Cobalt toxicity: Difference between revisions
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==Background== | ==Background== | ||
*Orthopedic hip prostheses | *Cobalt is essential for life as a catalytic center for vitamin B12. Toxicity is rare. | ||
*Cobalt toxicity has been reported through the following exposures:<ref>Simonsen, L., 2012. Cobalt metabolism and toxicology—A brief update.</ref> | |||
**Orthopedic hip prostheses containing cobalt | |||
**Work-related cobalt exposure | |||
**Excessive drinking of beer containing cobalt sulfate | |||
==Clinical Features<ref>Devlin, J., 2021. Clinical Features, Testing, and Management of Patients with Suspected Prosthetic Hip-Associated Cobalt Toxicity: a Systematic Review of Cases.</ref>== | |||
* '''Neurologic Dysfunction''' | |||
**Hearing impairment | |||
**Cognitive impairment | |||
**Parasthesias | |||
*'''Cardiovascular Dysfunction''' | |||
**Beer drinkers' (dilated) cardiomyopathy | |||
**[[Dyspnea]] | |||
**[[Atrial fibrillation]] | |||
*'''Thyroid Dysfunction''' | |||
**[[Hypothyroidism]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
''There is no consensus regarding treatment of patients with systemic symptoms of cobalt toxicity''<ref>Dwyer, J., 2021. Final Diagnosis-Elevated Blood Cobalt Levels in Patients with Metal-on-Metal Prosthesis. [online] Available at: <https://path.upmc.edu/cases/case806/dx.html> [Accessed 28 June 2021].</ref> | |||
*Manage symptoms supportively | |||
**Treat [[hypothyroidism]] (thyroid replacement therapy) | |||
**Treat [[cardiomyopathy]](beta-blockers/ACE-inhibitors/diuresis) | |||
*No conclusive evidence for [[plasmapheresis]] or chelation therapy<ref>Mohan, N., 2016. Identification and Management of Cobalt Toxicity: A Case Report of Rapidly Progressing Toxicity after Hip Arthroplasty Revision. [online] Jdc.jefferson.edu. Available at: <https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1359&context=tmf> [Accessed 28 June 2021].</ref> | |||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Toxicology (main)]] | |||
*[[Heavy Metals]] | |||
==External Links== | ==External Links== | ||
Latest revision as of 19:24, 28 June 2021
Background
- Cobalt is essential for life as a catalytic center for vitamin B12. Toxicity is rare.
- Cobalt toxicity has been reported through the following exposures:[1]
- Orthopedic hip prostheses containing cobalt
- Work-related cobalt exposure
- Excessive drinking of beer containing cobalt sulfate
Clinical Features[2]
- Neurologic Dysfunction
- Hearing impairment
- Cognitive impairment
- Parasthesias
- Cardiovascular Dysfunction
- Beer drinkers' (dilated) cardiomyopathy
- Dyspnea
- Atrial fibrillation
- Thyroid Dysfunction
Differential Diagnosis
- Aluminum toxicity
- Antimony toxicity
- Arsenic toxicity
- Barium toxicity
- Beryllium toxicity
- Bismuth toxicity
- Boron toxicity
- Cadmium toxicity
- Cesium toxicity
- Chromium toxicity
- Cobalt toxicity
- Copper toxicity
- Gold toxicity
- Iron toxicity
- Lead toxicity
- Lithium toxicity
- Manganese toxicity
- Mercury toxicity
- Nickel toxicity
- Phosphorus toxicity
- Platinum toxicity
- Selenium toxicity
- Silver toxicity
- Thallium toxicity
- Tin toxicity
- Vanadium toxicity
- Zinc toxicity
Evaluation
Management
There is no consensus regarding treatment of patients with systemic symptoms of cobalt toxicity[3]
- Manage symptoms supportively
- Treat hypothyroidism (thyroid replacement therapy)
- Treat cardiomyopathy(beta-blockers/ACE-inhibitors/diuresis)
- No conclusive evidence for plasmapheresis or chelation therapy[4]
Disposition
See Also
External Links
References
- ↑ Simonsen, L., 2012. Cobalt metabolism and toxicology—A brief update.
- ↑ Devlin, J., 2021. Clinical Features, Testing, and Management of Patients with Suspected Prosthetic Hip-Associated Cobalt Toxicity: a Systematic Review of Cases.
- ↑ Dwyer, J., 2021. Final Diagnosis-Elevated Blood Cobalt Levels in Patients with Metal-on-Metal Prosthesis. [online] Available at: <https://path.upmc.edu/cases/case806/dx.html> [Accessed 28 June 2021].
- ↑ Mohan, N., 2016. Identification and Management of Cobalt Toxicity: A Case Report of Rapidly Progressing Toxicity after Hip Arthroplasty Revision. [online] Jdc.jefferson.edu. Available at: <https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1359&context=tmf> [Accessed 28 June 2021].