catalogue
Principle of heavy metal poisoning
Common heavy metal poisoning
Matters needing attention in emergency treatment of minor poisoning of arsenic (arsenic, arsenic), cadmium, chromium (chromium, chromium), copper (copper, copper), mercury (mercury), manganese (manganese), nickel (nickel, nickel), lead (lead) and zinc (zinc, zinc).
Expand the principle of heavy metal poisoning
Common heavy metal poisoning
Matters needing attention in emergency treatment of minor poisoning of arsenic (arsenic, arsenic), cadmium, chromium (chromium, chromium), copper (copper, copper), mercury (mercury), manganese (manganese), nickel (nickel, nickel), lead (lead) and zinc (zinc, zinc).
Expand and edit the principle of heavy metal poisoning in this paragraph.
(Heavy metals refer to metals with relative atomic mass greater than 65, so all metals after copper belong to heavy metals in the periodic table.
Common examples of heavy metal poisoning are mercury poisoning and lead poisoning.
Edit this common heavy metal poisoning.
arsenic
I. Occupations that may be exposed:
In pesticide manufacturing and spraying, arsenic manufacturing and production, electronic semiconductor manufacturing and other related industries, arsenic hydride (AsH3) easily occurs in computer industry, metal industry, arsenic in traditional Chinese medicine and so on.
Second, acute poisoning:
Food poisoning:
In the acute stage, there will be nausea, vomiting, abdominal pain, bloody stool, shock, hypotension, hemolysis, garlic smell, metallic smell, hepatitis, jaundice, acute renal failure, coma and convulsion. In subacute stage, there will be peripheral neuritis and Mie's line on nails.
Inhalation poisoning:
Cough, dyspnea, chest pain, pulmonary edema, acute respiratory failure.
Arsenic hydride poisoning:
It occurs 2-4 hours after high concentration exposure, causing extensive hemolysis. Typical symptoms are abdominal pain, hematuria and jaundice, and acute renal failure is not uncommon.
Third, chronic poisoning:
A. Skin: eczema, keratinization, skin cancer, Bowen's disease.
B. nerves: central and peripheral neuropathy.
C. Blood: anemia, cytopenia and leukemia.
D Others: peripheral vascular diseases, limb necrosis (Blackfoot disease) and abnormal liver function. The pathogenesis of lung cancer, liver cancer and bladder cancer has greatly increased.
Four, laboratory inspection:
The 24-hour urine arsenic content is greater than 100ug/l (even after eating seafood), but the blood concentration of patients with chronic poisoning is often normal or slightly higher.
Verb (abbreviation of verb) diagnosis
A. blood concentration is often inaccurate. Do not eat seafood and other foods rich in arsenic within 48 hours, and the urine arsenic concentration is greater than 150 ug/L or 100 ug/ day.
B. change the content of inorganic arsenic in urine. The concentrations of trivalent arsenic (highly toxic) and pentavalent arsenic in urine exceed 50 μ g/g creatinine.
Sixth, treatment.
Acute poisoning-support treatment and antidote, such as D-D- penicillamine, BAL, DMSA, DMPS DMSA and DMPS. DMSA can improve the symptoms of chronic poisoning.
cadmium (Cd)
I. Occupations that may be exposed:
Cadmium manufacturing, lead-zinc casting, electroplating, plastic stabilizer manufacturing, cadmium-nickel battery manufacturing, alloy manufacturing for welding cadmium-plated substances, pigment manufacturing, electronics manufacturing and gem manufacturing.
Second, acute poisoning:
Intake-nausea, abdominal pain, vomiting, hemorrhagic gastroenteritis, necrosis of liver and kidney, enlargement of heart.
Inhalation-Cadmium oxide causes severe metal smog fever. 12- 24 hours after exposure, chest pain, headache, cough, dyspnea, fever, pulmonary edema, liver and kidney necrosis occurred.
Three kinds of chronic poisoning:
Intake nephropathy includes low molecular weight proteinuria, aminoaciduria and diabetes, pain, hypertension, cardiovascular diseases and cancer.
