Toxic metals and elements

Ahmad Y. Alqassim
PhD, MSPH, MD
 Learning Objectives
By the end of this chapter the reader will be able to:
• Name five heavy metals that pose health hazards to humans.
• State mechanisms for exposure of humans to toxic metals.
• Distinguish between essential and toxic levels of trace
metals.
• Describe occupational settings in which workers are exposed
to toxic metals.
• Discuss methods for prevention of exposure to toxic metals.
Facts about Toxic Metals
• Metals exist in many forms: metallic, ionized,
organic
• Metals are needed in moderate (Na, K, Mg, Ca,
Fe), trace (Cu, Mo, Mn), or ultra trace (Cr, Co)
amounts for proper health.
• Some metals are carcinogenic: As, Be, Cd, Cr, Ni,
Pt
Facts about Toxic Metals
• Include
– Heavy metals (e.g., lead, mercury, nickel)
– Other metallic compounds (e.g., aluminum, iron, tin)
• Heavy metals have a high atomic weight with a
specific gravity that exceeds the specific gravity of
water by five or more times
Bioaccumulation
• Toxic substances such as heavy metals become
more concentrated and potentially more harmful as
they move up the food chain.
Modes of Exposure to Metals
• Lungs
– Through inhalation of dusts, metal fumes, and vapors
• Skin
– Through contact with dusts
• Mouth
– By ingestion
High- and Low-Level Contacts
• Contact with high concentrations of toxic metals is
most likely to occur in an occupational setting.
– Example: people who work with metals
• Lower-level exposures may result from contact with
the ambient environment
– Example: children may ingest toxic metals present in
paint
Symptoms of Acute Toxic Metal
Poisoning
• Generally rapid onset of symptoms (few minutes to
approximately 1hour)
• Symptoms vary depending on portal of entry.
• Gastrointestinal effects (vomiting and stomach pain)
• Neurologic effects (headaches, suppression of normal breathing,
and convulsions)
Symptoms of Long-Term Exposure
at Lower Levels
• Difficult to differentiate from those of chronic
medical conditions
• Reduced cognitive functioning
– Learning impairment
Potential Exposure Media
• Air
• Soil/dust
• Water
• Biota/food
Gender Differences and Heavy
Metal Exposure Effects
• Effects are different for women than they are for
men.
• Differences have been attributed to hormonal and
metabolic processes related to menstruation,
pregnancy, and menopause.
Fetuses, Infants, and Children and
Exposure to Heavy Metals
• Present serious hazards
– Impairment of physical and mental development
– Damage to internal organs and the nervous system
– Some forms of cancer
– Mortality
Children Exposure to Heavy Metals

• Nervous system damage

– Memory impairment
– Difficulty in learning
– Range of behavioral problems, such as hyperactivity
syndrome and overt aggressiveness
Fetal Exposure to Heavy Metals
• Lead and mercury have the capacity to cross the
placental barrier.
• Can cause potential fetal brain damage
Heavy Metal Exposure among
Children vs. Adults
• Have smaller body weight
• Consume more food in proportion to their body
weight
• Receive higher doses of heavy metals that may be
present in food
 IARC Classification of carcinogens

https://monographs.iarc.fr/list-of-
classifications
Classification of Toxic
Effects of Metals
1. Major toxic metals with multiple effects
2. Essential metals with potential for toxicity
3. Metals related to medical therapy
1- Major Toxic Metals with Multiple
Effects
• Lead
• Mercury
• Arsenic
• Beryllium
• Cadmium
• Chromium
• Mercury
• Nickel
Lead
• Sources of environmental lead
– Leaded gasoline
– Tap water from soldered pipes
– Painted surfaces in older buildings
• Another common source of household lead
– Imported pottery used in food service
• Class 2A carcinogen
Lead Toxicity
• One of the most common environmental pediatric
health problems in the US
• Causes serious central nervous system effects
and other adverse health consequences even
when ingested at low levels.
• Lead is considered to be a potential renal
carcinogen in humans.
• The kidney is a target organ for lead and toxicity is
characterized by nephropathy.
Lead Toxicity
• Lead alters calcium homeostasis and lead levels
are inversely related to levels of vitamin D.
• Lead inhibits hemoglobin biosynthesis by
blocking several enzymes and Anemia is produced
when significant exposure to lead has occurred.
• Lead crosses the placenta and can affect the
fetus. (Reproductive and Developmental Effects)
Mercury
• Naturally occurring metal
• Highly toxic
• Released into the environment as a by-product of
industrial processes
• Organic mercury is class 2B carcinogen
Mercury Deposition in Lakes and
Rivers
• Potential hazard to human health even at low
levels in water
• Can increase to high levels
– Methylation—microorganisms convert elemental
mercury into methyl mercury
– Bioaccumulation—causes mercury levels to become
more concentrated in aquatic invertebrates
Mercury Toxicity
• Acute: respiratory tract irritation and inflammation,
CNS effects include tremor and excitability.
• Chronic: tremor, enlarged thyroid, increased iodine
uptake in thyroid, irregular pulse, tachycardia,
dermographism, hematologic changes, increased
Hg in urine. And lots of other symptoms
• Methyl Hg is of greatest concern because it is a
common environmental contaminant. Shellfish,
fish, bacteria, and other organisms methylate
mercury.
Legacy of Mercury Contamination
• Minamata disease
• Can people be poisoned by their dental (amalgam)
fillings?
• 1971 Iraq poison grain disaster
Arsenic
• Varies in toxicity depending on chemical form
• By-product of refining gold and other metals
• Used in pesticides, wood preservatives, and
manufacturing processes
• Exposure can come from ingestion and
inhalation.
• Class A carcinogen
Standards for Arsenic
• 2001 EPA standard: 10 µg of arsenic per liter of
drinking water, with the year 2006 set as the
compliance date
• Prior standard: 50 µg of arsenic per liter of water
Potential Health Effects of Arsenic
Exposure (1 of 2)
• Skin, bladder, kidney, and liver cancer when
ingested
• Lung cancer when inhaled
• Peripheral vascular disease
• Cerebrovascular disease
• Cardiovascular disease (e.g., hypertensive heart
disease)
Arsenic induced preneoplastic changes and
cancers

