$Unique_ID{BRK03804} $Pretitle{} $Title{Heavy Metal Poisoning} $Subject{Heavy Metal Poisoning Heavy Metal Toxicity Metal Fume Fever Fanconi's Anemia Wilson's Disease} $Volume{} $Log{} Copyright (C) 1989, 1991 National Organization for Rare Disorders, Inc. 669: Heavy Metal Poisoning ** IMPORTANT ** It is possible that the main title of the article (Heavy Metal Poisoning) is not the name you expected. Please check the SYNONYM listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Heavy Metal Toxicity Information on the following diseases can be found in the Related Disorders section of this report: Metal Fume Fever Fanconi's Anemia Wilson's Disease General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Heavy Metal Poisoning results from an overexposure to some types of metal. This may occur from industrial exposure, from air or water pollution, or from foods, medicines or improperly coated food containers. Occasionally hemodialysis (filtering of the blood mechanically to treat severe kidney failure) may be a cause. Symptoms The symptoms of metal poisoning vary according to which type of metal overexposure is involved. Some specific examples are: Aluminum containers used in the manufacture and processing of some foods, cosmetics and medicines, and also for water purification. Too much aluminum may affect the brain and the spinal cord. 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. Arsenic is used in the manufacture of pesticides. The gas from arsenic also has some industrial uses. Overexposure may cause headache, drowsiness, confusion, delirium, seizures and death. In cases of chronic poisoning, weakness, muscle aches, chills, and fever may develop. Berryllium is a metal used in the refining of precious metals. Overexposure is characterized by the formation of granulomas, nodular accumulations or inflammatory cells in the lungs. This may be accompanied by breathing problems. It is difficult to distinguish Chronic Beryllium Disease from Sarcoidosis, another granulomatous disease. (For more information on this disorder, choose "Sarcoidosis" as your search term in the Rare Disease Database). Beryllium is used in structural materials in the spacecraft industry, supersonic jets, and in certain components of the space shuttle. Reclaiming beryllium from discarded electronic components and other materials is an industry. Beryllium smelter workers have been exposed to high levels of the metal as it is crushed, milled, screened, and melted. Even though the workers are required to wear respirators, they may not carefully adhere to the safety regulations, and as a result, they can suffer from Beryllium poisoning. Cadmium is used for many items, including electroplating, storage batteries, vapor lamps and in some solders. Overexposure may cause lung disease (emphysema), fatigue, headache, vomiting, anemia, loss of the sense of smell and kidney damage. Chromium is used in the manufacture of cars, glass, pottery and linoleum. Too much chromium may cause lung and respiratory tract cancer and kidney diseases. Cobalt, used in making jet engines, may cause nausea, vomiting, lack of appetite (anorexia), ear ringing (tinnitus), nerve damage, respiratory diseases, goiter and heart and kidney damage. Copper, used in the manufacture of electrical wires, may cause a flu-like reaction called metal fume disease, plus disturbances in the blood. Overexposure to gold (as in treatment of rheumatoid arthritis) may cause skin rashes, bone marrow depression, jaundice, stomach and intestinal bleeding, headache and vomiting. Lead production workers, battery plant workers, welders and solderers may be overexposed to lead if proper precautions are not taken. The symptoms may cause miscarriage, birth defects, hearing and eye-hand coordination defects, anemia, abdominal pain (called lead colic) decreased male fertility, decreased muscular strength and endurance, kidney disease, wrist drop, hostility, depression and anxiety. Lithium, which is used to make glasses and pharmaceuticals, may cause diseases of the stomach, intestinal tract, central nervous system and kidneys. Manganese is used as a purifying agent in the production of several metals. Symptoms of too much manganese (by inhalation of manganese dust), may include damage to the central nervous system and pneumonia. One unusual reaction may be inappropriate laughter. Mercury is used by dental assistants and hygienists, and chemical workers. Mercury can affect the lungs and kidneys, cause shortness of breath, coughing and chest pain. There may be behavioral and neurological changes, such as excitability and quick-tempered behavior, lack of concentration, loss of memory, depression, fatigue, weakness and headache. Stomach and intestinal disturbances, kidney damage, dehydration, shock and permanent brain damage may also be a result of mercury poisoning. Molybdenum is used in the hardening of steel. Overexposure may cause a possible depletion of copper in the body. Overexposure to silver may cause a gray discoloration of the skin, hair and internal organs. Nausea, vomiting and diarrhea may also occur. Vanadium may cause loss of appetite (anorexia), throat pain, nasal irritation and acute bronchitis, including a cough that may be characterized by a whooping noise. Zinc overexposure may cause the flu-like symptoms of metal fume fever, stomach and intestinal disturbances and liver dysfunction. Causes Heavy Metal Poisoning is a result of overexposure to some types of metal. It may be from industrial sites, or polluted air, contaminated food or water. Improperly coated food containers, utensils or cookware can also cause heavy metal poisoning, if metals contained in the item seep into the food. Affected Population Heavy Metal Poisoning can affect males and females in equal numbers, depending on exposure. Outbreaks of this type of poisoning have occurred in the U.S. over the past several years from imported plates and cookware that were not properly coated to prevent heavy metals from contaminating food. 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 malaise, chills and fever. The patient may have excessive thirst and a metallic taste in their mouth. Symptoms usually subside spontaneously in 6 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). Therapies: Standard Treatment of Heavy Metal Poisoning consists of 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: BAL (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, the patient should be removed from the contaminated environment and his respiration supported. Occupational exposure to heavy metals requires prevention through the use of masks and protective clothing, or even a change of profession to avoid toxicity. In cases of cerebral edema (swelling of the brain), treatment with Mannitol (a diuretic), and corticosteroid drugs, along with intracranial monitoring, is required. Kidney failure may call for hemodialysis and other special treatment. In 1991 the FDA approved the drug Chemet for the treatment of children with severe lead poisoning. Chemet is manufactured by Johnson & Johnson Co. Therapies: Investigational Two orphan drugs are being tested for the treatment of Heavy Metal Poisoning. In the treatment of iron poisoning, the drug Bio-Rescue (Dertran and Deferaxamine) is being developed by Biomedical Frontiers, Inc. of Minneapolis, MN. Mercury poisoning is being treated by the drug Chemet (Succimer), developed by McNeil Consumer Products, Co., Ft. Washington, PA. This disease entry is based upon medical information available through June 1991. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Heavy Metal Poisoning, please contact; National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 National Institute of Environmental Health Sciences P.O. Box 12233 Research Triangle Park, NC 27709 (919) 541-3345 Food and Drug Administration (FDA) Office of Consumer Affairs 5600 Fishers Lane (HFE-88) Rockville, MD 20857 References INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, ed.-in-chief; Little, Brown and Co., 1987. Pp. 884. NEUROLOGIC DISORDERS, NURSES CLINICAL LIBRARY; Springhouse Corporation, 1984. Pp. 178, 186. THE METAL IN OUR METTLE: R.W. Miller, FDA Consumer; Dec., 1988 - Jan. 1989, Pp. 24-27.