Zinc toxicity: Difference between revisions
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**Rhinitis | **Rhinitis | ||
**[[Dyspnea]] | **[[Dyspnea]] | ||
** | **Acute lung injury | ||
**[[Acute Respiratory Distress Syndrome]] | **[[Acute Respiratory Distress Syndrome]] | ||
** | **Metal fume fever | ||
===Chronic=== | ===Chronic=== | ||
*Zinc induced copper deficiency | *Zinc induced copper deficiency | ||
**Reversible [[ | **Reversible sideroblastic [[anemia]] | ||
**Reversible [[myelodysplastic syndrome]] | **Reversible [[myelodysplastic syndrome]] | ||
*Progressive myeloneuropathy | *Progressive myeloneuropathy | ||
**Spastic gait | **Spastic gait | ||
**Sensory ataxia | **Sensory [[ataxia]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 53: | Line 53: | ||
**Supportive Care | **Supportive Care | ||
***Hydration | ***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 | ||
| Line 66: | Line 66: | ||
**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 | **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 | ||
Revision as of 01:10, 27 January 2019
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
- Hydration
- H2 receptor antagonists or PPI
- Antiemetics
- Consider whole bowel irrigation
- Supportive Care
- 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
References
Majlesi, N. Zinc. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1339-1344