Zinc toxicity: Difference between revisions
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**Acute lung injury | **Acute lung injury | ||
**[[Acute Respiratory Distress Syndrome]] | **[[Acute Respiratory Distress Syndrome]] | ||
**Metal fume fever | **[[Metal fume fever]] | ||
===Chronic=== | ===Chronic=== | ||
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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 | ||
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*Oral toxicity | *Oral toxicity | ||
**Supportive Care | **Supportive Care | ||
***Hydration | ***[[IVF|Hydration]] | ||
***[[H2 blocker|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> | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[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
- GI distress
- Nausea
- Vomiting
- Abdominal pain
- GI bleeding
- Partial and full thickness burns causing strictures with zinc chloride solutions with >20% zinc
- Inhalation
- Lacrimation
- Rhinitis
- Dyspnea
- Acute lung injury
- Acute Respiratory Distress Syndrome
- Metal fume fever
Chronic
- Zinc induced copper deficiency
- Reversible sideroblastic anemia
- Reversible myelodysplastic syndrome
- Progressive myeloneuropathy
- Spastic gait
- Sensory ataxia
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
- 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
- Supportive Care
- Consider whole bowel irrigation
- Inhalation
- Supportive care
- Metal fume fever
- Usually self limiting
- CXR usually normal
- 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
- Do not use water in metallic zinc exposures
- Copper replacement
- Oral copper alone shown to improve hematopoietic effects and prevent further neurological deterioration [2]
Disposition
- Consult Toxicology or poison control