Inhalation-pulmonary fibrosis and nephropathy.
Four, laboratory inspection:
A. The concentration of cadmium in renal cortex of patients with nephropathy is generally greater than 200 μ g/g tissue.
B The concentration of cadmium in normal people's blood is less than 5 ug/L, and that in urine is less than 1 ug/g creatine. The blood cadmium concentration of smokers will increase, but it is less than10ug/l.
C the concentration of cadmium in urine is greater than10ug/L. or the amount of cadmium in urine in 24 hours is greater than 15ug/ day, which indicates that cadmium is overexposed and poisoned.
Verb (abbreviation for verb) diagnosis and treatment:
A. have a history of cadmium exposure.
B. Comply with 4 1 (b) and; (c) the blood or urine concentration.
C. evidence of proximal renal tubular lesions.
Acute poisoning: EDTA and supportive therapy. But chronic poisoning: support and symptomatic treatment.
chrome
I. Occupations that may be exposed:
Electroplating industry, metal industry, color TV picture tube manufacturing, copper carving, glass industry, oil purification, photography industry, photo plate making, cement use, stainless steel (grinding), textile industry (pigment), welding industry,
Second, acute poisoning:
Hexavalent chromium: highly toxic and corrosive
Skin: (chrome ulcer) chrome ulcer, nasal septum perforation, allergic contact dermatitis (inhalation), gastrointestinal bleeding gastroenteritis (1-2g is fatal if ingested), kidney: acute renal failure (ingestion, inhalation or skin absorption), lung: pulmonary edema (massive inhalation) will occur after 72 hours.
Trivalent chromium:
Essential elements for human body, necessary for glucose metabolism, difficult to be absorbed by stomach (
Third, chronic poisoning:
Long-term exposure to hexavalent chromium may cause cancer, especially lung cancer. Respiratory system: asthma and pneumoconiosis,
Four, laboratory inspection:
The concentration of chromium in serum of normal people is between 0.3- 1.0 ug/L, and that in urine is less than 40 ug/L. The concentration of chromium in blood of overexposed people is often greater than 30 ug/L, and the total urine volume in 24 hours is often greater than 40 ug.
Verb (abbreviation for verb) diagnosis and treatment:
A. diagnosis: contact history, typical clinical symptoms, elevated blood and urine chromium.
B. treatment: mainly interactive therapy. Acute food poisoning can be treated by vomiting and gastric lavage, activated carbon, forced diuresis, vitamin C2-4 g/day and N- acetylcysteine. Renal failure can be combined with hemodialysis.
Skin exposure can be treated with 10X vitamin C solution or ointment.
copper
I. Occupations that may be exposed:
Asphalt manufacturers, battery manufacturers, copper refining industry, gem dyeing industry, pigment industry and coating industry, preservatives, fireworks, wallpaper manufacturing industry, soldiers, water treatment, welding industry, power industry, alloy industry, electroplating industry, bactericidal pesticides, molluscacide, pigment coating industry, etc.
Second, acute poisoning: mostly caused by eating copper sulfate or eating food and juice contaminated by copper utensils.
Ingesting a large amount of copper can cause serious nausea and vomiting, including green and blue substances, abdominal pain, diarrhea, vomiting blood, degenerative heme disease, hematuria and other symptoms. In severe cases, there will be complications such as hepatitis, hypotension, coma, hemolysis, acute renal failure and convulsion. Even death can happen.
Third, chronic poisoning:
A. Because copper is an essential element for human body, it is excreted through urine and bile after absorption. At present, there are few reports of chronic copper poisoning in medical literature. However, some people think that long-term exposure to too much copper or long-term use of copper tableware and water pipes may cause chronic liver disease. Long-term inhalation of copper dust and smoke can lead to perforation of nasal septum, pulmonary granuloma, pulmonary interstitial fibrosis (vineyard sprayer lung) and lung cancer.
