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Antimony Poisoning

Poisoning by Antimony

Antimony poisoning involves a toxic effect caused by a prolonged exposure to higher-than-normal concentrations of antimony, found either in the workplace or in therapeutic agents administered for the treatment of other conditions.


Presentation

Antimony poisoning primarily occurs due to inhalational or oral exposure to the metal antimony and can be diagnosed both as acute toxicity or toxicity resulting over a long period of toxin exposure. This condition leads to a multitude of symptoms, affecting the respiratory, gastrointestinal, cardiovascular and reproductive systems, as well as the skin and eyes. Various compounds of antimony, such as antimony oxide, trioxide, pentoxide, trichloride, and trisulfide, have been causally associated with a plethora of abnormalities in humans.

Chronic bronchitis and emphysema, latent tuberculosis, and pneumoconiosis are the main manifestations of antimony poisoning after persistent contact with airborne antimony [1] [2]. Concerning pneumoconiosis, a variety of other potential metallic compounds such as arsenic oxide and sodium hydroxide may have been responsible for the disease, alongside antimony. Refractory cough and inflammation of the respiratory tract are amongst the predominant symptoms while pleural adhesions may also be caused by antimony poisoning. Inhalation of antimony also leads to gastrointestinal (GI) abnormalities, which include abdominal cramping, diarrhea, vomiting and GI ulceration. The trisulfide, oxide and trichloride compounds have been particularly linked to these symptoms, even though co-toxicity due to other metals cannot be excluded [3] [4] [5]. Headache is an additional manifestation associated with antimony poisoning, along with conjunctivitis.

Menstrual irregularities and instances of miscarriage are also symptoms of antimony poisoning [6]. Furthermore, individuals employed in high-temperature working spaces tend to develop dermal pustules referred to as antimony spots, in regions adjacent to sebaceous and sweat glands [7] [8]. Chronic antimony poisoning by inhalation has been considered the culprit behind cardiovascular pathologies, such as an elevated blood pressure and T-wave abnormalities, although a firm association has yet to be established [9]. A 1990 study also suggested that antimony poisoning of infants from antimony-containing cot mattress covers was the cause of Sudden Infant Death Syndrome (SIDS) [10].

Ingested antimony compounds are also known to lead to poisoning; individuals are expected to develop symptoms such as vomiting, nausea, epigastralgia and abdominal cramps, which can persist for days after the initiation of treatment [11].

Antimony poisoning can also be caused by antimonials used to treat other diseases, such as leishmaniasis and schistosomiasis. Pentavalent antimonials used to cure leishmaniasis can induce poisoning which may rarely manifest with cardiotoxicity and death [12] [13] [14] [15] [16]. Pancreatitis, leukopenia and acute renal failure can also be ways in which antimony poisoning from therapeutic agents can present, especially in HIV-positive patients suffering from visceral leishmaniasis. Trivalent antimonials used to treat schistosomiasis were also a confirmed cause of antimony poisoning and patients presented with anorexia, vomiting, electrocardiographic abnormalities, while acute vascular collapse has also been documented; these drugs were discontinued as a therapy against schistosomiasis in 1970 [17] [18].

