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Cadmium Poisoning

Various forms of cadmium poisoning have been documented in the literature. Acute poisoning, depending on the mode of exposure, can cause life-threatening respiratory or gastrointestinal symptoms in the absence of immediate supportive therapy, while chronic toxicity, mostly through occupational exposure may lead to renal failure, osteomalacia and increase the risk for cardiovascular disease. Patient history and laboratory studies are vital for the diagnosis.


Presentation

Cadmium is used for various industrial purposes, including plastic and battery manufacturing, smelting, pigment production, metal-plating, but also in the production of tobacco, suggesting that a wide range of workers are at risk of exposure [1] [2] [3] [4]. Cadmium poisoning can occur either by inhalation or ingestion and in both settings, poisoning may be acute or chronic, depending on the amount of cadmium introduced into the body and the rate of exposure [1] [2] [3] [5] [6]:

  • Acute poisoning - Inhalation of cadmium-contaminated air causes profound damage to the respiratory system, and is primarily seen in the industrial setting [1] [2] [3]. Dyspnea, pulmonary edema, cyanosis, tachycardia, chest pain and pneumonitis develop within 4-24 hours after cadmium reaches the lungs and can be life-threatening without early recognition of the cause [1] [3]. Ingestion of large amounts of cadmium, on the other hand, occurs accidentally by eating food grown in cadmium-rich soil, or intentionally in suicidal purposes [3] [6]. As little as 10 mg is sufficient to cause severe erosion of the gastrointestinal (GI) tract, while > 100 mg is considered to be lethal [6]. Principal symptoms of acute poisoning after ingestion appear within 15-30 minutes and are abdominal pain, diarrhea, nausea, vomiting, but also muscle cramping, vertigo, bone pain, loss of consciousness, convulsions and even coma [1] [6].
  • Chronic poisoning - Cadmium is known for its very long half-life in the human body (about 15-30 years), and is able to accumulate in the proximal renal tubules, the principal site of its reabsorption after glomerular filtration [1] [7]. Chronic exposure to this heavy metal results in its progressive deposition in the kidneys leading to chronic kidney disease [2], the most important long-term consequence of chronic cadmium poisoning. Because cadmium is found in cigarettes, tobacco smoking is a well-known risk factor for chronic poisoning, and urine levels of cadmium have shown to be substantially higher in this population compared to non-smokers [1] [2]. In addition to kidney damage and proteinuria, other known complications are hypertension, diabetes mellitus and diabetic nephropathy, anemia, osteomalacia, yellowing of teeth, and cardiovascular damage, while its carcinogenic potential is still being investigated [2] [3] [5] [7] [8] [9]. Moreover, the term Itai-Itai disease was designated to describe patients who suffer from frequent fractures, accelerated osteoporosis and bone-associated pain due to consumption of foods that were contaminated with high amounts of cadmium [1] [9].
Weakness
  • Later on you may experience some of these toxic cadmium inhalation symptoms: dyspnea sweating shivering coughing arthralgia wheezing dry throat headache chest pain pneumonitis muscle weakness Inhalation of cadmium fumes can cause severe lung inflammation[healthblurbs.com]
  • Owing to hypokalaemia and muscle weakness, barium intoxication was strongly suspected initially; in addition, the emergency room physicians were told that the industrial chemical solution he had taken contained a chromium salt.[academic.oup.com]
  • High school and he was this big black guy that was friendly and smart, a honor student,a Popular Football player (so much for the idea pot makes you stupid and weak.) He never got to graduate College. It was a stupid stupid waist.[marijuana.com]
Fever
  • Case A 42-year-old man presented to our emergency room with marked lethargy and fever. His vital signs were: blood pressure 129/72 mmHg, heart rate 87/min, respiratory rate 16/min and temperature 38 C.[academic.oup.com]
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
  • Overexposure may cause fatigue, headaches, nausea, vomiting, abdominal cramps, diarrhea, and fever.[rarediseases.org]
Chills
  • ., "the cadmium chills") that can increase in severity to include respiratory, liver and kidney problems, which may be irreversible and fatal.[home-health-chemistry.com]
  • View of Los Angeles' Hollywood Blvd Penguins chill at the Kansas City Zoo in Missouri More Privacy Policy Your CA Privacy Rights Children's Online Privacy Policy Interest-Based Ads Terms of Use Contact Us Search Menu Interest Successfully Added We'll[abcnews.go.com]
  • The person may experience fever and chills. Cadmium may also increase blood flow to the lungs, further complicating the alveolar hemorrhage. The lungs may also become inflamed and swell, causing difficulty breathing.[livestrong.com]
  • […] and/or zinc Eating food or drinking water contaminated with high levels of cadmium can result in: Nausea and vomiting Stomach cramps Diarrhea Kidney damage Fragile bones Death Breathing in cadmium can result in: Flu-like symptoms, such as body aches, chills[health.cvs.com]
Shivering
  • Later on you may experience some of these toxic cadmium inhalation symptoms: dyspnea sweating shivering coughing arthralgia wheezing dry throat headache chest pain pneumonitis muscle weakness Inhalation of cadmium fumes can cause severe lung inflammation[healthblurbs.com]
Cough
  • Chronic inhalation exposure to low doses of cadmium can cause poisoning symptoms of: coughing proteinuria weight loss difficulty breathing sense of smell loss Chronic cadmium exposure can also cause an increased risk for these health conditions: anemia[healthblurbs.com]
  • Chronic poisoning from inhalation may cause a loss of the sense of smell, coughing, difficult breathing, weight loss, and injury of the liver and kidneys. Treatment usually includes the oral administration of calcium edetate.[britannica.com]
  • Acute inhalation of Cadmium dusts, fumes or soluble salts may produce cough, pneumonitis and fatigue. Manifestations of Cadmium toxicity may be lessened or delayed by an individualâ s protective and detoxification capacities.[chelationmedicalcenter.com]
