Diferencia entre revisiones de «Copper toxicity»

Revisión del 18:11 6 ago 2018

Background

Toxicokinetics

Clinical Features

Differential Diagnosis

Heavy metal toxicity

Evaluation

BMP
CBC
Copper level
Ceruloplasmin level
Abdominal films to assess for foreign bodies

Management

Disposition

Consult Toxicology or Poison Control Center

References

Nelson, L. Gold. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1256-1265

Authors:

@@ Línea 1: / Línea 1: @@
 ==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===
@@ Línea 64: / Línea 36: @@
 *Ceruloplasmin level
 *Abdominal films to assess for foreign bodies
-*MRI
-**Will show increase T<sub>2</sub> signal in the dorsal columns of the cervical cord
 ==Management==
-*Oral toxicity
-**Supportive Care
-***Hydration
-***H<sub>2</sub> receptor antagonists or PPI
-***Antiemetics
-**Consider whole bowel irrigation
-*Inhalation
-**Supportive care
-***Oxygen therapy
-***Bronchodilators
-**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 <ref>Majlesi, N. Zinc. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1342</ref>
-**Consider in patients with hemodynamic compromise
-**CaNa<sub>2</sub>EDTA, British anti-Lewisite, DTPA were all successfully used in case reports
-**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
-*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
-*Copper replacement
-**Oral copper alone shown to improve hematopoietic effects and prevent further neurological deterioration <ref> Rowin J, Lewis SL. Copper deficiency myeloneuropathy and pancytopenia secondary to overuse of zinc supplementation. J Neurol Neurosurg Psychiatry. 2005;76:750-751. </ref>
 ==Disposition==
 *Consult Toxicology or Poison Control Center
 ==References==
 <references/>
-Majlesi, N. Zinc. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1339-1344
+Nelson, L. Gold. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1256-1265