Cobalt poisoning can manifest with symptoms of varying degrees of severity and can even cause death. An individual is exposed to this chemical element via inhalation, ingestion, or dermal exposure and, in general, chronic exposure is required for most of the adverse effects to develop.

The manifestations originating from the respiratory tract are traditionally linked to toxicity due to cobalt inhalation and comprise asthma, fibrosis, pneumonia, decreased lung function, and bronchospasm [1] [2] [3]. Cardiovascular manifestations are generally limited to cardiomyopathy accompanied with cardiomegaly and cardiac failure, while anemia with an approximate 5% decrease in hemoglobin has also been reported [4] [5] [6] [7]. Also documented are the effects of cobalt poisoning on the endocrine system, and specifically on the thyroid gland: even though reports evince a certain dissent, increased serum thyroxine (T4) or decreased concentrations of triiodothyronine (T3) have been observed [8]. In addition to the aforementioned symptomatology, persisting occupational exposure to cobalt may also lead to conjunctival congestion, weight loss in patients with the cobalt-associated pulmonary disease, and neurological sequelae which include nerve deafness, as well as memory and visual acuity impairment [9] [10] [11].

Ingesting cobalt is an important way of exposure to the element's toxic effects, with lethal cardiomyopathy having been reported as the most detrimental manifestation [12]. It develops abruptly with a clinical picture that resembles beriberi or alcoholic cardiomyopathy. Sinus tachycardia, left ventricular failure, and cardiogenic shock are some of the main manifestations, which may be preceded by nausea, diarrhea, and vomiting [13]. Ingestion of cobalt has also shown to result in polycythemia, increased hemoglobin levels, goiter, and histological changes of the thyroid gland [14].

Cobalt is known to cause dermatitis, should it come into contact with an individual's skin [15] [16].

An additional way in which cobalt poisoning is induced is metal-on-metal hip arthroplasty (MoM) [17]. The phenomenon is known as prosthetic hip-associated cobalt toxicity (PHACT) and leads to some of the manifestations that inhaled and ingested cobalt does, including cardiac, neurologic, and thyroid impairment [18]. Depression, lack of orientation and concentration, as well as aphasia, are also results of PHACT-related cobalt poisoning [19].

• Fatigue

  She had regained a normal appetite and gained weight, the metallic taste in her mouth was gone, and she had less fatigue and greater energy. Additionally, her hip pain was gone and her cobalt levels had come back down to normal. [schmidtandclark.com]

  Prodromal cobaltism consists of non-specific constitutional symptoms: fatigue, disordered sleep and mood, and anorexia. [orthopaedicprinciples.com]

  She had regained a normal appetite and gained weight, the metallic taste in her mouth had gone, and she had less fatigue and greater energy. The hip pain had completely resolved and she was walking up to 2 km a day. [mja.com.au]

  Cobalt-60 emits radiation, causing long-lasting symptoms like fatigue and hairloss, and even loss of consciousness. [environmentalpollutioncenters.org]

  Symptoms of cobaltism include: Irritability Fatigue Tinnitus Hearing loss Headaches Loss of coordination Cognitive decline Depression Metal-on-Metal Hip Implants Can Shed Cobalt and Chromium Debris A hip implant that uses all-metal components is known [yourlawyer.com]

• Soft Tissue Mass

  Pseudotumors Pseudotumor from a metal on metal hip implant A pseudotumor (SUE-dough-two-mur) is a large soft tissue mass that forms around the hip. [mctlawyers.com]

• Poor Growth

  This in turn leads to poor growth of the plant as well as leaf loss which overall decreases the amount of oxygen produced by plants during photosynthesis. Eventually the deficiency would lead to plant death. [en.wikipedia.org]

• Nausea

  Sinus tachycardia, left ventricular failure, and cardiogenic shock are some of the main manifestations, which may be preceded by nausea, diarrhea, and vomiting. [symptoma.com]

  In some rare cases, Cobalt-57 may also generate the Acute Radiation Syndrome, with symptoms like bleeding, diarrhea, nausea, vomiting, coma and even sudden death. [environmentalpollutioncenters.org]

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

  Typical Presentation of the Most Commonly Encountered Metals and Their Treatment (Open Table in a new window) Metal Acute Chronic Toxic Concentration Treatment Arsenic Nausea, vomiting, "rice-water" diarrhea, encephalopathy, MODS, LoQTS, painful neuropathy [emedicine.medscape.com]

  In sensitized individuals, exposure causes an asthma-like attack, with wheezing, bronchospasm, and dyspnea Ingestion of cobalt may cause nausea, vomiting, diarrhea, and a sensation of hotness. [osha.gov]

• Abdominal Pain

  Additional symptoms may include fever, headaches, fatigue, sluggishness (letheragy), vomiting, loss of appetite (anorexia), abdominal pain, constipation, joint pain, loss of recently acquired skills, incoordination, listlessness, difficulty sleeping [rarediseases.org]

  The signs and symptoms may include: Nausea and vomiting from ingesting large amounts of cobalt compounds Abdominal pain Exposure of the compound to the eye may result in pain, irritation, redness, and watery eyes Contact dermatitis from direct contact [dovemed.com]

  […] neuropathy, coma, autonomic instability, MODS Late: Alopecia, Mees lines, residual neurologic symptoms Alopecia, neuropathy Toxic: >3 µg/L (blood) MDAC Prussian blue Zinc MFF (oxide fumes); vomiting, diarrhea, abdominal pain (ingestion) Copper deficiency [emedicine.medscape.com]

  Lead poisoning can present with abdominal pain, headache, anemia, peripheral neuropathy and irritability. In severe cases, it can cause seizure, coma and death. Lead is very common in the environment. [house.wikia.com]

