MICAH LOU C.
CALAMBA MD 2 May 17, 2022
CHEMICAL DESCRIPTION
have widespread commercial
application, including
production of storage batteries
LEAD ammunition, metal alloys,
solder, glass, plastics, pigments,
and ceramics
a naturally occurring element in
the earth’s crust with a long
history of use as a constituent
ARSENIC of commercial and industrial
products, as a component in
pharmaceuticals, and as an
agent of deliberate poisoning
“quicksilver”—the only metal
that is liquid under ordinary
Conditions—has attracted
MERCURY scholarly and scientific interest
from antiquity. The mining of
mercury was early recognized
as being hazardous to health.
Cadmium is a natural element
in the earth's crust. It is usually
CADMIUM found as a mineral combined
with other elements such as
oxygen, chlorine, or sulfur.
an oily, colorless liquid with a
strong mercaptan-like odor,
was developed in Great Britain
DIMERCAPROL
during World War II as a
(2,3-DIMERCA- therapeutic antidote against
PTOPROPANOL, poisoning by the arsenic-
BAL) containing warfare agent
lewisite. It thus became known
as British anti-lewisite, or BAL.
PHARMACOLOGY -Heavy Metals & Chelators
MECHANISM OF ACTION
Inhibits enzymes; interferes
with essential cations; alters
membrane structure
Inhibits enzymes; interferes
with oxidative
phosphorylation;
alters cell signaling, gene
expression
Inhibits enzymes; alters
membranes
After absorption, mercury is
distributed to the tissues
within a few hours, with the
highest concentration
occurring in the kidney.
accumulates especially in the
kidneys leading to dysfunction
of the
kidney with increased
secretion of proteins in urine
prevents and reverses arsenic
induced
inhibition of sulfhydryl-
containing enzymes and, if
given soon after exposure, may
protect against the lethal
effects of inorganic and
organic arsenicals.
CLINICAL EFFECTS
CNS deficits; peripheral
neuropathy; anemia;
nephropathy; hypertension;
reproductive toxicity
Cardiovascular -shock-
arrhythmias
CNS-encephalopathy -peripheral
neuropathy
OTHER-Gastroenteritis -
pancytopenia-cancer
CNS: tremor, behavioral
(erethism); gingivastomatitis,
peripheral neuropathy;
acrodynia; pneumonitis (high-
dose)
Long-term exposure may cause
kidney stones and lung damage,
and have been linked to lung
cancer and high blood pressure.
Short-term exposure may irritate
the lungs.
single-agent treatment of acute
poisoning by arsenic and
inorganic mercury and for the
treatment of severe lead
poisoning when used in
conjunction with edetate
calcium disodium (EDTA)
TREATMENT
• Chelation therapy with DMSA
(succimer)
• BAL, D-penicillamine, and EDTA
• Whole bowel irrigation
• termination of exposure and
nonspecific supportive care.
• oral chelation with unithiol or
succimer for symptomatic
individuals
• dietary supplementation of folate
• oral or intravenous unithiol,
intramuscular dimercaprol, or oral
succimer
• Unithiol and succimer increase urine
mercury excretion
there is no effective treatment for
cadmium intoxication, and patients
are given supportive treatment
according to their symptoms. some
of new chelating agents may be
effective
dimercaprol is associated with a high
incidence of adverse effects,
including hypertension, tachycardia,
nausea, vomiting, lacrimation,
salivation, fever
(particularly in children), and pain at
the injection site.