  • Difficulty breathing, cough, chest pain. Complications include pneumonitis and pulmonary oedema. Chronic exposure may cause anaemia, emphysema or renal failure and cadmium may be a risk factor in the development of prostate or lung cancer.[patient.info]
Anosmia
  • Anosmia and yellowing of teeth have been reported. Developmental Effects In animals, cadmium crosses the placenta, and large parenteral doses during early gestation cause birth defects.[atsdr.cdc.gov]
  • […] unusually rapid heart beat (tachycardia); low levels of iron within the red blood cells (anemia); bluish discoloration (cyanosis) of the skin and mucous membranes due to insufficient oxygen supply to these tissues; and/or an impaired sense of smell (anosmia[rarediseases.org]
  • Anosmia is a frequent symptom in cadmium workers after prolonged exposure.[inchem.org]
Throat Irritation
  • When its initially inhaled you may notice a sweet or metallic taste, and then throat irritation.[healthblurbs.com]
  • Cadmium workers sometimes suffered from symptoms such as coughing and throat irritation, but did not show abnormal chest X-ray findings when exposed to cadmium oxide fume at a concentration of 100 µg/m 3 for 4-8 years (Hardy & Skinner, 1947) or 40-1440[inchem.org]
Dyspepsia
  • Ingested cadmium poisoning causes symptoms of: shock vertigo choking salivation dyspepsia convulsions abdominal pain muscle cramps nausea, vomiting loss of consciousness Breathing high levels of cadmium can severely irritate and damage your lungs.[healthblurbs.com]
Hypertension
  • […] and, possibly, years later, cancer. cadmium poisoning A condition associated with industrial exposure; cadmium poisoning occurred in Japan due to contamination of drinking water by mining runoffs, resulting in itai-itai (“ouch-ouch”) disease, possibly hypertension[medical-dictionary.thefreedictionary.com]
  • Once this occurs, high blood pressure, which promotes hypertension, often develops. Some individuals with high blood pressure have blood cadmium levels three to four times higher than those with normal blood pressure.[coreonehealth.com]
  • Environmental Cd exposure may be a significant contributory factor to the development of chronic kidney disease, especially in the presence of other co-morbidities such as diabetes or hypertension; therefore, the sources and environmental impact of Cd[ncbi.nlm.nih.gov]
  • In addition to kidney damage and proteinuria, other known complications are hypertension, diabetes mellitus and diabetic nephropathy, anemia, osteomalacia, yellowing of teeth, and cardiovascular damage, while its carcinogenic potential is still being[symptoma.com]
  • This toxic metal is known to cause cancer, hypertension and enzyme activity decrease as well.[healthblurbs.com]
Chest Pain
  • Dyspnea, pulmonary edema, cyanosis, tachycardia, chest pain and pneumonitis develop within 4-24 hours after cadmium reaches the lungs and can be life-threatening without early recognition of the cause.[symptoma.com]
  • Later on you may experience some of these toxic cadmium inhalation symptoms: dyspnea sweating shivering coughing arthralgia wheezing dry throat headache chest pain pneumonitis muscle weakness Inhalation of cadmium fumes can cause severe lung inflammation[healthblurbs.com]
  • Difficulty breathing, cough, chest pain. Complications include pneumonitis and pulmonary oedema. Chronic exposure may cause anaemia, emphysema or renal failure and cadmium may be a risk factor in the development of prostate or lung cancer.[patient.info]
  • Breathing air with high levels of cadmium over a short period of time is initially like the flu with chills, fever and muscle pain, then later can cause lung damage, shortness of breath, chest pain and cough, which may lead to death in severe cases.[betterhealth.vic.gov.au]
Tachycardia
  • Dyspnea, pulmonary edema, cyanosis, tachycardia, chest pain and pneumonitis develop within 4-24 hours after cadmium reaches the lungs and can be life-threatening without early recognition of the cause.[symptoma.com]
  • In some cases, affected individuals may exhibit increased salivation; yellowing of the teeth; an unusually rapid heart beat (tachycardia); low levels of iron within the red blood cells (anemia); bluish discoloration (cyanosis) of the skin and mucous membranes[rarediseases.org]
  • Furthermore, several types of abnormalities in the electrocardiogram of the exposed workers were observed: 39% showed tachycardia, between 11 and 13% were regarded as normal, and 26% had changes in the "R" spike (compared to the normal 7-9%).[inchem.org]
Purpura
  • Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Case 3-2019: A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy Caplacizumab Treatment for Acquired Thrombotic Thrombocytopenic Purpura Randomized[nejm.org]
Myalgia
  • Diarrhoea, vomiting and abdominal pain subsided, but weakness and myalgias persisted. On hospital day 3, laboratory studies showed serum chloride 111 mEq/l, sodium 144 mEq/l, potassium 4.2 mEq/l and thrombocytopenia (platelet count of 77 000/mm 3 ).[academic.oup.com]
  • Myalgia. Gastrointestinal upset. Subsequent peripheral neuropathy, hepatic dysfunction or renal failure may develop. Chronic poisoning Irritability. Personality changes. Headache. Peripheral neuropathy. Memory problems. Ataxia. Coma.[patient.info]
Dizziness
  • Workers exposed to cadmium can suffer symptoms such as memory loss, dizziness, headaches, lack of strength, and pain in the back and limbs. In 2006, the European Union banned cadmium in electronics due to its extremely toxic properties.[goodelectronics.org]
Polyuria
  • Sufficient cadmium exposure can also lead to decreased GFR and chronic renal failure manifested by: aminoaciduria, glucosuria, hypercalcuria, hyperphosphaturia, polyuria, and reduced buffering capacity for acids (Jarup 2002).[atsdr.cdc.gov]
  • The polyuria is due to loss of urinary concentrating ability (Kazantzis, 1979), and, in addition, the kidneys of cadmium-poisoned workers lose their ability to handle an acid load after a standard NH 4 Cl-loading test.[inchem.org]
Renal Stone
  • stones among 43 cadmium workers and drew attention to the possibility of renal stones being associated with exposure to cadmium.[inchem.org]