Anemia
  • Monjack's autopsy listed “acute pneumonia and severe anemia” as his cause of death.[medpagetoday.com]
  • Arsenic Useful lab tests include Urinalysis ( Oliguria, Hematuria, Hemoglobinuria); Complete Blood Count and Peripheral Smear (Macrocytic Anemia ); Tissue Exam (reveals arsenic deposits – urine, nails, hair) and Serum Arsenic levels.[diagnose-me.com]
  • Weakness, anemia, loss of weight and general depression may also occur.[espimetals.com]
Plethora
  • Various compounds of antimony, such as antimony oxide, trioxide, pentoxide, trichloride, and trisulfide, have been causally associated with a plethora of abnormalities in humans.[symptoma.com]
Vomiting
  • Inhalation of antimony also leads to gastrointestinal (GI) abnormalities, which include abdominal cramping, diarrhea, vomiting and GI ulceration.[symptoma.com]
  • It is characterized by vomiting, diaphoresis, diarrhea, and a metallic taste in the mouth. Irritation of the skin or mucous membranes may result from external exposure. Severe poisoning resembles arsenic poisoning.[medical-dictionary.thefreedictionary.com]
  • Toxicity can also result from repeated exposure to antimony in medications, such as tartar emetic (antimony and potassium tartrate), used to induce vomiting and in treatment of helminthic and fungal infestations.[britannica.com]
  • Wikimedia Commons Vomiting, diarrhoea and liver damage may have been a part of daily life for Romans in Pompeii.[ibtimes.co.uk]
  • Repeated prolonged exposure to airborne antimony trichloride, antimony trisulfide or antimony oxide was seen to cause abdominal pain, diarrhea, vomiting, and ulcers.[holicolorsindia.com]
Diarrhea
  • It is characterized by vomiting, diaphoresis, diarrhea, and a metallic taste in the mouth. Irritation of the skin or mucous membranes may result from external exposure. Severe poisoning resembles arsenic poisoning.[medical-dictionary.thefreedictionary.com]
  • Inhalation of antimony also leads to gastrointestinal (GI) abnormalities, which include abdominal cramping, diarrhea, vomiting and GI ulceration.[symptoma.com]
  • Repeated prolonged exposure to airborne antimony trichloride, antimony trisulfide or antimony oxide was seen to cause abdominal pain, diarrhea, vomiting, and ulcers.[holicolorsindia.com]
  • Large doses cause vomiting, diarrhea, abdominal discomfort and tingling of the extremities. Despite the fact that large doses work as an emetic, if left untreated, a person may die.[buzzle.com]
  • Along with diarrhea and vomiting, it can cause cardiac arrest in severe cases. This toxic chemical element also naturally occurs in groundwater near volcanoes.[iflscience.com]
Nausea
  • Ingested antimony compounds are also known to lead to poisoning; individuals are expected to develop symptoms such as vomiting, nausea, epigastralgia and abdominal cramps, which can persist for days after the initiation of treatment.[symptoma.com]
  • Low doses cause headaches, nausea, dizziness and depression. Large doses cause vomiting, diarrhea, abdominal discomfort and tingling of the extremities. Despite the fact that large doses work as an emetic, if left untreated, a person may die.[buzzle.com]
  • Looking for adverse effects, patients were asked about abdominal pain, nausea, vomiting or anorexia in each medical visit.[allaboutheaven.org]
  • Arsenic Symptoms include nausea or vomiting, abdominal pain, diarrhea, garlic odor on breath, excessive salivation, headache, vertigo, fatigue, paresthesia, paralysis, kidney failure, progressive blindness, and mental impairment.[diagnose-me.com]
  • In battery plant workers, median blood antimony concentrations of 2.6 mcg/L were found in metal casters and 10 mcg/L in metal formers.(4) The effects of acute or chronic antimony poisoning are similar to arsenic and include abdominal pain, dyspnea, nausea[mayomedicallaboratories.com]
Abdominal Pain
  • Repeated prolonged exposure to airborne antimony trichloride, antimony trisulfide or antimony oxide was seen to cause abdominal pain, diarrhea, vomiting, and ulcers.[holicolorsindia.com]
  • Looking for adverse effects, patients were asked about abdominal pain, nausea, vomiting or anorexia in each medical visit.[allaboutheaven.org]
  • In the latest Case Record of the Massachusetts General Hospital , a 34-year-old man was seen in the emergency department because of abdominal pain and vomiting after his wife had given him a powder to cause him to stop drinking alcohol.[blogs.nejm.org]
