Environment and Health: Heavy Metal Toxicity.

Heavy metals are naturally occurring, high-density elements such as arsenic, cadmium, chromium, lead, and mercury. These five metals are the most common causes of heavy metal poisonings. Zinc is also of concern. Heavy metals are widely distributed in the environment and can be toxic even at low concentrations. Exposure commonly occurs via ingestion, inhalation, or skin absorption. Occupational exposures are common and can occur in mining, refining, and smelting operations. Lead exposure disproportionately affects lower-income, inner-city communities due to older housing stock and historical industrial contamination. Adverse health effects of exposure to heavy metals vary by type and form of metal, exposure factors (eg, route, dose, duration), and individual patient characteristics (eg, age, sex). Toxicity management includes supportive treatments, decontamination, chelation, and/or surgery depending on the clinical situation and metal involved. For some types of heavy metal toxicity, there are no definitive treatments. Acute poisoning with arsenic and chromium can be fatal. Pregnant and breastfeeding patients and young children are particularly vulnerable to heavy metal exposure due to its effects on fetal and child development. In cases of suspected exposure, patients should be evaluated with a thorough history, including detailed occupational and social histories, and a physical examination, with laboratory tests and imaging as needed.

Intoxicación ocupacional por metales pesados / Occupational poisoning due to heavy metals

Se efectuó una revisión bibliográfica exhaustiva con vistas a demostrar la relación existente entre ciertas profesiones y las intoxicaciones por metales pesados. A tales efectos, en el presente artículo se describen las fuentes de emisión y las aplicaciones de dichos metales, así como las afecciones que provocan a la salud. Se constató que las intoxicaciones diagnosticadas en trabajadores de la provincia, en el período 2000-2016, estuvieron asociadas a diferentes empleos, tales como reparación de baterías, plomería, soldadura y odontología. A partir de lo anterior se exponen algunas recomendaciones a considerar en los campos salud ocupacional-metales pesados

An exhaustive literature review aimed at demonstrating the existent relationship between certain professions and poisonings due to heavy metals was carried out. To such effects, the emission sources and uses of these metals are described in this work, as well as the disorders that cause to health. It was verified that the poisonings diagnosed in workers of the province, during 2000-2016, were associated with different jobs, such as batteries repair, plumbing, welding and dentistry. From the above-mentioned, some recommendations to consider everything regarding occupational health-heavy metals are exposed

Chemical Hand Warmer Packet Ingestion: A Case of Elemental Iron Exposure.

For individuals who work outdoors in the winter or play winter sports, chemical hand warmers are becoming increasingly more commonplace because of their convenience and effectiveness. A 32-year-old woman with a history of chronic pain and bipolar disorder presented to the emergency department complaining of a "warm sensation" in her mouth and epigastrium after reportedly ingesting the partial contents of a chemical hand warmer packet containing between 5 and 8 g of elemental iron. She had been complaining of abdominal pain for approximately 1 month and was prescribed unknown antibiotics the previous day. The patient denied ingestion of any other product or medication other than what was prescribed. A serum iron level obtained approximately 6 hours after ingestion measured 235 micrograms/dL (reference range 40-180 micrograms/dL). As the patient demonstrated no new abdominal complaints and no evidence of systemic iron toxicity, she was discharged uneventfully after education. However, the potential for significant iron toxicity exists depending on the extent of exposure to this or similar products. Treatment for severe iron toxicity may include fluid resuscitation, whole bowel irrigation, and iron chelation therapy with deferoxamine. Physicians should become aware of the toxicity associated with ingestion of commercially available hand warmers. Consultation with a medical toxicologist is recommended.

Disparities of Selected Metal Levels in the Blood and Scalp Hair of Ischemia Heart Disease Patients and Healthy Subjects.

Imbalances in the concentrations of trace metals have become an increasingly recognized source of infirmity worldwide particularly in the development of ischemia heart disease (IHD). Present study is intended to analyze the concentrations of Ca, Cd, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Na, Pb, Sr, and Zn in the blood and scalp hair of the patients and counterpart controls by flame atomic absorption spectrometry after wet-acid digestion. On the average, Cd, Co, Cr, Fe, K, Li, Mn, Na, and Pb revealed significantly elevated concentrations in the blood of the patients compared with the controls (p < 0.05), whereas mean levels of Ca, Cd, Fe, K, Li, Pb, and Sr in the scalp hair were significantly higher in the patients than the controls (p < 0.05). Most of the metals exhibited noticeable disparities in their concentrations based on gender, abode, dietary/smoking habits, and occupations of both donor groups. The correlation study and multivariate statistical analyses revealed some significantly divergent associations and apportionment of the metals in both donor groups. Overall, comparative variations of the metal contents in blood/scalp hair of the patients were significantly different than the controls; thus, evaluation of trace metals status may be indicative of pathological disorders, such as IHD.