Workup

The diagnosis of cadmium poisoning must be made promptly, especially if the overall condition of the patient suggests acute poisoning. A detailed patient history is vital in order to determine the potential source of symptoms - whether the patient was exposed to cadmium in the industrial setting (in the case of respiratory symptoms), or if "suspicious" food was eaten prior to the onset of complaints. After a thorough clinical examination to assess breathing, cardiac function and vital signs, an immediate laboratory workup comprised of serum electrolytes, renal function tests (blood urea nitrogen and creatinine), a complete blood count (CBC) and liver enzymes (alanine and aspartate aminotransferases, or ALT and AST, respectively) must be performed [3] [4]. If poisoning through inhalation is suspected, a chest X-ray, arterial blood gas (ABG) measurements, and oxygen saturation are also necessary. Regardless of the mode of exposure or severity of symptoms, cadmium can be detected in both serum and urine, and levels of > 5 μg/dL in serum will be present in the setting of acute poisoning [1] [3]. In addition to urine testing for cadmium (which will show >100 nmol/L and a markedly increased creatinine), levels of β2-microglobulin in urine will be markedly elevated in this patient population, whereas N-acetyl-α-D-glucosaminidase (NAG) and retinol-binding-protein (RBP) are also excreted in higher amounts in these patients. All three compounds are useful when cadmium is the presumed cause of symptoms, as their increased excretion occurs as a result of impaired proximal tubule reabsorption [1] [5] [9].

Glycosuria
  • The effects of cadmium proximal renal function are characterized by increased cadmium in the urine, proteinuria (primarily Beta-2-microglobulin), aminoaciduria, glycosuria, and decreased renal tubular reabsorption of phosphate.[pathopedia-india.com]
  • In the final stages of cadmium nephropathy, glycosuria, wasting of calcium and phosphate, and altered calcium metabolism with secondary effects on the skeleton of osteoporosis and osteomalacia are seen (Roels et al. 1999; Jarup et al. 2000).[atsdr.cdc.gov]
  • Renal dysfunction affects calcium, vitamin D, phosphorus and sodium levels, resulting in proteinuria, glycosuria, renal hypertension and other metabolic disorders.[arltma.com]
  • Proteinuria and glycosuria appeared at a later stage, 37 and 42 weeks, respectively, after exposure had started. The cadmium concentration in the renal cortex was 300 mg/kg wet weight after 40 weeks. Table 12.[inchem.org]

