Case Study On Metallic Poisoning

1. Jaskaran Sir
Forensic Toxicology
Name: Pravin Singh
Reg: 11603759

2. Case Study On Metallic Poisoning:

3. Toxic metals are metals that form poisonous
soluble compounds and have no biological role, or
are in the wrong form[
Toxic metals comprise a group of minerals that
have no known function in the body and, in fact,
are harmful.
Today mankind is exposed to the highest
levels of these metals in recorded history.
This is due to their industrial use, the
unrestricted burning of coal, natural gas and
petroleum, and incineration of waste materials
worldwide.
Toxic metals are now everywhere and affect
everyone on planet earth. They have become a
major cause of illness, aging and even genetic
defects.

4. Heavy Metal
Heavy metals are elements in the periodic table which are metals or metalloids. There are about 23
heavy metals. These are transition metals, actinides, and lanthanides. Antimony, arsenic, bismuth,
cadmium, cerium, chromium, cobalt, copper, gallium, gold, iron, lead, manganese, mercury, nickel,
platinum, silver, tellurium, thallium, tin, uranium, vanadium, and zinc are the heavy metals that we
know of. Heavy metals are specially known because of their toxicity. In our environment, small
amounts of these elements are present.
It is necessary to have a certain amount of heavy metals in our diet and body in order to maintain a
good health. However, large concentrations of heavy metal cause toxicity and it can cause a lot of
damages to living organisms. For example, it can cause reduced mental activity or damage it.
Further it can damage lungs, kidneys, liver and other important organs. Heavy metals can be
accumulated in side living organisms over food chains. So it is important to know the sources of
heavy metals and control their release to the natural environment.

6. Today mankind is exposed to thehighest
levels in recorded history of lead,
mercury, arsenic, aluminum, copper,
nickel, tin, antimony, bromine, bismuth
and vanadium.
 Dr. Henry Schroeder, MD
◦ “Most organic substances are degradable by
natural processes. However, no metal is
degradable…they are here to stay for a long
time”.

7. A

8. 1. Acute exposure
◦ Symptoms occur rapidly after ingestion
(throat and abdominal pain)
◦ Vomiting and profuse diarrhea: profound
fluid and electrolyte loss may cause death
within 24 hours
◦ Delirium and coma have been reported
◦ Survivors may develop peripheral sensory
neuropathy, exfoliative dermatitis and hair
loss

9. Cont…
2. Chronic exposure
Irritation of the skin and mucous
membrane and respiratory tract with
occasionally perforation of the nasal septum
Systemic effects: weakness, anorexia,
nausea, vomiting, diarrhea, hepatitis,
peripheral sensory neuropathy and alopecia
Skin hyperpigmentation and transverse
white lines on the nails (MEES LINES)
Associated to lung and skin cancers

10. Heavy metals become toxic when
they are not metabolized by the
body and accumulate in the soft
tissues

11. • Mental disorders
• Pain in muscle and
joints
• Gastro intestinal
disorders
• Vision problems
• Chronic fatigue
• Susceptibility to fungal
infections
TheSymptoms

12. 1.Arsenic is the most common cause of acute heavy metal poisoning in adults
and is number 1 on the ATSDR's "Top 20 List.“
2.Arsenic is released into the environment by the smelting process of copper,
zinc, and lead, as well as by the manufacturing of chemicals and glasses.
3.People can be exposed to arsenic by inhaling it, by consuming contaminated
foods, water, or beverages, or by skin contact.
4..People may be exposed to higher levels if they live near industrial areas.
SOMEFACTSABOUTARSENIC

13. SYMPTOMPS
• Vomiting
• Abdominal Pain
• Diarrhea
• Dark urine (termed black water urine)
• Dehydration
• Cardiac problems
• Hemolysis (destruction of red blood cells)
• Vertigo
• Delirium
• Shock
• Death

14. Lead
• Lead-based paint and lead-contaminated
dust in older buildings.
• Contaminated air, water and soil.
• Adults who work with batteries
• Do home renovations
• Work in auto repair shops.

15. SYMPTOMPS
• High blood pressure
• Abdominal pain
• Constipation
• Joint pains
• Muscle pain
• Declines in mental functioning
• Pain, numbness or tingling of the extremities
• Headache, Memory loss, Mood disorders
• Reduced sperm count, abnormal sperm
• Miscarriage or premature birth in pregnant women

16. 1. Number 3 on ATSDR's "Top 20 List" ismercury.
2. Mercury is generated naturally in the environment from the
degassing of the earth's crust, from volcanic emissions.
3.
inorganic mercury.
4.
similar and some different symptoms.
SOMEFACTSABOUTMERCURY

17. SYMPTOMPS
• Damage to the brain, kidneys and lungs.
• Mercury poisoning can result in several
diseases, including Acrodynia (pink
disease),Hunter-Russell syndrome,and
Minamata disease.

