Heavy Metal Toxicity Treatment & Management

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

Emergency Department Care

Decontamination

Removal of the patient from the source of exposure is critical to limiting dose.

Treatment may include whole-bowel irrigation with polyethylene glycol electrolyte solution if radiographic evidence of retained metal (toys, coins, paint chips) is present.

Resuscitation

Good supportive care is critical. Ensure airway patency and protection, provide mechanical ventilation where necessary, correct dysrhythmias, replace fluid and electrolytes (significant fluid losses generally occur and require aggressive rehydration), and monitor and treat the sequelae of organ dysfunction.

Chelation

Chelation is rarely indicated in the emergent setting. A possible exception is lead encephalopathy. Consideration of chelation therapy for patients with suspected or confirmed metal exposures should be made in conjunction with a medical toxicologist or the local poison control center.

Guidelines

Clinical guidelines on treatment of iron and mercury exposure are available from the American Association of Poison Control Centers. [23, 24]

Next:

Consultations

Recommended consultations include the following:

  • Contact a certified poison control center or medical toxicologist
  • Consult a gastroenterologist if the possibility of corrosive GI effects is present
  • If intentional ingestion or overdose is suspected, place the patient in a closely monitored unit and consult a medical toxicologist and psychiatrist
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