Treatment

  • Treatment usually includes the oral administration of calcium edetate.[britannica.com]
  • The rats of the 0.05 mg/kg group showed slight anemia and mild degeneration of tubular epithelium after 50 weeks of treatment. In the 0.5 mg/kg group, the rats showed definite osteomalacia of bones and nephrosclerosis.[ncbi.nlm.nih.gov]
  • For now, no effective treatment for more toxic cadmium poisoning is available. However, hemodialysis and chelation therapy for bloodstream heavy metal removal might be used to help treat severe ingested cadmium poisoning.[healthblurbs.com]
  • Treatment of the Acute High-dose Exposure The mainstay of management for most inhalation exposure victims is supportive treatment including fluid replacement, supplemental oxygen, and mechanical ventilation.[atsdr.cdc.gov]

Prognosis

  • 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]
  • FRIBERG, L. & NYSTROM, A. (1952) [Aspects on the prognosis of chronic cadmium poisoning.] Läkartidningen, 49: 2629-2639 (in Swedish).[inchem.org]

Etiology

  • Carcinogenesis And Teratogenesis Cadmium has been suggested as an etiologic factor in certain human cancers. Birth defects, probably due to zinc deficiency, have been observed in mice, rats and hamsters.[arltma.com]
  • At present, there is no convincing evidence for cadmium being an etiological agent of essential hypertension.[inchem.org]

Epidemiology

  • The gross and pathological findings of forensic autopsies of two case of cadmium poisoning are presented and related to an epidemiological investigation.[ncbi.nlm.nih.gov]
  • Epidemiology The degree of Cd pollution in different parts of the endemic area determined by the analyzed Cd concentration of the soil in the paddy fields was shown in Fig.1 .[kanazawa-med.ac.jp]
  • Genotoxicity Cadmium expresses genotoxic activities in vitro in cells and in vivo in animals; and there is limited epidemiological evidence for in vivo human genotoxicity.[atsdr.cdc.gov]
  • Epidemiology Heavy metal poisoning is rare in the UK, even in industries where there is an increased risk. [ 1 ] The most common cause of heavy metal poisoning is lead.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Because the renal anemia is based on the same pathophysiology as Cd-induced osteomalacia, which is derived from the disturbance of mineral metabolism due to renal tubular dysfunction, it is reasonable to include renal anemia in the criteria for the diagnosis[jstage.jst.go.jp]

Prevention

  • Our observations provide new clues for the future recognition and prevention of Cd poisoning. Crown Copyright 2012. Published by Elsevier Ireland Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • The American Association of Poison Control Centers offers the following tips aimed at preventing lead and cadmium poisoning. Read product ingredient labels before purchasing an item, especially if it's intended for children.[articles.sun-sentinel.com]
  • Choking is the leading cause […] Bisphenol A , BPA , Cadmium Poisoning , Child Injury , Choking Hazards , Fire , Holiday Season Safety , Infant Safety , Injury Prevention , Recalls , Strangulation Hazard , Toy Poisoning Permalink Comments Off on Avoiding[personalinjurylawupdate.com]
  • The purpose of this program is to prevent cadmium induced disease.[atsdr.cdc.gov]
  • . […]The government has paid little attention to preventing this. For instance, of the sites of the 142 factories relocated from Beijing between 2001 and 2005, only eight had been decontaminated, said Caijing.[chinadigitaltimes.net]

References

Article

  1. Godt J, Scheidig F, Grosse-Siestrup C, et al. The toxicity of cadmium and resulting hazards for human health. J Occup Med Toxicol. 2006;1:22.
  2. Jaishankar M, Tseten T, Anbalagan N, Mathew BB, Beeregowda KN. Toxicity, mechanism and health effects of some heavy metals. Interdiscip Toxicol. 2014;7(2):60-72.
  3. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.
  4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  5. Chunhabundit R. Cadmium Exposure and Potential Health Risk from Foods in Contaminated Area, Thailand. Toxicol Res. 2016;32(1):65-72.
  6. Hung YM, Chung HM. Acute self-poisoning by ingestion of cadmium and barium. Nephrol Dial Transplant. 2004;19(5):1308-1309.
  7. Tellez-Plaza M, Navas-Acien A, Menke A, Crainiceanu CM, Pastor-Barriuso R, Guallar E. Cadmium Exposure and All-Cause and Cardiovascular Mortality in the U.S. General Population. Environ Health Perspect. 2012;120(7):1017-1022.
  8. Tellez-Plaza M, Guallar E, Howard BV, et al. Cadmium Exposure and Incident Cardiovascular Disease. Epidemiology. 2013;24(3):421-429.
  9. Satarug S, Garrett SH, Sens MA, Sens DA. Cadmium, Environmental Exposure, and Health Outcomes.Environ Health Perspect. 2010;118(2):182-190.

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Last updated: 2018-06-22 06:22