B. Wilson's disease: it is a congenital disorder of copper metabolism. Copper will accumulate on brain nuclei, viscera and cornea, causing health damage, also known as liver degeneration. Over time, there will be permanent brain lesions and cirrhosis after puberty.
Fourth, laboratory inspection.
A. The copper concentration in normal human serum is 70 ~ 160 ug/dl, and that in red blood cells is 90 ~ 150 ug/dl. 24-hour urine contains 3-35ug/ day, most of which are less than 100 ug.
B. Pay attention to the detection of liver and kidney function, hemoglobin, electrolyte and water balance.
Verb (abbreviation for verb) diagnosis and treatment
A. the diagnosis is based on exposure history, typical clinical symptoms, and increased blood and urine concentrations. 100 micrograms.
B. Acute poisoning is mainly based on support and symptom treatment, and attention should be paid to maintaining airway patency and blood pressure stability. EDTA and BAL, D- penicillamine are used for treatment. Taking zinc tablets and D- penicillamine for chronic poisoning can promote copper excretion.
mercury
I. Occupations that may be exposed:
Elemental mercury: dentistry, battery industry, manometer and calibration instrument manufacturing, caustic soda manufacturing, chlor-alkali industry, ceramic industry, ultrasonic amplifier, red line detector, electroplating industry, electrical products, fingerprint detector, gold and silver refining, jewelry industry, mercury lamp and fluorescent lamp industry, paint, pulp manufacturing, photography industry, thermometer and semiconductor photovoltaic cell manufacturing. Inorganic mercury: traditional Chinese medicine, disinfectants, dyes and paints, tobacco industry, fur treatment, ink manufacturing, chemical laboratory, leather industry Kimura anticorrosion, peeling industry, vinyl chloride manufacturing, mercury vapor lamps, silver powder in mirrors, photography industry, perfume and cosmetics industry. Organic mercury: bactericide, paper industry, bactericide, pesticide manufacturing, Kimura preservative, etc.
Two. Elemental mercury poisoning:
A. Acute poisoning: (mainly caused by inhalation of mercury vapor)
Acute bronchitis, pneumonia, stomatitis, enteritis, fever, confusion, dyspnea,
The intake of elemental mercury is usually asymptomatic unless it is quite large.
B. Chronic poisoning:
It mainly affects the central nervous system and has three special symptoms (triad): trembling, gingivitis and redness. Erethism (including insomnia, shyness, memory loss, emotional instability, nervousness and loss of appetite)
Other people with visual impairment have lens opacity, similar to Parkinson's symptoms and peripheral neuropathy.
Three, inorganic mercury poisoning:
A. Acute poisoning: mainly food poisoning, patients will have local corrosiveness, leading to gastrointestinal bleeding, necrosis, shock and even acute renal failure. Acute inhalation of smoke can lead to acute respiratory distress syndrome, pulmonary fibrosis and hypoxia death.
B. Chronic poisoning is similar to that of elemental mercury.
Four, organic mercury:
The toxicity of long-chain organic mercury is similar to that of inorganic mercury, and the toxicity of short-chain organic mercury such as methylmercury is as follows:
A. acute poisoning:
Heart disease, vomiting, abdominal pain, cytopenia, stomatitis, proteinuria, nephrotic syndrome and renal failure, but the main symptoms are still central neuropathy, including itchy skin and exfoliative dermatitis.
B. Chronic poisoning:
Similar to acute poisoning, the main symptom is central nervous system abnormality, but the visual field is reduced, the vision is impaired, and the sensory and motor disorders, muscle atrophy and mental retardation are more obvious. Children born will have symptoms similar to cerebral palsy, and the most famous example is Minamata disease.
Verb (abbreviation for verb) diagnoses and. treat cordially
A. The whole blood mercury of normal people is less than 5- 10 ug/L, and the urine mercury concentration is less than 20 ug/L. The urine concentration of poisoned people is often greater than150 ug/L..
B. inorganic mercury and mercury poisoning
Penicillamine, bal, DMPS and dmsa are effective.
