Heavy metal ingestion medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Medical Therapy

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When heavy metal poisoning is suspected, it is important to begin treatment as soon as possible to minimize long-term damage to the patient's nervous system and digestive tract. Heavy metal poisoning is considered a medical emergency, and the patient should be taken to a hospital emergency room.

The treatment for most heavy metal poisoning is chelation therapy. A chelating agent specific to the metal involved is given either orally, intramuscularly, or intravenously. The three most common chelating agents are calcium disodium edetate, dimercaprol (BAL), and penicillamine. The chelating agent encircles and binds to the metal in the body's tissues, forming a complex; that complex is then released from the tissue to travel in the bloodstream. The complex is filtered out of the blood by the kidneys and excreted in the urine. This process may be lengthy and painful, and typically requires hospitalization. Chelation therapy is effective in treating lead, mercury, and arsenic poisoning, but is not useful in treating cadmium poisoning. To date, no treatment has been proven effective for cadmium poisoning. Thallium poisoning is treated with a combination of Prussian blue (potassium ferric hexacyanoferrate) and a diuretic, because about 35% of it is excreted in the urine; however, if treatment is not started within 72 hours of ingesting the poisoning, damage to the patient's nervous system may be permanent.

In cases of acute mercury, arsenic, or thallium ingestion, vomiting may be induced. Activated charcoal may be given in cases of thallium poisoning. Washing out the stomach (gastric lavage) may also be useful. The patient may also require treatment such as intravenous fluids for such complications of poisoning as shock, anemia, and kidney failure.

Patients who have taken arsenic, thallium, or mercury in a suicide attempt will be seen by a psychiatrist as part of emergency treatment.

## References

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