain, tremors, headache, encephalopathy and seizures.
  • Diagnosis is made with a whole blood lead level. 
  • Treatment initially is remove the source then chelate based on the level with BAL, EDTA or succimer.
  • Classic lead findings are: basophillic stipling, Burton's lines and lead lines on xrays. 
  • Iron causes GI symptoms, metabolic acidosis and periportal hepatic necrosis. 
  • There are various formulations of iron with different percentages of elemental iron.
  • There are 5 stages to iron toxicity: 1) GI symptoms, 2) latent 3) Multiorgan failure 4) Hepatic failure 5) Recovery/Long term effects
  • Fatal iron poisonings are >60mg/kg
  • Iron level after 4 hours if >500mcg/dL need to be treated. 
  • Deferoxamine should be started for severe acidosis, refractory GI symptoms, shock, altered mental status, or level >500mcg/dL .
  • Deferoxamine has been associated with hypotension and Yersinia infections. 
  • If there are GI symptoms and neurological symptoms think about metal toxicities.
​
Remember that metals are caustics. 

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    • Official Site
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    • EMS
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    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
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    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
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    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
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      • PGY - 3
      • Simulation Reading
      • Resident Wellness
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      • Resume Builder
    • Individualized Interactive Instruction