C for methylmercury poisoning, there is no proven effective drug at present, and DMSA may be effective but controversial.
manganese
manganese
I. Occupations that may be exposed:
Mainly from the dust produced in the process of steel manufacturing, welding, mining and refining. In addition, organic manganese is also used as a substitute for organic lead and a fuel anti-seismic agent.
Second, acute poisoning:
Inhaling manganese oxide dust may produce so-called metal smog fever or chemical pneumonia. Manganese oxide is often produced by welding or cutting manganese-containing substances. Chills, fever, nausea and cough can all occur.
Third, chronic poisoning.
Wang Ruo's neurological and mental abnormalities can be divided into three stages.
A. Early-cognitive impairment and emotional distress, including loss of appetite, myalgia, nervousness, restlessness, uncontrollable violence, insomnia and decreased sexual desire.
B. Mid-term-uncontrollable crying and laughing, speech disorder, hallucination, clumsy movements and vague consciousness.
C advanced stage-difficulty in walking, rigidity, inability to speak and trembling, similar to Parkinson's disease.
Fourth, laboratory inspection.
Serum manganese increased and calcium decreased. Many other tests included thyroid function, VitB 12, CT, MRl, EEG, etc. Is used to rule out brain damage caused by other factors.
Verb (abbreviation for verb) diagnosis and treatment
Complete neuropsychological examination, occupational exposure history and laboratory examination are needed to confirm the increase of blood and urine concentration in order to rule out other possibilities. Acute poisoning mainly depends on supportive therapy. For chronic poisoning, anti-Parkinson drugs can be considered.
nickel
nickel
I. Occupations that may be exposed:
Nickel refining industry, nickel alloy industry, electroplating industry, welding industry, nickel-cadmium battery industry, glass bottle industry, coin industry, jewelry industry, ceramics industry, dye industry. Computer parts and tape industry.
Second, acute poisoning:
A. It is generally caused by inhalation of organic nickel carbonyl, and the poisoning symptoms are similar to those of carbon monoxide poisoning, but accompanied by increased blood sugar and urine sugar; Nausea, vomiting, headache, dizziness, insomnia and fidgeting often last for several hours, and then 12 hours to 5 days without symptoms. Then there will be chest tightness, dyspnea, cough, palpitation, sweating, weakness, blurred vision and other symptoms similar to pneumonia. Severe cases may die in 4 to 13 days.
B bivalent inorganic nickel poisoning: caused by ingestion of drinking water contaminated by nickel or dialysis water, with symptoms of nausea, vomiting, headache, palpitation, fatigue, diarrhea, shortness of breath, cough 1-2 days.
Third, chronic poisoning:
Long-term skin contact can lead to allergic dermatitis, chronic respiratory diseases, immune dysfunction, cancer and so on. Common in electroplating industry.
Four, laboratory inspection:
If the urine is less than 100 ug/L eight hours after contact, it is mild poisoning, 100-500 ug/L is moderate poisoning and more than 500 ug/L is severe poisoning.
Verb (abbreviation for verb) diagnosis and treatment
Diagnosed with a history of exposure, nickel concentration increased.
B. Treatment of acute poisoning
When the urine nickel was greater than 100ug/L/L in the first 8 hours, nickel carbonyl poisoning was treated with DDC or Antabuse, and the discharge of nickel was accelerated by diuresis. Nickel poisoning is supportive therapy. Chronic poisoning can only be treated symptomatically.
lead
lead
I. Occupations that may be exposed:
Electrical and electronic industry, manufacture and use of plastic stabilizer, lead refining industry, battery manufacturing industry, welding and cutting industry, rubber industry, plastic industry, paint industry, shooting, cooler repair, lead welding supplies, paint additives for lead, zinc and copper refining, pigments and paint manufacturing industry, and red lead for Chinese medicine.
Second, acute poisoning (adult):
A mild and moderate poisoning: fatigue, restlessness, paresthesia, myalgia, abdominal pain, jitter, headache, nausea, vomiting, constipation, weight loss and decreased libido.
