CHROMIUM

Introduction

• Chromium (Cr), from the Greek word chroma ("color"), makes rubies red and emeralds green.
Chromium is the 21st most abundant element in the earth's crust and is used in the manufacturing of
stainless steel.

• Occupational exposure to chromium occurs in wood treatment, stainless steel welding, chrome
plating, the leather tanning industry, and the use of lead chromate or strontium chromate paints.
Chromium exists in two main valency states: trivalent and hexavalent.

Absorption, Transport, and Excretion

• Cr(6+) is better absorbed and much more toxic than Cr(3). Both transferrin and albumin are involved in
chromium absorption and transport. Transferrin binds the newly absorbed chromium at site B, while
albumin acts as an acceptor and transporter of chromium if the transferrin sites are saturated." Other
plasma proteins, including B- and y-globulins and lipoproteins, bind chromium.

Health Effects, Deficiency, and Toxicity

• Cr(3+) is an essential dietary element and plays a role in maintaining normal metabolism of glucose,
fat, and cholesterol. The estimated safe and adequate daily intake of chromium for adults is in the range
of 50 to 200 μg/d, although data are insufficient to establish a recommended daily allowance.

• Dietary chromium deficiency is relatively uncommon and most cases occur in persons with specific
clinical situations such as total parenteral nutrition, diabetes, and malnutrition. Chromium deficiency is
characterized by glucose intolerance, glycosuria, hypercholesterol-emia, decreased longevity, decreased
sperm counts, and impaired fertility.

• Cr(6+) compounds are powerful oxidizing agents and are more toxic systemically than Cr(3+)
compounds, given similar amounts and solubilities. At physiological pH, Cr(6) forms CrO4 and readily
passes through cell membranes due to its similarity to essential phosphate and sulfate oxyanions.

• Intracellularly, Cr(6+) is reduced to reactive intermediates, producing free radicals and oxidizing
deoxyribonucleic acid (DNA), both potentially inducing cell death. Severe dermatitis and skin ulcers can
result from contact with Cr(6+) salts.

• Up to 20% of chromium workers develop contact dermatitis. Allergic dermatitis with eczema has been
reported in printers, cement workers, metal workers, painters, and leather tanner. Data suggest that a
Cr3-protein complex is responsible for the allergic reaction.
• When inhaled, Cr(6+) is a respiratory tract irritant, resulting in airway irritation, airway obstruction,
and possibly lung cancer.

• The target organ of inhaled chromium is the lung; the kidneys, liver, skin, and immune system may
also be affected.

• Low-dose, chronic chromium exposure typically results only in transient renal effects.

• Elevated urinary B2-microglobulin levels (an indicator of renal tubular damage) have been found in
chrome platers, and higher levels have generally been observed in younger persons exposed to higher
Cr(6+) concentrations.

• In May 2011, the FDA issued orders for postmarket surveillance studies to manufacturers of metal-on-
metal (MoM) hip replacement systems in response to an increasing concern over failed implant devices
reported in Europe.

• In the United States, no guidelines have been established for the assessment of metal ions in
asymptomatic patients due to a lack of knowledge regarding the prevalence of adverse events in the US
population and no clear threshold levels associated with an adverse event.

Laboratory Evaluation

• Chromium may be detemined by GFAAS, NAA, or ICP-MS. Plasma, serum, and urine do not indicate the
total body status of the individual, whereas urine levels may be useful for metabolic studies.

• In the setting of suspected failure of MoM hip implants that use a cobalt chrome alloy femoral head,
serum is the preferred specimen type for both chromium and cobalt analysis.