Zinc toxicity: Difference between revisions

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*Exposure from diet, medicinal uses, nutritional supplements, and occupational exposures
*Exposure from diet, medicinal uses, nutritional supplements, and occupational exposures
**Multiple case reports of zinc toxicity related to ingestion of United States pennies which contain 97.5% zinc
**Multiple case reports of zinc toxicity related to ingestion of United States pennies which contain 97.5% zinc
==Toxicokinetics==
 
===Toxicokinetics===
*Absorbed primarily in the jejunum
*Absorbed primarily in the jejunum
*Excreted via the GI tract with minimal amounts excreted in the urine
*Excreted via the GI tract with minimal amounts excreted in the urine
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*Inverse relationship with copper
*Inverse relationship with copper
**Excess zinc absorption will cause a counterregulatory response resulting in copper elimination
**Excess zinc absorption will cause a counterregulatory response resulting in copper elimination
==Clinical Features==
==Clinical Features==
*'''Acute'''
===Acute===
**GI distress
*GI distress
***Nausea
**[[Nausea]]
***Vomiting
**[[Vomiting]]
***Abdominal pain
**[[Abdominal pain]]
***GI bleeding
**[[GI bleeding]]
***Partial and full thickness burns causing strictures with zinc chloride solutions with >20% zinc
**Partial and full thickness burns causing strictures with zinc chloride solutions with >20% zinc
**Inhalation
*Inhalation
***Lacrimation
**Lacrimation
***Rhinitis
**Rhinitis
***Dyspnea
**[[Dyspnea]]
***[[Acute Lung Injury]]
**Acute lung injury
***[[Acute Respiratory Distress Syndrome]]
**[[Acute Respiratory Distress Syndrome]]
***[[Metal fume fever]]
**[[Metal fume fever]]
*'''Chronic'''
 
**Zinc induced copper deficiency
===Chronic===
***Reversible [[sideroblastic anemia]]
*Zinc induced copper deficiency
***Reversible [[myelodysplastic syndrome]]
**Reversible sideroblastic [[anemia]]
**Progressive myeloneuropathy
**Reversible [[myelodysplastic syndrome]]
***Spastic gait
*Progressive myeloneuropathy
***Sensory ataxia
**Spastic gait
**Sensory [[ataxia]]
 
==Differential Diagnosis==
==Differential Diagnosis==
===[[Heavy metal]] toxicity===
{{Heavy metals list}}
*[[Aluminum toxicity]]
 
