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Pharm Unit 6: Misc > Metal toxicity notes > Flashcards

Metal toxicity notes Flashcards

1
Q

What are the chronic toxicities of the nervous system?

A

altered mental status, peripheral neuropathy

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2
Q

What are the chronic toxicities of the renal system?

A

renal insufficiency

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3
Q

What are the chronic toxicities of the hematologic system?

A

Anemia and cytopenia

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4
Q

What are the chronic toxicities of the dermatologic system?

A

Rashes

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5
Q

What are the acute toxicities of the nervous system?

A

Altered mental status, peripheral neuropathy

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6
Q

What are the acute toxicities of the cardio system?

A

tachycardia, hypotension

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7
Q

What are the acute toxicities of the renal system?

A

Proteinuria, acute tubular necrosis

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8
Q

What are the acute toxicities of the GI system?

A

N/V/D

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9
Q

What are the acute toxicities of the derm system?

A

Skin hair nail changes days to weeks post exposure

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10
Q

What labs need to be checked for suspected toxicities?

A

• CBC with diff: check for hemolysis or basophilic stippling
• Renal fxn: BUN, Cr
• UA – proteinuria
• LFT’s
• KUB – may show evidence of metal ingestion
• ECG: abnormalities suggest specific metals
• Metal specific testing:
o Whole blood levels
o Urine excretion levels
o Hair analysis
o Chelator mobilization tests NOT considered reliable

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11
Q

What are the potential sources of arsenic poisoning?

A
  1. Inhalation of dust residues (occupational)
  2. Pesticide sprays
  3. Arsenic Trioxide (antineoplastic) for leukemia
  4. Alternative medicines/remedies
  5. Well water
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12
Q

What are the acute effects of arsenic poisoning?

A
  • GI – n/v/d/bleeding
  • CV – shock, dysrhythmia, prolonged QT (Torsades)
  • CNS – coma, seizures, agitation
  • Renal – acute tubular necrosis, hematuria/proteinuria
  • Bone marrow suppression
  • Peripheral neuropathy
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13
Q

What are the chronic effects of arsenic poisoning?

A
  • Skin: dermatitis, hyperpigmentation, malignancy
  • Neurologic: Stocking glove parathesias
  • Hepatotoxicity
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14
Q

What are the specific dx tests for suspected arsenic poisoning?

A
  • Urine arsenic lead
  • Blood arsenic level
  • Levels do not correlate with severe clinical findings
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15
Q

What are the treatment options for arsenic poisoning?

A
  • ABC’s
  • Activated charcoal to absorb arsenic in GI tract
  • Whole bowel irrigation is KUB positive
  • Chelation Rx – BAL and succimer and/or DMPS
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16
Q

What are the 3 forms of mercury?

A

elemental, inorganic and organic

17
Q

Where can one be exposed to elemental mercury?

A

o Mining and ore processing industries, paint & battery manufacturing, ceramics, jewelry

18
Q

Where can one be exposed to inorganic mercury?

A

o Industries involving fireworks, dye & ink manufacturing, hide and fur processing

19
Q

Where can one be exposed to organic mercury?

A

o Farming, pesticide production, embalming fluids, wood preservatives

20
Q

What are the clinical effects of elemental mercury?

A
  1. Acute Exposure: malaise, HA, fever, lung injury, encephalopathy
  2. Chronic Exposure: stomatitis, psychological changes (mood swings, memory loss, sensory-motor neuropathy)
21
Q

What are the clinical effects of inorganic mercury salts?

A
  1. Acute Exposure: skin blistering, weakness, pallor, shock-like symptoms
  2. Chronic Exposure: same as elemental mercury + acrodynia and rash
22
Q

What are the clinical effects of organic mercury?

A
  1. Acute Exposure (Methyl & Dimethyl mercury): sensory & motor neuropathy, dysarthia, ataxia, tremor, hearing deficits, psychological changes
  2. Acute Exposure (phenyl and methoxyethyl mercury): similar to inorganic mercury salt exposure
23
Q

What are the dx for mercury toxicities?

A
  1. Whole blood mercury level
    A. Significant level > 20 mcg/dl
  2. 24 hour urine for mercury (gives accurate reading of inorganic, but not organic mercury levels)
  3. Hair analysis
24
Q

How is mercury toxicity treated?

A
  1. ABC’s
  2. Activated charcoal to absorb mercuric chloride in GI tract
  3. Whole bowel irrigation if KUB positive
  4. Chelation Rx – BAL (elemental and inorganic mercury) & DMSA (organic mercury only)
25
Q

What are the sources of exposure for Thallium?

