Zinc toxicity: Difference between revisions
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==Clinical Features== | ==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== | ==Differential Diagnosis== | ||
Revision as of 20:39, 12 August 2018
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
Heavy metal toxicity
- 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
- 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
- Hydration
- H2 receptor antagonists or PPI
- Antiemetics
- Consider whole bowel irrigation
- Supportive Care
- Inhalation
- Supportive care
- Oxygen therapy
- Bronchodilators
- Metal fume fever
- Usually self limiting
- CXR usually normal
- Supportive care
- 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 anti-Lewisite, 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 Center
References
Majlesi, N. Zinc. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1339-1344