  • Arsenic Symptoms include nausea or vomiting, abdominal pain, diarrhea, garlic odor on breath, excessive salivation, headache, vertigo, fatigue, paresthesia, paralysis, kidney failure, progressive blindness, and mental impairment.[diagnose-me.com]
  • pain, dyspnea, nausea, vomiting, dermatitis, and visual disturbances.(1) Additionally, toxicity can include pneumoconiosis, and altered electrocardiograms.(2) Normal blood concentrations are 0.7-2 ng/mL in the unexposed, and 2.6-10 ng/mL in exposed workers[mayomedicallaboratories.com]
Abdominal Cramps
  • Inhalation of antimony also leads to gastrointestinal (GI) abnormalities, which include abdominal cramping, diarrhea, vomiting and GI ulceration.[symptoma.com]
  • At the time of her death, Murphy had displayed several symptoms consistent with heavy metal poisoning: headaches, dizziness, abdominal cramps, coughing, sweating, disorientation, wheezing, congestion and pneumonia.[medpagetoday.com]
Toothache
  • He himself was taking laudanum for a toothache, and the theory is that he mistakenly took the "medicine" he'd been giving his wife, and it killed him.[annerallensbooks.blogspot.com]
Jaundice
  • […] liver failure not induced by acetaminophen, poor prognostic factors include a prothrombin time of more than 100 seconds or any three of the following criteria: drug toxicity or indeterminate cause, an age younger than 10 years or older than 40 years, a jaundice-to-coma[blogs.nejm.org]
Flushing
  • They then get flushed out with your pee. Chelation can be an important part of treatment. But the therapy can be dangerous, and it doesn’t work with all heavy metals.[webmd.com]
  • EYES : Flush eyes with lukewarm water, including under upper and lower eyelids, for at least 15 minutes. Seek medical attention if irritation develops or persists. Most Important Symptoms/Effects, Acute and Delayed : May cause irritation.[espimetals.com]
Suggestibility
  • A 1990 study also suggested that antimony poisoning of infants from antimony-containing cot mattress covers was the cause of Sudden Infant Death Syndrome (SIDS).[symptoma.com]
  • The antimony in a home was correlated to the amount of lead in the dust, suggesting that this was where it was originating.[flandershealth.us]
  • The results of HQ and HI were less than unity, suggesting a low risk of metals in the region. However, HQ for antimony (Sb) was found to be 4.4   10-1, 2.1   10-1 and 5.4   10-1 in three river basins and HI near unity, suggesting its potential risk.[allaboutheaven.org]
  • Bostock/Shutterstock This new research suggests that antimony might have been a bigger problem.[iflscience.com]
  • Instead of lead being to blame, however, the analysis suggests antimony was poisoning the public, at least in Pompeii.[dailymail.co.uk]
Headache
  • Damaged lungs, degraded muscles: Why flu makes you feel so bad 1/2/19 We all know the symptoms of influenza infection include fever, cough, sore throat, muscle aches, headaches and fatigue. But just what causes Read More[barnstablecountyhealth.org]
  • Headache is an additional manifestation associated with antimony poisoning, along with conjunctivitis. Menstrual irregularities and instances of miscarriage are also symptoms of antimony poisoning.[symptoma.com]
  • Low doses cause headaches, nausea, dizziness and depression. Large doses cause vomiting, diarrhea, abdominal discomfort and tingling of the extremities. Despite the fact that large doses work as an emetic, if left untreated, a person may die.[buzzle.com]
  • Symptoms of heavy metal toxicity include mental confusion, pain in muscles and joints, headaches, short-term memory loss, gastrointestinal upsets, food intolerances/allergies, vision problems, chronic fatigue, and others.[diagnose-me.com]
  • In small doses, antimony causes headache, dizziness and depression. Larger doses cause violent and frequent vomiting, and will lead to death in few days.[pt.chemicalstore.com]
Confusion
  • Mental symptoms include restlessness, insomnia, irritability, confusion, excitement, anxiety, delusions, and disturbing dreams.[diagnose-me.com]
  • Symptoms usually come on quickly and you may: Feel confused Go numb Feel sick and throw up Pass out Acute poisoning is an emergency. Call your doctor or local poison control center right away. The national Poison Help Line is 800-222-1222.[webmd.com]
  • Signs of acute poisoning include confusion, numbness, nausea and vomiting, and coma. Other frequent finding include metabolic acidosis, acute tubular necrosis, encephalopathy, cardiomyopathy and dysrhythmias.[medpagetoday.com]

