Heavy Metal Poisoning: Cadmium

Cadmium poisoning can be a serious health problem from mining of cadmium. There was serious cadmium poisoning from contamination of food and water by mining effluents in Japan, in 1946 lead to outbreak of “itai-itai” (“ouch-ouch”) disease. The disease was so named because of cadmium-induced bone toxicity that led to painful bone fractures.

Sources of arsenic poisoning: Metal plating, battery, pigment, smelting, and plastics industries and incineration of these products are the main sources of cadmium poisoning. Tobacco smoking and consumption of food that concentrate cadmium like grains and cereals are also important source of cadmium poisoning.

Clinical manifestations: Acute cadmium inhalation causes pneumonitis 4–24 hours after inhalation and acute ingestion causes gastroenteritis. Chronic exposure causes anosmia (loss of smell), yellowing of teeth, emphysema, microcytic hypochromic anemia that do not respond to iron therapy, proteinuria (protein in urine), calciuria (calcium crystals in urine), leading to chronic renal failure, osteomalacia, and fractures.

Symptoms of cadmium poisoning due to inhalation include chest pain, breathlessness, fever, pulmonary edema, nausea and high pulse rate. Symptoms due to ingestion are nausea, vomiting, cramps, and diarrhea.

Diagnosis: If poisoning is due to recent exposure, serum cadmium is about 5µg/dL. Urinary cadmium (10µg/g creatinine) and/or urinary ?2-microglobulin more than 750µg/g creatinine (but urinary ?2-microglobulin also increased in other renal diseases such as pyelonephritis, so it is not reliable).

Treatment: There is no effective and specific treatment for cadmium poisoning. Chelation is not useful and dimercaprol can aggravate renal toxicity. So the main management is further avoidance of exposure to cadmium and supportive therapy. Vitamin D is given for osteomalacia.

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