• Cardiomegaly

  Cardiovascular manifestations are generally limited to cardiomyopathy accompanied with cardiomegaly and cardiac failure, while anemia with an approximate 5% decrease in hemoglobin has also been reported. [symptoma.com]

  Little JA,Sunico R (1958) Cobalt-induced goiter with cardiomegaly and congestive failure. J Pediatr 52: 284-288 Sederholm T,Kouvalainen K,Lamberg BA (1968) Cobalt-induced hypothyroidism and polycythemia in lipoid nephrosis. [toxicology.imedpub.com]

• Cerebellar Sign

  The patient reported difficulty in remembering names and registering information, headaches and cerebellar signs (ataxia and dysdiadochokinesis). [schmidtandclark.com]

  She had particularly noted difficulty in remembering names and registering information (both written and aural), headaches and cerebellar signs (ataxia and dysdiadochokinesis). [mja.com.au]

The diagnosis of cobalt poisoning initially requires a thorough medical history, including a history of potential exposure to toxic metals. This chemical element can be detected in the blood or urine [20] [21]. On average, an individual that has not been exposed to an excessive amount of cobalt is expected to exhibit values of the element less than 0.19 μg/dL and 2 μg/dL in the serum and urine, respectively [22]. A patient believed to have been exposed to a dangerous amount of cobalt should undergo laboratory evaluation of cobalt concentration in the urine and blood as soon as possible upon presentation, as the excretion rate is maximized within 24 hours after an occasion of exposure. Cobalt-associated allergic reactions can lead to elevated levels of IgE and IgA in the serum, which can be used both for diagnostic and monitoring purposes [23].

• Creatine Phosphokinase Increased

  Gastrointestinal PO 0.04 mgCo/kg/day [27,28] Nausea Vomiting Diarrhea Hepatic effects [26,27] PO 0.04 mgCo/kg/day Central hepatic necrosis Increased Serum Bilirubin Increase AST,ALT,LDH Increase Creatine Phosphokinase Increase Ornithine CarbamylTransferase [toxicology.imedpub.com]

• Hepatic Necrosis

  Gastrointestinal PO 0.04 mgCo/kg/day [27,28] Nausea Vomiting Diarrhea Hepatic effects [26,27] PO 0.04 mgCo/kg/day Central hepatic necrosis Increased Serum Bilirubin Increase AST,ALT,LDH Increase Creatine Phosphokinase Increase Ornithine CarbamylTransferase [toxicology.imedpub.com]

In the first month, patients receive between five and 30 treatments (with 30 being most common), and are often advised to continue preventive treatment once a month. Individuals must pay for the treatment themselves. [sullolaw.com]

Treatment for skin contact : Since these rashes are rarely serious, very little will be done. The area may be washed and a skin cream may be prescribed. Treatment for lung involvement : Breathing problems will be treated based on your symptoms. [nlm.nih.gov]

Treatment Treatment for signs of cobalt toxicity from a metal on metal hip implants may include removing the implant and replacing it with a traditional hip implant. [thelawfirm.com]

The prognosis of Cobalt Poisoning is dependent on the amount of substance consumed, time between consumption and treatment, severity of the symptoms, as well as general health status of the patient. [dovemed.com]

Morin Y,Daniel P (1967) Quebec beer-drinkers' cardiomyopathy: Etiological considerations. Can Med Assoc J 97: 926-928. Sullivan JF,Egan JD,George RP (1969) A distinctive myocardiopathy occurring in Omaha,Nebraska:Clinical aspects. [toxicology.imedpub.com]

Exclusion of other potential etiologies. [path.upmc.edu]

Epidemiological studies found that Dow had been adding cobalt sulfate to the beer for foam stability since July 1965 and that the concentration added in the Quebec city brewery was ten times that of the same beer brewed in Montreal where there were no [en.wikipedia.org]

Related: Cobalt Toxicity in Two Hip Replacement Patients (pdf) State of Alaska Epidemiology Bulletin, May 28, 2010 Out of joint: The story of the ASR BMJ 2011; 342:d2905 doi: 10.1136/bmj.d2905 (Published 14 May 2011) Cite this as: BMJ 2011; 342:d2905 [nursinghomelawcenter.org]

Epidemiology A. Cobalt Toxicity in Two Hip Replacement Patients. State of Alaska Epidemiology Bulletin. May 28, 2010 2010(Bulletin No. 14). 19. Tower SS. [orthopaedicprinciples.com]

Tower, wrote about two cases of metallosis in the 2010 State of Alaska Epidemiology Bulletin. Both patients were fit, healthy 49-year-old men who received metal-on-metal implants. [drugwatch.com]

However, it is often found in clusters as from an epidemiological standpoint, the two most likely reasons for heavy metal toxicity are environmental contamination and occupational exposure. [house.wikia.com]

Useful For Suggests clinical disorders or settings where the test may be helpful Detecting cobalt toxicity Monitoring metallic prosthetic implant wear Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate [mayomedicallaboratories.com]

The purpose of this review is to examine the use of cobalt alloys in total hip arthroplasty, to review the methods of measuring circulating cobalt levels, to define a level of cobalt which is considered pathological and to review the pathophysiology, [doi.org]

They bind to heavy metals in the body and prevent them from binding to other agents, creating a compound that can then be excreted from the body. [sullolaw.com]

Elevated cobalt levels could prevent the body from repairing DNA while elevated chromium levels can result in DNA mutation. [depuyhiprecallattorney.wordpress.com]

There are, however, statutes of limitations that can prevent you from protecting your rights. Every case is unique and yours is no exception, contact us today to find out how we can help you. From Our Clients It has been a pleasure working with you. [gpwlaw.com]

You should call if you have any questions about poisoning or poison prevention. You can call 24 hours a day, 7 days a week. [nlm.nih.gov]

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