18. Cadmium SOURCES
• Cadmium is regularly found in ores together with zinc, copper
and lead. Therefore volcanic activity is one natural source.
• Cadmium is widely used in industrial processes, e.g.: as an
anticorrosive agent
• As a stabilizer in PVC products
• As a color pigment
• A neutron-absorber in nuclear power plants
• In the fabrication of nickel-cadmium batteries

19. SYMPTOMPS
More severe exposures can cause
• Tracheo-bronchitis, pneumonitis, and pulmonary edema.
• Symptoms of inflammation may start hours after the exposure
and include cough, dryness and irritation of the nose and
throat, headache, dizziness, weakness, fever, chills, and chest
pain.
• The bones become soft (osteomalacia), lose bone mineral
density (osteoporosis) and become weaker.
• The kidneys lose their function to remove acids from the blood
in proximal renal tubular dysfunction

20. SYMPTOMPSRELATEDTOIRONTOXICITY
• Stomach Pain
• Nausea and vomiting
• Bloody vomiting
• Metabolic acidosis, which in turn damages internal organs,
particularly the brain and the liver.
• Iron poisoning can cause hypovolemic shock due to iron's
potent ability to dilate the blood vessels
• Death may occur from liver failure.

21. 1. Fluoride is poorly absorbed from intact skin but
• readily absorbed from the lung andthe
•
2.
gastrointestinal tract
• It accumulates in the body at levels of 4mg/day.
SOMEFACTSABOUTFLUORIDE

22. SYMPTOMPS
• Skeletal fluorosis, resulting in an increased
bone density associated with skeletal
deformities and spinal rigidity.
• Skeletal changes as well as musculoskeletal
complaints are observed in highly exposed
groups

23. 7. Manganese

24. SYMPTOMPS
• Anorexia
• Asthenia
• Apathy
• Somnolence
• Headaches, etc.
• A few may experience a brief period of aggressiveness,
increased sexual activity, and hallucinations.
• The toxicity may be manifested as a chronic disorder of the
central nervous system (CNS) resembling Parkinson's disease

25. LEAD

26. Found in all animals
Batteries
Paints
Pots and ceramics
Leaded gasoline

27. Lead displaces other metals such as iron,
• zinc and copper from normal binding sites to produce some of its
biochemical effect
• Binds to sulfhydryl groups anddisrupt cellular metabolism
• Primary organs affected are CNS andkidneys and the reproductive
and hematopoietic system

28. 1.Background: Lead is a toxic element of the environment which leads to major complications once it enters the blood
stream, affecting multiple organs and systems of the body.
Methods: We present the case of a 16-year-old girl, diagnosed with lead poisoning after occupational exposure due to
the fact that the girl was actively involved in the family's pottery business.
History revealed that the girl participated in the process of pottery, her father was also diagnosed with lead poisoning 2
years before. The patient's personal history underlined that approximately 1 year ago she presented with severe
abdominal pain, being diagnosed with acute appendicitis and she underwent appendectomy, but the pain persisted, thus
due to family history of lead poisoning, the suspicion of saturnine colic rose, and she was diagnosed with lead poisoning.
The main symptoms and signs were severe abdominal pain, vomiting, and arterial hypertension. The clinical evolution
was favorable under symptomatic treatment and chelation therapy.
Results: Lead toxicity is a life-threatening condition because of its severe acute and chronic complications. In children,
there is no safe blood lead level, prevention methods are, therefore, very important in order to avoid toxic multiorganic
effects of this metal.
Conclusion: Even though the diagnosis of lead poisoning remains difficult in children, it must also be taken into
consideration by the clinician facing a child with gastrointestinal or neurological involvement.

29. 2.Mercury poisoning in a fisherman working on a
pelagic fishing vessel due to excessive tuna
consumption
• Case report: A 48-year-old male deep-sea fisherman developed paresthesia
and pain in both legs while working at sea. He continued working for over 4
months on a pelagic fishing vessel but was eventually unable to function
normally as his condition deteriorated. Upon arrival on land, he received
specialist treatment, including imaging studies, for 2 months; however, the
cause of the symptoms was not identified. An examination of his occupational
history revealed that he had worked as a crew member on a pelagic fishing
vessel catching tuna for the last 2 years and consumed tuna for two or more
meals per day, every day. Two months after discontinuation of tuna
consumption, he was tested for mercury.

