Categories
Internal Medicine

Cadmium poisoning

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

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


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

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:

ijms-18-01590-g001
General scheme of the toxic effects of Cadmium (Cd) exposure in dam (female parent of an animal), placenta and fetus. MT: Metallothionein; LWMP: Low Molecular Weight Proteins; RME: Receptor-Mediated Endocytosis (e.g., Megalin or 24p3 Receptor); TRPV6: Transient Receptor Potential Cation Channel Subfamily V Member 6; DMT1: Divalent Metal Transporter-1; ZIP-14: Zrt/Irt-like Protein 14; ZnT2: Zinc Transporter 2.

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

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)

Leave a Reply

%d