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

  The proximal renal tubular dysfunction creates low phosphate levels in the blood (hypophosphatemia), causing muscle weakness and sometimes coma. [en.wikipedia.org]

  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]

• Fatigue

  Long term-exposure to lead can include irritability, fatigue, behavioral change, and developmental delays. [articles.sun-sentinel.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]

  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]

  Overexposure may cause fatigue, headaches, nausea, vomiting, abdominal cramps, diarrhea, and fever. [rarediseases.org]

• Fever

  Symptoms of inflammation may start hours after the exposure and include cough, dryness and irritation of the nose and throat, headache, dizziness, weakness, fever, chills, and chest pain. [en.wikipedia.org]

  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]

• Chills

  Symptoms of inflammation may start hours after the exposure and include cough, dryness and irritation of the nose and throat, headache, dizziness, weakness, fever, chills, and chest pain. [en.wikipedia.org]

  "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]

  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]

• Turkish

  […] of Lamiaceae family from Vidlic Mountain (Serbia) 027650 Metal transporters in intestine and brain: their involvement in metal-associated neurotoxicities 019575 Toxins in lipstick - Cosmetic companies 014502 Cancer and uranium 006728 Contamination of Turkish [allaboutheaven.org]

• 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]

  Symptoms of inflammation may start hours after the exposure and include cough, dryness and irritation of the nose and throat, headache, dizziness, weakness, fever, chills, and chest pain. [medicaljournal.blogspot.com]

• Anosmia

  Similar to zinc, long term exposure to cadmium fumes can cause life long anosmia. Inside cells, cadmium ions act as a catalytic hydrogen peroxide generator. [en.wikipedia.org]

  PMID: 17405690 Anosmia Anosmia is the technical name for not being able to smell things - “an inability to perceive odours”. Cadmium can cause anosmia. Cancer Carla Mascaro A host of different types of cancer are known to be caused by cancer. [allaboutheaven.org]

  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]

  Other patients lose their sense of smell (anosmia). Pathogenesis: In the 1950s and 1960s industrial exposure to cadmium was high. [medicaljournal.blogspot.com]

  […] 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]

• 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]

• Nausea

  Nausea, vomiting, diarrhea, and prostration usually occur within 15 minutes after ingestion and subside within 24 hours. Inhalation of cadmium fumes in industry produces an acute, extremely severe inflammation of the lungs that may be fatal. [britannica.com]

  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]

  These include: abdominal pain, burning sensation, nausea, vomiting, salivation, muscle cramps, vertigo, shock, loss of consciousness and convulsions. [academic.oup.com]

• Abdominal Pain

  Cadmium exposure is associated with the following symptoms and conditions: Abdominal pain, weight loss, vomiting Disrupted iron, copper, and magnesium metabolism Immune suppression, immune dysfunction, slow healing Sodium retention, low body temperature [coreonehealth.com]

  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]

  These include: abdominal pain, burning sensation, nausea, vomiting, salivation, muscle cramps, vertigo, shock, loss of consciousness and convulsions. [academic.oup.com]

  Watch for signs of lead poisoning in children, which include loss of appetite, tiredness, abdominal pain, and vomiting. Long term-exposure to lead can include irritability, fatigue, behavioral change, and developmental delays. [articles.sun-sentinel.com]

• 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]

  This toxic metal is known to cause cancer, hypertension and enzyme activity decrease as well. [healthblurbs.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]

  Cardiovascular System : Cadmium in occupationally-exposed individuals appears to induce an increase in systolic and diastolic blood pressure and an increase in the prevalence of hypertension. [pathopedia-india.com]

• Chest Pain

  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]

  Symptoms of inflammation may start hours after the exposure and include cough, dryness and irritation of the nose and throat, headache, dizziness, weakness, fever, chills, and chest pain. [en.wikipedia.org]

  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]

  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]

• Eye Irritation

  In addition, welding workers suffer from eye irritation, photokeratitis, cataract, skin irritation, erythema, pterygium, non-melanocytic skin cancer, malignant melanoma, reduced sperm count, motility and infertility. [allaboutheaven.org]

• Osteoporosis

  […] 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 liver damage osteoporosis [healthblurbs.com]

  Cadmium may also produce bone defects (osteomalacia, osteoporosis) in humans and animals. [medicaljournal.blogspot.com]

  Compounds containing cadmium are also carcinogenic.The bones become soft (osteomalacia), lose bone mineral density (osteoporosis) and become weaker. This causes pain in the joints and the back, and also increases the risk of fractures. [en.wikipedia.org]

  Effects kidney toxicity:  Edema and Emphysema by killing macrophages Skeletal effects:  Osteoporosis and osteomalacia (pseudofractures)  Cancer:  Carcinogenic in animal studies  Approx.8% of lung cancers may be attributable to Cd 7. [slideshare.net]

  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. [symptoma.com]

• Back Pain

  Sanhe, the site of lead and zinc mining, is home to about 800 people, of whom about 80 per cent suffered from back pain and other ailments, residents said. Some villagers also complain of swollen knees and elbows. [scmp.com]

  pain, cancer, and peripheral neuropathy. [chelationmedicalcenter.com]

  Toxic metal accumulation in the kidneys including aluminum, mercury and cadmium, also contributes to kidney infections, kidney stones, electrolyte imbalances, back pain, and edema. [tvernonlac.com]

  These symptoms may include fatigue, metallic taste in the mouth, low back pain, stomach distress, poor appetite, skin eruption and/or headache. [arltma.com]

• 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]

• Osteopenia

  Normocytic and normochromic anemia, renal lesions characterized by tubular atrophy and interstitial fibrosis (Cd nephropathy), and bone lesions characterized by an increase of osteoid and osteopenia (Cd osteopathy) were induced in the monkeys treated [ncbi.nlm.nih.gov]

  The pitcher is taken to Princeton-Plainsboro where they discover that he is suffering osteopenia, a weakening of the bone. [house.wikia.com]

  A study by Kido et al. (1989) indicates that exposure to cadmium could cause osteopenia, particularly in women. [inchem.org]

• Painful Muscle Cramps

  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]

• Headache

  Ren, a migrant worker originally from Sichuan, suffers from frequent headaches and breathing difficulties. If untreated, the cadmium poisoning can lead to kidney failure, cancer, and even death. [goodelectronics.org]

  The effects may include vomiting, dyspnea, headache, prostration, pulmonary edema, and, possibly, years later, cancer. cadmium poisoning A condition associated with industrial exposure; cadmium poisoning occurred in Japan due to contamination of drinking [medical-dictionary.thefreedictionary.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]

  Symptoms of inflammation may start hours after the exposure and include cough, dryness and irritation of the nose and throat, headache, dizziness, weakness, fever, chills, and chest pain. [medicaljournal.blogspot.com]

• 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]

  Symptoms of inflammation may start hours after the exposure and include cough, dryness and irritation of the nose and throat, headache, dizziness, weakness, fever, chills, and chest pain. [en.wikipedia.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]

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]

• Dyslipidemia

  Renal cadmium ….may be related to hypertension, sodium retention, glucose intolerance, dyslipidemia, and zinc deficiency. Dietary calcium may mitigate some of the toxicity of cadmium. [allaboutheaven.org]

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.