B. Severe poisoning: motor neuropathy, brain injury, convulsion, coma, severe abdominal cramps and acute renal failure.
Third, chronic poisoning:
Central nervous system: brain diseases, mental retardation, abnormal neurobehavior (blood lead concentration above 30ug/dl), affecting children's development, development and IQ (blood lead concentration above 5 ug/dl).
Peripheral nerve: the conduction speed of motor nerve slows down, and the conduction of ulnar nerve is affected when the blood lead concentration is greater than 30ug/dl.
Blood: anemia, hemolysis, ALAD inhibition (blood lead concentration is higher than 10ug/dl) and FEP( 15ug/dl). ALA in urine is increased (blood lead concentration is above 30ug/dl), and red blood cells are basophilic.
Kidney: hypertension, gout, chronic renal failure.
Others: reduce thyroid hormone concentration and chronic renal failure, interfere with vitamin D metabolism, reduce sperm activity and quantity, and cause cancer.
Four, laboratory inspection:
Generally speaking, anemia will occur when blood lead is above 40ug/dl, and the excretion of ALA in urine will also increase, which requires further medical evaluation and treatment. Exposure and treatment should be stopped immediately when the blood lead is greater than 60ug/dl, but when the blood lead is as small as 10ug/dl, it indicates that abnormal changes in biochemical indexes have occurred.
Verb (abbreviation for verb) diagnosis and treatment:
A. When the blood lead concentration ALAD rises and there is clinical abnormality, it can be diagnosed, and sometimes it can be diagnosed by EDTA mobility test (more than 1000ug/24 hours means lead poisoning).
B. If the blood lead is greater than 100ug/dl, EDTA+BAL should be used to prevent the aggravation of brain lesions; if it is less than 100ug/dL and has clinical symptoms, DMSA or EDTA should be used to avoid continuous exposure of rabbits for effective treatment; It is also quite important.
Zinc (zinc, zinc)
Zinc (zinc, zinc)
I. Occupations that may be exposed:
Alloy manufacturing, pottery industry, chemical synthesis, deodorant manufacturing, disinfectant manufacturing, battery manufacturing, dye manufacturing, electroplating industry, electronic workers, zinc plating industry, paper industry, paint and pigment industry, manufacturing industry, rubber industry, peeling industry, welding industry and Kimura anti-corrosion industry.
Second, acute poisoning:
A. cannibalism: nausea, vomiting, abdominal pain, bloody stool, fever, often self-healing.
B. Inhalation: Inhalation of zinc chloride smoke particles will cause cough and dyspnea, and in severe cases, it will become respiratory distress, acute renal failure and even death.
C. Contact: Skin contact with zinc compounds will cause dermatitis, and some people will have ulcers. Spraying eyes with zinc chloride and zinc sulfate solution will cause harm.
D metal smog fever: it occurs after inhaling zinc oxide dust and smog for 4-4 hours, and has a metallic smell, such as cough, shortness of breath, fatigue, myalgia, fever, sweating, chemical pneumonia, pulmonary edema, etc. Also known as metal smog fever. Most people can fully recover their functions.
Third, chronic poisoning:
Long-term exposure to zinc will cause chronic zinc poisoning, such as long-term consumption of male genitals and taking a large number of zinc tablets. It will cause symptoms such as a sharp drop in blood copper concentration, anemia, leukopenia, decreased immunity and weight loss.
Fourth, laboratory inspection.
A. The concentration of zinc in normal human serum is about 60- 100ug/dl, that in whole blood is about 500ug/d 1, and that in 24-hour urine is about 500ug.
B. The average urine creatine of occupational contacts is 800 ug/g, and the serum is 140ug/dl.
Verb (abbreviation for verb) diagnosis and treatment
A diagnosis is based on exposure history, typical clinical symptoms and increased urine concentration in blood.
B. Acute poisoning is mainly based on symptomatic support and treatment. EDTA, BAL, D- penicillamine and N- acetylcysteine can be used to promote the excretion of zinc.
First aid for minor poisoning
If there is slight heavy metal poisoning in the laboratory, take yogurt immediately and seek medical advice in time.