!
Potential Health Effects of Arsenic
Exposure (2 of 2)
• Diabetes (long-term exposure)
• Adverse pregnancy outcomes
– Spontaneous abortions
– Stillbirths
– Preterm births
Beryllium
• Used widely in industry because of its special
properties (lighter than aluminum and stronger
than steel)
• Employees in the metal processing industry most
likely to be exposed
• Inhalation one of the most common methods of
exposure
• Class A carcinogen
Cadmium
• Primary sources of cadmium exposure for the
general population
– Cigarette smoke
– Dietary cadmium
• Bioaccumulates in shellfish
• Found in some species of mushrooms
Occupational Exposure to Cadmium
• Production of nickel cadmium batteries
• Zinc smelting
• Paint manufacturer
• Soldering
• Employment in metal factories
Effects of Cadmium Exposure
• Osteoporosis in women
• Height loss in men
• Kidney damage
• Elevated blood pressure
• Cardiovascular diseases
• It is primarily associated with human lung,
prostate, and kidney cancers, and recently
pancreatic cancer.
• “Itai-itai” disease
Chromium
• Naturally occurring element in the earth’s crust
(e.g., in rocks, soils, and materials of volcanic
origin)
• Most common forms
– Chromium(0)
– Chromium(III): an essential nutrient
– Chromium(VI): classified as class A carcinogen
‫السادس‬
Effects of Hexavalent
Chromium(VI) Exposure
• Ingestion
– Digestive problems
– Damage to organs such as the kidney and liver
• Topical
– Skin ulcers
• Inhalation in high concentrations
– Respiratory problems (e.g., nose bleeds, perforation of
the nasal septum, and runny nose)
Erin Brockovich
• Advocated for residents of Hinkley, California,
against a power company accused of polluting the
town’s water with chromium(VI)
Nickel
• Classified as a heavy metal
• One of the constituents of the earth’s crust
• Human exposure to low levels likely universal and
unavoidable
• Used in steel, batteries, electronics, catalysts,
jewelry
Effects of Nickel Exposure
• Contact dermatitis (nickel allergy)
• Cardiovascular-related and renal diseases
• Fibrosis of the lungs
• Main toxicity is occupational, inhalation is route of
exposure to Ni dusts which cause respiratory
cancers.
• Potential carcinogenic action
• Class A carcinogen
2- Essential Metals with Potential
for Toxicity
• Toxic at high levels
– Copper
– Zinc
– Iron
• An optimal range of these essential metals is
necessary to maintain health.
Copper and the Environment
• Present in electrical wires, pipes, in combination
with other metals to form alloys, as a mildew
inhibitor, and as a wood and leather preservative
• Approximately 1.4 billion pounds of copper were
released into the environment during industrial
processing in 2000 alone (per ATSDR estimates).
Exposure to Copper
• Routes of exposure
– Inhalation
– Ingestion of copper-containing foods and water
– Direct contact with the skin
• Tap water considerations
– Small amounts may dissolve into tap water from copper
piping, increasing copper levels
Effects of Copper Exposure
• Concentrated amounts (far above trace levels)
– Respiratory and gastrointestinal disturbances
• Copper dust
– Irritation of the respiratory tract (e.g., nose and mouth)
• Very high levels
– Liver and renal damage
– Death
Zinc
• Frequently occurring element found in the earth’s
crust
• Permeates air, soil, water, and, to some degree, all
foods
• Used commercially
– Coating for rust inhibition
– Component of batteries
– Alloys
• Nutritional element important for maintaining health
Negative Effects of Excessive
Amounts of Zinc
• Gastrointestinal problems
– Stomach cramps, nausea, and vomiting
• Anemia
• Damage to the pancreas
• Metal fume fever (inhalation)
– Appears to be an immune-mediated response that
originates in the lungs
Iron
• One of the most ubiquitous metals in the earth’s
crust
• Vital to human health
– Growth of cells
– Transport of oxygen within the circulatory system
Iron Toxicity
• Acute iron intoxication (accidental iron poisoning)
– Among most common childhood poisonings
• Other groups at risk from iron overload (iron
toxicity)
– Adult men
– Postmenopausal women
3- Metals Used in Medical Therapies
• Aluminum
• Lithium
• platinum
Aluminum
• Silver-white metal
• Used widely in food and beverage containers, in
pots and pans, and in construction sites
• An ingredient in various medicines and cosmetics
(e.g., to buffer aspirin and in antiperspirants)
• Concern about possible association with
Alzheimer’s disease
Summary
• Metals have specific properties, and these
properties contribute to toxicity in different ways,
such as uptake.
• Diet, pollution, occupation, genetics, age, sex, and
other factors influence metal toxicity.
• Dose –response curves for metal toxicity are often
steep (e.g., lead levels and CNS toxicity)
• CNS, PNS, and renal systems are general targets
for metals