Cadmium poisoning

Cadmium is a naturally occurring toxic heavy metal with common exposure in industrial workplaces, plant soils, and from smoking.

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Exposure

• Nickel-cadmium batteries
• Industrial areas, hazardous waste-sites or factories (esp. in Japan)
• Smoking
• Artists (cadmium pigments)
• Fertilizers (some phosphate-containing agents)
• Affected plants

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Clinical features

• Inhalation: Respiratory & renal systems
• Ingestion: GI + liver damage & renal system

Acute symptoms:

• Flu-like symptoms:
  • Chills, fever, and muscle ache sometimes referred to as “the cadmium blues“
  • May resolve after a week if there is no respiratory damage
• Severe exposures (respiratory damage):
  • Tracheobronchitis, pneumonitis, and pulmonary oedema

Later symptoms:

• Symptoms of inflammation (hours after the exposure):
  • Cough, dryness and irritation of the nose and throat, headache, dizziness, weakness, fever, chills, and chest pain
• Irreversible anosmia (total loss of smell)
• Musculoskeletal system:
  • Osteomalacia (soft bones), osteoporosis (less bone density)
    • Pain in the joints and the back, and also increases the risk of fracture
• Renal system:
  • Proximal renal tubular dysfunction
    • Hypophosphatemia → muscle weakness and sometimes coma
    • Hyperuricemia → Gout
    • Hypercloremia
    • Kidneys shrink by up to 30%
    • ↑ risk of kidney stones

During pregnancy:

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Diagnosis

Low & chronic (prolonged) exposure:

• Urinary β-2 microglobulin (indirect method of measuring cadmium exposure)
  • Early indicator of renal dysfunction in persons chronically exposed to low but excessive levels of environmental cadmium

Excessive exposure (industrial situations) or acute poisoning:

• Blood or urine cadmium concentrations

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Management

Screening

• Urinary β-2 microglobulin screening for renal damage in workers with long-term exposure to high levels of cadmium

Treatment:

• Gastric decontamination (soon after exposure):
  • Emesis or gastric lavage
• Activated charcoal, chelation therapies are not effective
• Prevent additional exposure (M/imp measure)