A
  1. Extremely toxic
  2. once used as a pesticide
  3. Manufacture of semiconductors
  4. jewelry
  5. optical lenses
  6. thermometers
26
Q

What are effects of thallium exposure within hours?

A

nausea, vomiting, diarrhea and pleuritic chest pain

27
Q

What are effects of thallium exposure within days?

A
  1. CNS: lethargy, coma, psychosis, seizures, central respiratory failure
  2. PNS: painful, ascending peripheral neuropathy w/o motor involvement
  3. Autonomic NS: tachycardia, hypertension, diaphoresis, fever
  4. CV: myocardial necrosis, dysrrhythmias, ARDS
  5. Skin: alopeica
28
Q

What are the dx for thallium toxicities?

A
  • Blood thallium level > 5 mcg/dl

* Hair analysis to confirm dx

29
Q

What is the treatment for thallium toxicities?

A
  • Prussian Blue is used to increase fecal elimination of thallium
  • Also use activated charcoal early in decontamination
30
Q

What are the sources of exposure for lead?

A
  1. Environmental sources
    A. Paint (homes pre-1978), House dust from deteriorated paint, Water leached from leaded plumbing, Leaded gasoline (pre-1976), “natural” dietary supplements, Foreign body/toys (not made in US)
  2. Occupational sources
    A. Lead welders, Bridge painters; construction workers, Firing range, Shot makers
31
Q

What are the clinical effects of lead toxicity on children?

A
  1. Severe toxicity
    A. CNS: encephalopathy, coma, AMS, seizures, ataxia, loss of developmental skills, cranial nerve palsies, increased ICP
    B. GI: persistent vomiting
    C. Hematologic: pallor (anemia)
  2. Mild to Moderate toxicity
    A. CNS: hyperirritable behavior, intermittent lethargy, “difficult child”
    B. GI: intermittent vomiting, abdominal pain anorexia
  3. Asymptomatic
    A. CNS: impaired cognition, behavior, balance, fine-motor coordination
    B. Impaired hearing and growth
32
Q

What are the clinical effects of lead toxicity on adults?

A
  1. Severe toxicity
    A. CNS: encephalopathy, coma, seizure, delirium, HA, papilledema, optic neuritis, increased ICP
    B. PNS: foot drop, wrist drop
    C. GI: abdominal colic
    D. Hematologic: pallor (anemia)
    E. Renal: nephropathy
  2. Moderate toxicity
    A. CNS: HA, memory loss, decreased libido, insomnia
    B. PNS: peripheral neuropathy
    C. GI: metallic taste, abdominal pain, anorexia, constipation
    D. Kidney: arthritis due to gout
    E. Mild anemia, myalgias, muscle weakness, arthralgias
  3. Mild toxicity
    A. CNS: fatigue, somnolence, moodiness, lessened interest in leisure activity
    B. Impaired kidney function, HTN, CVD, increased risk for cancer
33
Q

How are children assessed for lead toxicities?

A

well-child visits at age 1 and 2 by fingerstick, if lead level elevated then draw whole blood

34
Q

How are adults assessed for lead toxicities?

A

Whole blood levels

35
Q

How is lead toxicity treated?

A
  • Removal from the source of exposure
  • Whole bowel irrigation if lead in GI tract
  • Encephalopathic patients: BAL + CaNa2EDTA for 5 days
  • Succimer for 20 days
36
Q

What are the sources of exposure for iron toxicity?

A

Excess iron consumption, blood transfusions

37
Q

What are the clinical effects of iron toxicities?

A 
1. Local Effects
A. GI mucosa resulting in n/v/d/bleeding
2. Systemic Effects
A. High anion gap metabolic acidosis
B. CV toxicity (vasodilation, inotopic effects due to myocyte damage)
C. Liver toxicity
38
Q

What are the dx tests for iron toxicities?

A
  • Iron levels
  • < 300 mcg/dl – nontoxic
  • 300-500 mcg/dl – mild-mod toxicity
  • > 500 mcg/dl – severe toxicity
  • CBC, electrolytes, renal fxn, ABG
39
Q

How is iron toxicity treated?

A

• IV fluids
• Aggressive supportive care
• Whole bowel irrigation (activated charcoal does not absorb Fe)
• Deferoxamine (DFO)
o High affinity iron chelator
o Removes Fe from ferritin and transferring, chelates Fe in spleen, liver and bone marrow
o Typically given IV

Pharm Unit 6: Misc (9 decks)

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