30. 3. Lead Poisoning in Animal
• Even though there was no history of exposure, the rabbit was admitted and
treated for lead poisoning. An antidote was given (sodium calcium edetate)
alongside syringe feeding, medication to stimulate gut motility and analgesia.
The following morning, the owner phoned and said that she might have found
the source of the problem. Both rabbits were always left in an outhouse when
she was at work and she found they had been chewing at the whitewashed
walls. The rabbit responded to treatment and was sent home a few days later.
Her owner decided to keep the rabbits in the house all the time.
An adult rabbit was brought in to our clinic because she was depressed, not eating or defaecating and had not
responded to the treatment for gut stasis. A lateral abdominal radiograph showed some suspicious radiopaque areas
in the stomach and colon that could have been due to ingestion of a metallic compound but the owner was adamant
that the rabbit had no access to anything toxic. The rabbit and her companion were houserabbits. The property was
old but was not under renovation.

31. 4.Man's Heavy Metal Poisoning Leads to Vision
Loss, Baldness
• A young man who started losing his vision and even suddenly became color blind turned
out to have an unusual cause for the problems: thallium poisoning.
• Thallium is a metal that can be absorbed through a person's skin and can lead to
neurological problems. It does so because it takes the place of the similar chemical
potassium in a number of processes in the body, particularly in the nervous system.
Thallium poisoning can cause nerve pain, confusion and loss of muscle control, and the
heavy metal can be fatal in high doses, according to the report of the young man's case.
• But thallium is not included in standard tests for heavy metals in the body, and it wasn't
until the doctors learned that the man worked in a chemistry laboratory that they
thought to test for the element. [In Photos: The Power of Poison Through Time]

32. • The patient "had all the hallmark signs" of thallium poisoning, said Dr. Enchun
Liu, a ophthalmologist at the Retina Institute in St. Louis, Missouri, who
treated the man for his vision problems and was the lead author of the case
report, published Sept. 24 in JAMA Ophthalmology.
• "This was the first case of thallium poisoning I've ever seen," Liu told Live
Science. "As far as I know, it is a pretty rare condition."
• The man first went to the emergency room in December 2014 because of
stomach pain, nausea and diarrhea, Liu said. Healthcare workers there gave
the man intravenous fluids, diagnosed him with gastroenteritis (also known as
stomach flu) and sent him home, Liu said.

33. 5.Low back pain and waddling gait in a 60-year-old
woman
• A 60-year-old woman comes to your office with complaints of low back pain, which is causing progressive difficulty in walking. The pain has
gradually increased since the onset of menopause 5 years ago. This discomfort is especially noticeable after prolonged sitting.
• Social history reveals that the patient has been a housewife since her marriage 38 years ago. Her husband, who is in good health, owns and
operates a small retail shop in their home. The patient has been making jewelry for sale in her husband’s shop and as a hobby for about 35
years. They have two adult sons who are in good health.
• The patient denies a personal or family history of kidney disease, hypertension, diabetes mellitus, or cardiovascular disease; she also denies
history of back trauma or weight loss. She has smoked one to two packs of cigarettes a day for the past 40 years. She does not take
estrogens, calcium supplements, vitamins, or other medications.
• On examination you find a thin female with a slightly stooped posture and a waddling gait. Blood pressure is 120/70. Her teeth have a
yellow discoloration above the crown, and her fingernails are stained with nicotine. She is anosmic on cranial nerve examination. Results of
cardiovascular and abdominal examination are normal. The lower lumbar spine is tender to percussion, but the patient does not complain
of pain on straight leg raising. Her deep tendon reflexes are intact, and the remainder of the physical examination, including neurologic
testing, is normal. Sensation and strength are normal in legs and feet. Range of motion is normal in hips and knees.

34. • Initial laboratory data include a urinalysis showing 3+ proteinuria and
glycosuria. BUN, creatinine, and albumin levels are normal.
Roentgenograms of the pelvis and lumbosacral spine reveal
pseudofractures and other evidence of severe osteomalacia and mild
osteoporosis. There are no osteolytic or osteoblastic lesions.

35. 6.Erosion of nails following thallium poisoning
This case report describes a patient with thallium poisoning caused by
repeated exposure to low doses of thallium. Alopecia and nail changes
were the most prominent features of this case. There was dystrophy of
nails in the form of whitish lunular stripes. This is the first report of
complete erosion of proximal parts of nails following thallium
poisoning. This case is the first report of thallium poisoning from India
occurring from repeated low dose exposure.

36. • Thallium is a toxic heavy metal, which was accidentally discovered by
Sir William Crookes in 1861 by burning the dust from a sulphuric acid
industrial plant.1 It is silvery white in colour in its pure state, and is
more toxic than lead and as toxic as arsenic. It is well absorbed by any
route, including skin. In blood, about 70% of it is bound to red cells; it
is mainly excreted by the kidneys.2 Poisoning by thallium causes a
variety of symptoms ranging from tachycardia, hypotension, and
gastroenteritis to polyneuropathy, alopecia, and dystrophy of nails

37. Reference:
• 1.https://journals.lww.com
• 2.https://www.nap.edu
• 3.https://www.jstage.jst.go.jp
• 4.https://oem.bmj.com