Some debate
exists as to exactly what constitutes a "heavy metal" and which
elements should properly be classified as such. Some authors have
based the definition on atomic weight, others point to those metals
with a specific gravity of greater than 4.0, or greater than 5.0.
The actinides may or may not be included. Most recently, the term
"heavy metal" has been used as a general term for those metals and
semimetals with potential human or environmental toxicity. This
definition includes a broad section of the periodic table under the
rubric of interest.
Regardless of how one chooses to define the category, heavy metal
toxicity is an uncommon diagnosis. With the possible exceptions of
acute iron toxicity from intentional or unintentional ingestion and
suspected lead exposure, emergency physicians will rarely be alerted
to the possibility of metal exposure. Yet, if unrecognized or
inappropriately treated, heavy metal exposure can result in
significant morbidity and mortality. This article provides a brief
overview of general principles in the diagnosis and management of
metal toxicity. The Table reviews the typical presentation of the
most commonly encountered metals and their treatment in summary
form. It is not intended to guide clinical decision-making in
specific cases.
Many of the elements that can be considered heavy metals have no
known benefit for human physiology. Lead, mercury, and cadmium are
prime examples of such "toxic metals." Yet, other metals are
essential to human biochemical processes. For example, zinc is an
important cofactor for several enzymatic reactions in the human
body, vitamin B-12 has a cobalt atom at its core, and hemoglobin
contains iron. Likewise, copper, manganese, selenium, chromium, and
molybdenum are all trace elements, which are important in the human
diet.
Another subset
of metals includes those used therapeutically in medicine; aluminum,
bismuth, gold, gallium, lithium, and silver are all part of the
medical armamentarium. Any of these elements may have pernicious
effects if taken in quantity or if the usual mechanisms of
elimination are impaired.
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