*[[Antimony toxicity]]
*[[Arsenic toxicity]]
*[[Barium toxicity]]
*[[Bismuth toxicity]]
*[[Cadmium toxicity]]
*[[Chromium toxicity]]
*[[Cobalt toxicity]]
*[[Copper toxicity]]
*[[Gold toxicity]]
*[[Iron toxicity]]
*[[Lead toxicity]]
*[[Lithium toxicity]]
*[[Manganese toxicity]]
*[[Mercury toxicity]]
*[[Nickel toxicity]]
*[[Phosphorous toxicity]]
*[[Platinum toxicity]]
*[[Selenium toxicity]]
*[[Silver toxicity]]
*[[Thallium toxicity]]
*[[Tin toxicity]]
*[[Zinc toxicity]]
==Evaluation==
==Evaluation==
*BMP
*BMP
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*Ceruloplasmin level
*Ceruloplasmin level
*Abdominal films to assess for foreign bodies
*Abdominal films to assess for foreign bodies
*MRI
*[[brain MRI|MRI]]
**Will show increase T<sub>2</sub> signal in the dorsal columns of the cervical cord
**Will show increase T<sub>2</sub> signal in the dorsal columns of the cervical cord
==Management==
==Management==
*Oral toxicity
*Oral toxicity
**Supportive Care
**Supportive Care
***Hydration
***[[IVF|Hydration]]
***H<sub>2</sub> receptor antagonists or PPI
***[[H2 blocker|H<sub>2</sub> receptor antagonists]] or [[PPI]]
***Antiemetics
***[[Antiemetics]]
**Consider whole bowel irrigation
**Consider [[whole bowel irrigation]]
*Inhalation
*Inhalation
**Supportive care
**Supportive care
***Oxygen therapy
***[[Oxygen therapy]]
***Bronchodilators
***[[Bronchodilators]]
**Metal fume fever
**[[Metal fume fever]]
***Usually self limiting
***Usually self limiting
***CXR usually normal
***[[CXR]] usually normal
*Chelation
*Chelation
**Limited data on use, and data present is based off of case reports and treatment for lead toxicity <ref>Majlesi, N. Zinc. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1342</ref>
**Limited data on use, and data present is based off of case reports and treatment for lead toxicity <ref>Majlesi, N. Zinc. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1342</ref>
**Consider in patients with hemodynamic compromise
**Consider in patients with hemodynamic compromise
**CaNa<sub>2</sub>EDTA, British anti-Lewisite, DTPA were all successfully used in case reports
**CaNa<sub>2</sub>[[EDTA]], [[British antilewisite]], DTPA were all successfully used in case reports
**1000mg/m<sup>2</sup>/d IV CaNa<sub>2</sub>EDTA every 6 hours
**1000mg/m<sup>2</sup>/d IV CaNa<sub>2</sub>EDTA every 6 hours
***Based on a successful case report, but should be given in conjunction with toxicology or poison control center
***Based on a successful case report, but should be given in conjunction with toxicology or poison control center
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*Copper replacement
*Copper replacement
**Oral copper alone shown to improve hematopoietic effects and prevent further neurological deterioration <ref> Rowin J, Lewis SL. Copper deficiency myeloneuropathy and pancytopenia secondary to overuse of zinc supplementation. J Neurol Neurosurg Psychiatry. 2005;76:750-751. </ref>
**Oral copper alone shown to improve hematopoietic effects and prevent further neurological deterioration <ref> Rowin J, Lewis SL. Copper deficiency myeloneuropathy and pancytopenia secondary to overuse of zinc supplementation. J Neurol Neurosurg Psychiatry. 2005;76:750-751. </ref>
==Disposition==
==Disposition==
*Consult Toxicology or Poison Control Center
*Consult Toxicology or [[poison control]]
 
==References==
==References==
<references/>
<references/>
Majlesi, N. Zinc. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1339-1344


[[Category:Toxicology]]
[[Category:Toxicology]]

Latest revision as of 18:26, 28 September 2021

Background

  • Transition metal
  • Essential nutrient
  • Exposure from diet, medicinal uses, nutritional supplements, and occupational exposures
    • Multiple case reports of zinc toxicity related to ingestion of United States pennies which contain 97.5% zinc

Toxicokinetics

  • Absorbed primarily in the jejunum
  • Excreted via the GI tract with minimal amounts excreted in the urine
  • Accumulates in erythrocytes
    • Whole blood concentrations are 6-7x higher than in the serum
  • Inverse relationship with copper
    • Excess zinc absorption will cause a counterregulatory response resulting in copper elimination

Clinical Features

Acute

Chronic

Differential Diagnosis

Evaluation

  • BMP
  • CBC
  • Copper level
  • Ceruloplasmin level
  • Abdominal films to assess for foreign bodies
  • MRI
    • Will show increase T2 signal in the dorsal columns of the cervical cord

Management

  • Oral toxicity
  • Inhalation
  • Chelation
    • Limited data on use, and data present is based off of case reports and treatment for lead toxicity [1]
    • Consider in patients with hemodynamic compromise
    • CaNa2EDTA, British antilewisite, DTPA were all successfully used in case reports
    • 1000mg/m2/d IV CaNa2EDTA every 6 hours
      • Based on a successful case report, but should be given in conjunction with toxicology or poison control center
  • Dermal Exposures
    • Do not use water in metallic zinc exposures
      • Concern metal will ignite
    • Remove zinc with forceps and apply mineral oil to affected skin
  • Copper replacement
    • Oral copper alone shown to improve hematopoietic effects and prevent further neurological deterioration [2]

Disposition

References

  1. ↑ Majlesi, N. Zinc. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1342
  2. ↑ Rowin J, Lewis SL. Copper deficiency myeloneuropathy and pancytopenia secondary to overuse of zinc supplementation. J Neurol Neurosurg Psychiatry. 2005;76:750-751.
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