Riesgo sanitario por sustancias tóxicas en aguas superficiales de Tres Arroyos, Argentina / Health risk by toxic substances in freshwater of Tres Arroyos, Argentina / Risco sanitário por substâncias tóxicas em águas superficiais de Tres Arroyos, Argentina

En cursos de agua del partido de Tres Arroyos (provincia de Buenos Aires, Argentina) se encontraron sustancias tóxicas (metales pesados, nitratos, nitritos, fluoruros, sustancias fenólicas y pesticidas organoclorados). El objetivo del trabajo fue estimar el riesgo sanitario para el baño recreativo en esas aguas. El análisis se basó en el modelo USEPA probabilístico para riesgo agregado y acumulativo, tanto para efectos no carcinogenéticos (ENC) como carcinogenéticos (EC), considerando la ingesta accidental de agua y el contacto dérmico. Se planteó un escenario de exposición basado en datos propios y de la literatura para un niño de 10 años como representativo de la población expuesta. Los resultados indican que no existiría riesgo relevante para la actividad recreativa para las concentraciones consideradas. De todos los cuerpos de agua el de mayor riesgo es el Arroyo Claromecó, pero sólo alcanza al 20% del valor limitante. Los metales contribuyen con un 82 y 99% del riesgo total acumulado por ENC y EC, respectivamente, seguidos por las sustancias inorgánicas. Y de los metales, el mayor contribuyente al riesgo es el arsénico, quien aporta el 78 y 99% del riesgo agregado y acumulado por todas las sustancias para ENC y EC, respectivamente.

Toxic substances (heavy metals, nitrate, nitrite, fluoride, phenolic substances and organochlorine pesticides) were detected in Tres Arroyos county freshwaters (Buenos Aires province, Argentina). The aim of this study was estimate the human health risk (HR) associated with these substances during recreational bathing. The probabilistic HR assessment was based on aggregated and cumulative USEPA models. Cancer (CE) and non-cancer (NCE) risk were estimated for accidental drinking and dermal contact during the recreational activity. The exposure scenario considered was based on own and literature data, and a ten year-old child was selected as representative of the exposed population. The results indicated that surveyed substances do not generate any health risk for recreational bathing with direct contact at the specified concentrations and exposure conditions. Claromecó creek station was the riskiest point of whole water bodies, but it reaches only 20% of the limitating value. Metals were the major contributors to overall aggregated and cumulative risk (82% for NCE and 99% for CE), followed by inorganic substances. Arsenic was the most dangerous metal, responsible for the 78 and 99% of the aggregate and cumulative risks for all substances for NCE and CE, respectively.

Em cursos d´água da localidade de Tres Arroyos (Província de Buenos Aires, Argentina) foram encontradas substâncias tóxicas (metais pesados, nitratos, nitritos, fluoretos, substâncias fenólicas e pesticidas organoclorados). O objetivo do trabalho foi calcular o risco sanitário para o banho com fins recreativos nessas águas. A análise foi realizada com base no modelo USEPA probabilístico para risco agregado e acumulativo, tanto para efeitos não carcinogênicos (ENC) como carcinogênicos (EC), considerando a ingestão acidental de água e o contato dérmico. Foi apresentado um cenário de exposição com base em dados próprios e da literatura para um menino de dez anos como representativo da população exposta. Os resultados indicam que não existiria risco relevante para a atividade recreativa para as concentrações consideradas. De todos os corpos de água aquele de maior risco é o Arroyo Claromecó mas só atinge 20% do valor limitante. Os metais contribuem com 82 e 99% do risco total acumulado por ENC e EC, respectivamente, seguidos pelas substâncias inorgânicas. E dos metais, o maior contribuinte ao risco é o arsênico, que oferece 78 e 99% do risco agregado e acumulado por todas as substâncias para ENC e EC, respectivamente.