Workup

The complete workup in order to diagnose antimony poisoning requires a thorough medical history, including potential exposure to metals. Occupational exposure is most common, as workers in metallurgy plants, mines, and other similar workplaces are susceptible to antimony poisoning.

A complete blood count and biochemical profile are performed to assess patient status and evaluate creatinine, electrolytes and hematocrit levels. Sector field and quadrupole inductively coupled plasma mass spectrometry can be used to detect antimony in the urine. Levels that exceed 10 mcg/L are deemed elevated [19]. The toxic metal can also be found and measured in the blood, hair, and feces; blood levels greater than 2 ng/mL are also considered compatible with antimony poisoning [20]. The workup is completed with a multitude of other procedures aimed at assessing each case separately, depending on the symptoms with which an individual presents.

T Wave Abnormality
  • Chronic antimony poisoning by inhalation has been considered the culprit behind cardiovascular pathologies, such as an elevated blood pressure and T-wave abnormalities, although a firm association has yet to be established.[symptoma.com]
Pleural Adhesions
  • Refractory cough and inflammation of the respiratory tract are amongst the predominant symptoms while pleural adhesions may also be caused by antimony poisoning.[symptoma.com]
  • Other respiratory effects reported include chronic bronchitis, chronic emphysema, inactive tuberculosis, pleural adhesions, and respiratory irritation (characterized by chronic coughing, wheezing and upper airway inflammation).[holicolorsindia.com]

Treatment

  • Antimony poisoning involves a toxic effect caused by a prolonged exposure to higher-than-normal concentrations of antimony, found either in the workplace or in therapeutic agents administered for the treatment of other conditions.[symptoma.com]
  • Treatment is the same as for arsenic and other heavy metal poisoning—gastric lavage if it has been ingested recently, then treatment with chelating agents that will bind with the metal so the body will eliminate it naturally.[annerallensbooks.blogspot.com]
  • Toxicity can also result from repeated exposure to antimony in medications, such as tartar emetic (antimony and potassium tartrate), used to induce vomiting and in treatment of helminthic and fungal infestations.[britannica.com]
  • M.D. visit: Lead is an environmental toxin and measurements of high levels in the bloodstream require treatment. Avoiding the source of lead, having your home and water supply inspected for possibly sources may be completed by the health department.[healthtap.com]
  • Trivalent and pentavalent antimony compounds are used in medicine as anti-infective agents in the treatment of tropical diseases, especially those of protozoan origin. All antimony compounds are potentially poisonous and must be used with caution.[medical-dictionary.thefreedictionary.com]

Prognosis

  • Q: What are the indicators of poor prognosis in acute liver failure? A: The King’s College Hospital criteria remain the most used prognostic criteria for acute liver failure.[blogs.nejm.org]
  • Prognosis; Complications Although complete cure is possible, many people suffer the effects of toxicity for extended periods. Some of the damage, for instance to the liver or brain, may not be fully reversible.[diagnose-me.com]

Etiology

  • Página 330 - Intestinal infections in patients with the acquired immunodeficiency syndrome (AIDS): etiology and response to therapy. ‎[books.google.es]

Epidemiology

  • We discuss their sources, toxic effects, and epidemiology, as well as identify groups at risk for toxic exposure.[allaboutheaven.org]
  • An epidemiological survey carried out by Professor Peter Fleming of the Institute of Child Health at the Royal Hospital for Sick Children in Bristol came to the conclusion that PVC-covered mattresses were less likely to be associated with cot death.[flandershealth.us]
Sex distribution
Age distribution

Pathophysiology

  • Página 302 - Groszmann RJ, Atterbury CE: The pathophysiology of portal hypertension: a basis for classification. Semin Liver Dis 1982; 2:177. ‎[books.google.es]

