Diferencia entre revisiones de «Antimony toxicity»
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==Clinical Features==
==Clinical Features==
''Clinical features can range from mild local irritation to organ dysfunction''
''Clinical features can range from mild local irritation to organ dysfunction''
*'''GI'''
*GI
**Anorexia
**Anorexia
**[[Nausea/vomiting]]
**[[Nausea/vomiting]]
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**[[Pancreatitis]]
**[[Pancreatitis]]
**Can react with water in salvia, producing sufficient hydrochloric acid to cause GI [[burns]]
**Can react with water in salvia, producing sufficient hydrochloric acid to cause GI [[burns]]
*'''CV'''
*CV
**Decreases myocardial contraction
**Decreases myocardial contraction
**[[hypotension|Decreased systolic pressure]] through decreased coronary vasomotor tone
**[[hypotension|Decreased systolic pressure]] through decreased coronary vasomotor tone
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***Inversion or flattening of T waves
***Inversion or flattening of T waves
***[[Torsades de pointes]]
***[[Torsades de pointes]]
*'''Pulmonary'''
*Pulmonary
**Local irritation
**Local irritation
***[[Laryngitis]] and Tracheitis
***[[Laryngitis]] and Tracheitis
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***[[Cough]], [[wheezing]], and exertional [[dyspnea]]
***[[Cough]], [[wheezing]], and exertional [[dyspnea]]
***[[CXR]] showing diffuse, dense, punctate non-confluent opacities in the middle and lower lobes
***[[CXR]] showing diffuse, dense, punctate non-confluent opacities in the middle and lower lobes
*'''Renal'''
*Renal
**[[Proteinuria]]
**[[Proteinuria]]
**Increased BUN
**Increased BUN
**ATN
**ATN
**[[Renal failure]]
**[[Renal failure]]
*'''Hepatic'''
*Hepatic
**Elevated aminotransferase
**Elevated aminotransferase
**Hepatic necrosis
**Hepatic necrosis
*'''Hematologic'''
*Hematologic
**[[Thrombocytopenia]]
**[[Thrombocytopenia]]
**[[Leukopenia]]
**[[Leukopenia]]
**Severe [[anemia]] seen in HIV patients being treated for leishmaniasis
**Severe [[anemia]] seen in HIV patients being treated for leishmaniasis
*'''Dermatologic'''
*Dermatologic
**Antimony Spots
**Antimony Spots
***Papules and pustules around sweat glands
***Papules and pustules around sweat glands
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**[[Eczema]]
**[[Eczema]]
**Lichenification
**Lichenification
*'''Musculoskeletal'''
*Musculoskeletal
**[[Myalgia]]s
**[[Myalgia]]s
**[[Arthralgia]]s
**[[Arthralgia]]s
*'''Reproductive'''
*Reproductive
**Increased risk of [[spontaneous abortion]] and [[premature labor]]
**Increased risk of [[spontaneous abortion]] and [[premature labor]]
*'''Ocular'''
*Ocular
**Local irritation
**Local irritation
**[[Conjunctivitis]]
**[[Conjunctivitis]]

Revisión actual - 09:30 22 mar 2026

Background

  • Antimony is a metalloid and will react as a metal and nonmetal
    • Shares many similar properties with arsenic
  • Used to treat leishmaniasis and schistosomiasis
    • Most reported cases are due to complication of treatment
  • Most common forms used for treatment are trivalent and pentavalent compounds
  • Additional exposure occur from industrial exposures as inhalation of antimony dusts or fumes during processing
  • Antimony is thought to exert its toxic effects due to inactivation of various thiol-containing proteins and enzymes

Stibine

  • Most toxic form of antimony
  • Colorless gas that is formed when antimony reacts with hydrogen
    • Can result when mixing drain cleaners containing sodium hydroxide in areas with antimony ore
  • Can result in massive hemolysis

Toxicokinetics

  • Absorption
    • Inhalation
    • Ingestion
    • Transcutaneous
    • Bioavailability is 15-50%
  • Distribution
    • Predominately in highly vascular organs
    • Trivalent form seen in red blood cells
    • Pentavalent form accumulates in the liver
  • Metabolism
    • Pentavalent form is converted to trivalent form in the liver
  • Excretion
    • Trivalent form undergoes enterohepatic recirculation
    • Renal
      • Trivalent has a slow elimination with approximately 10% cleared within the first 24 hours
      • Pentavalent will have approximately 50-60% cleared within the first 24 hours

Clinical Features

Clinical features can range from mild local irritation to organ dysfunction

Differential Diagnosis

Evaluation

  • BMP
  • CBC
  • Urinalysis
  • EKG to look for cardiac affects of antimony
  • Cardiac monitor to assess for arrhythmia
  • CXR
  • Cases of stibine
    • Add type and cross, and coagulation factors as transfusions are likely required
  • Serum level 0.8 - 3 μg/L (6.6-24.6 nmol/L)
  • Urine level (24 hr) 0.5-6.2 μg/L (4.1-50.1 nmol/L)

Management

Stibine

Disposition

  • Will require admission to a monitored bed, likely ICU.

See also

References

Tarabar, A. Antimony. In: Goldfrank's Toxicologic Emergencies. 9th Ed. New York: McGraw-Hill; 2011: 1207-1213

  1. 1. Lauwers LF, Roelants A, Rosseel PM, et al. Oral antimony intoxications in man. Crit Care Med. 1990;18:324-326.
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