Heavy Metal Toxicity Follow-up

Updated: Jun 30, 2016
  • Author: Adefris Adal, MD, MS; Chief Editor: Asim Tarabar, MD  more...
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Follow-up

Further Outpatient Care

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  • The first priority in managing any patient with detectable serum lead is to determine the source of exposure and to remove the person from it. The finding of any elevated serum or urine metal concentration in an asymptomatic person should prompt a thorough dietary, occupational, and recreational history, and radiographs where indicated to identify any source of ongoing exposure.
  • A majority of asymptomatic children and adults with elevated lead levels can be safely managed solely by removing the source of exposure. Contact a medical toxicologist or the local poison control center for specific recommendations.
  • All cases of significantly elevated lead levels should be reported to the local health department.
  • Report any industry- or workplace-related heavy metal toxicities to OSHA.
  • Symptomatic patients with elevated metal concentrations should be treated more aggressively. Please refer to the relevant articles (see Toxicity, Arsenic; Toxicity, Lead; Toxicity, Mercury; Toxicity, Iron) or contact a medical toxicologist for more specific recommendations.
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Further Inpatient Care

Arsenic is frequently used for homicidal or suicidal purposes. Thoroughly scrutinize all arsenic toxicity cases for evidence of such activity. Report all cases with possible homicidal association to the proper legal authorities before discharge. Patients with suspected suicidal intent should undergo psychiatric evaluation before discharge from hospital.

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Complications

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  • Metal toxicity is rarely encountered clinically and may be difficult to recognize.
  • If untreated, acute exposures may progress to multiorgan failure and death or permanent organ damage.
  • Chronic exposure to metals may present with nonspecific symptoms, but if it is not identified and the exposure is allowed to continue, permanent neurologic damage, organ failure, or cancer may develop.
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