Recognizing and Managing Lead and Mercury Poisonings
URGENT CARE Special Section Recognizing and Managing Lead and Mercury Poisonings After iron, which was covered in EM’s May issue, lead and mercury are the two metals most likely to be implicated in heavy metal toxicity syndromes. The authors review the diagnostic considerations and update guidelines for detoxification. hat constitutes a heavy metal? It de- W pends on who you ask. In industrial and environ- mental studies, heavy metals are generally defined as those elements that have high atomic weights—elements with a spe- cific gravity of 5 or higher. A strict chemistry definition classifies ev- Urgent Care Section Urgent Care erything between copper and bis- muth on the periodic table as a heavy metal. Medical usage of the term, however, is much more lib- Inc Researchers, Associates/Photo © 2009 Biphoto eral, encompassing lighter metals Chronic Effects of Lead Poisoning. Dark or bluish discoloration and metalloids that are excluded of the gum-tooth line, known as a “lead line,” may be noted on exam and is the result of a chemical reaction between lead and dental plaque. by other definitions. The list of medically recognized toxic met- als and metalloids includes (but is not limited to) aluminum, arse- poisonings can often result in sig- nic, barium, bismuth, cadmium, nificant morbidity and mortality if cobalt, copper, chromium, gold, unrecognized and inappropriately lead, manganese, mercury, sele- treated. The physician also needs Christian Balmadrid, MD nium, silver, thallium, and zinc.1 to be prepared for the postdiag- Staff Physician Heavy metal or metalloid tox- nostic responsibility of identifying Durham Emergency Physicians Durham Regional Hospital icity is relatively uncommon in possible exposures to the same Durham, North Carolina urgent care centers, but for that toxin within the patient’s family, very reason it is important to workplace, or community that Michael J.
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