Prevention

  • Página 302 - Lee GC-Y, et al: Prevention of perinatally transmitted hepatitis B virus infection with hepatitis B immune globulin and/or HB vaccine, in Vyas GN, Dienstag JL, Hoofnagle JH (eds): Viral Hepatitis and Liver Disease. ‎[books.google.es]
  • Centers for Disease Control and Prevention is opening an investigation into the safety of firefighters’ uniforms containing antimony trioxide, a chemical compound used as a flame retardant.[findingdulcinea.com]
  • The goal of chelation is to form a stable complex between antimony and the sulfur donors, or dithiols, on the chelator, preventing the antimony from chelating host enzymes.[blogs.nejm.org]
  • “A lead pipe gets calcified rather quickly, thereby preventing the lead from getting into the drinking water.[iflscience.com]
  • A lead pipe gets calcified rather quickly, thereby preventing the lead from getting into the drinking water.[sciencedaily.com]

References

Article

  1. Cooper DA, Pendergrass EP, Vorwald AJ, Mayock RL, Brieger H. Pneumoconiosis among workers in an antimony industry. Am. J. Roentgen. Rad. Ther. Nuclear Med. 1968;103:495–508.
  2. Potkonjak V, Pavlovich M. Antimoniosis: A particular form of pneumoconiosis. I. Etiology, clinical and x-ray findings. Int. Arch. Occup. Environ. Health. 1983;51:199–207.
  3. Taylor PJ. Acute intoxication from antimony trichloride. Br. J. Ind. Med. 1966;23:318–321.
  4. Brieger H, Semisch CW, Stasney J, Piatnek DA. Industrial antimony poisoning. Ind. Med. Surg. 1954;23:521–523.
  5. Renes LE. Antimony poisoning in industry. Arch. Ind. Hyg. 1953;7:99–108.
  6. Belyaeva AP. The effect of antimony on reproduction. Gig. Truda. Prof. Zabol. 1967;11:32.
  7. Stevenson CJ. Antimony spots. Trans. St. Johns Hosp. Dermatol. Soc. 1965;51:40–42.
  8. White GP Jr, Mathias CG, Davin JS. Dermatitis in workers exposed to antimony in a melting process. J. Occup. Med. 1993;35:392–395.
  9. Sundar S, Chakravarty J. Antimony Toxicity. Int J Environ Res Public Health. 2010 Dec; 7(12): 4267–4277.
  10. Richardson BA. Cot mattress biodeterioration and SIDS. Lancet. 1990;335:670.
  11. Dunn JT. A curious case of antimony poisoning. Analyst. 1928;531:532–533.
  12. Herwaldt BL, Berman JD. Recommendations for treating leishmaniasis with sodium stibogluconate (Pentostam) and review of pertinent clinical studies. Am. J. Trop. Med. Hyg. 1992;46:296–306.
  13. Chulay JD, Spencer HC, Mugambi M. Electrocardiographic changes during treatment of leishmaniasis with pentavalent antimony (sodium stibogluconate) Am. J. Trop. Med. Hyg. 1985;34:792–799.
  14. Sundar S, Singh VP, Sharma S, Makharia MK, Murray HW. Response to interferon-g plus antimony in Indian visceral leishmaniasis. J. Infect. Dis. 1997;176:1117–1119.
  15. Singh NKP, Sharma D, Jha TK. Kala-azar mortality in hospitalized cases in North Bihar, India. J. Assoc. Physicians India. 1989;37:514–516.
  16. Franco AM, Grafova I, Soares FV. Nanoscaled hydrated antimony (V) oxide as a new approach to first-line antileishmanial drugs. Int J Nanomedicine. 2016 Dec 13;11:6771-6780
  17. Farid Z, Bassily S, Kent DC, Hassan A, Abdel-Wahab MF, Wissa J. Urinary schistosomiasis treated with sodium antimony tartrate a quantitative evaluation. Brit. Med. J. 1968;3:713–714.
  18. Davis A. Comparative trials of antimonial drugs on urinary schistosomiasis. Bull. World Health Organ. 1968;38:197–227.
  19. Tarabar AF, Khan Y, Nelson LS, Hoffman RS. Antimony toxicity from the use of tartar emetic for the treatment of alcohol abuse. Vet Human Toxicol. 2004;46:331–3.
  20. Gebel T, Claussen K, Dunkelberg H. Human biomonitoring of antimony. Int Arch Occup Environ Health 1998;71(3):221-224

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Last updated: 2018-06-22 05:43