Diferencia entre revisiones de «Chromium toxicity»

Revisión del 03:03 10 ago 2018

Absorption
- Cr³⁺
  - Limited oral absorption with 98% recovered in feces
- Cr⁶⁺
  - Modestly absorbed
    - 10% orally
    - 50-85% inhalational
Distribution
- Cr⁶⁺ is rapidly converted to Cr³⁺ in the blood
- 50% total body burden is localized to the kidney and liver
  - With additional stores in bone marrow, lymph nodes, spleen, and testes
Elimination
- Urinary excretion of Cr³⁺ form
Cr⁶⁺
- Oxidative agent producing oxidative DNA damage
- Main cause of toxicity
Cr³⁺
- Rarely develops toxicity

Form	Toxicity	Absorption	Distribution	Elimination
Cr³⁺	Rarely develops toxicity	Limited oral absorption with 98% recovered in feces	Cr6+ is rapidly converted to Cr3+ in the blood	Urinary excretion
Cr⁶⁺	Main cause of toxicity Oxidative agent producing oxidative DNA damage	Modestly absorbed 10% orally 50-85% inhalational		50% total body burden is localized to the kidney and liver With additional stores in bone marrow, lymph nodes, spleen, and testes

Acute
- Similar to corrosive metal ingestions
- GI hemorrhage
- Vomiting
- Bowel perforation
- Intravascular hemolysis with DIC
- Acute tubular necrosis and Renal failure
- Metabolic acidosis
- Hyperkalemia
- Acute lung injury
- Skin inflammation and ulcerations
  - Dermal chromic acid (H₂CrO₄) can lead to systemic toxicity with as little as 10% BSA
Chronic
- Most are occupational inhalation exposures
- Chrome holes
  - Nasal septal perforation
  - Skin ulcerations
- Chronic cough
- Dyspnea and bronchospasm
- Anaphylactoid-like reactions
- Pneumoconicosis
- Increase risk of lung cancer
  - Small cell lung cancer, however all types are associated with Cr⁶⁺ exposure
- Contact dermatitis and Type IV hypersensitivity reaction

Decontamination
- Activated charcoal not indicated
- Consider NG lavage if Cr⁶⁺ ingestion and presenting within 1-2 hours without signs of vomiting
- Consider oral N-acetylcysteine
  - Shown to increases renal elimination of chromium in rats
Supportive care
Chelation
- Not effective in reducing chromium levels
Dialysis
- Not effective in those with normal renal function
- Consider in those on chronic dialysis

Bird, S. Chromium. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1243-1247

Authors:

@@ Línea 40: / Línea 40: @@
 | align="center" style="background:#f0f0f0;"|'''Elimination'''
 |-
-| Cr<sup>3+</sup>||Rarely develops toxicity||Limited oral absorption with 98% recovered in feces||Cr6+ is rapidly converted to Cr3+ in the blood||Urinary excretion
+| Cr<sup>3+</sup>||
+*Rarely develops toxicity
+||
+*Limited oral absorption with 98% recovered in feces
+||
+*Cr6+ is rapidly converted to Cr3+ in the blood
+||
+*Urinary excretion
 |-
-| Cr<sup>6+</sup>||Main cause of toxicity *Oxidative agent producing oxidative DNA damage||Modestly absorbed **10% orally **50-85% inhalational||||50% total body burden is localized to the kidney and liver *With additional stores in bone marrow, lymph nodes, spleen, and testes
+| Cr<sup>6+</sup>||
+*Main cause of toxicity
+*Oxidative agent producing oxidative DNA damage
+||
+*Modestly absorbed
+**10% orally
+**50-85% inhalational
+||||
+*50% total body burden is localized to the kidney and liver
+**With additional stores in bone marrow, lymph nodes, spleen, and testes
 |}