Heavy Metal Toxicity Treatment & Management

Updated: Dec 31, 2020
  • Author: Adefris Adal, MD, MS; Chief Editor: Sage W Wiener, MD  more...
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Treatment

Approach Considerations

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.

Clinical guidelines on treatment of iron and mercury exposure are available from the American Association of Poison Control Centers. [26, 27]  

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.

Please refer to the relevant articles (see Arsenic ToxicityLead ToxicityMercury ToxicityIron Toxicity) or contact a medical toxicologist for more specific recommendations.

 

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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 studies show evidence of retained metal (toys, coins, paint chips) in the gastrointestinal tract.

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.

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Consultations

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, screen for coingestion of acetaminophen, and consult a medical toxicologist and psychiatrist.

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