| Heavy Metal |
Acute |
Chronic |
Toxic Concentration |
| Lead |
Nausea, vomiting, encephalopathy (headache, seizures, ataxia, obtundation) |
Encephalopathy, anemia, abdominal pain, nephropathy, foot-drop/ wrist-drop |
Pediatric: symptoms or [Pb] ≥45 µ/dL (blood); Adult: symptoms or [Pb] ≥70 µ/dL |
| Copper |
Blue vomitus, GI irritation/ hemorrhage,
hemolysis, MODS (ingested); MFF (inhaled) |
Vineyard sprayer’s lung (inhaled); Wilson
disease (hepatic and basal ganglia degeneration) |
Normal excretion:
25 µg/24 hours (urine) |
| Cadmium |
Pneumonitis (oxide fumes) |
Proteinuria, lung cancer,
osteomalacia |
Proteinuria and/or ≥15 µg/g
creatinine |
| Chromium |
GI hemorrhage, hemolysis,
acute renal failure (Cr6+ ingestion) |
Pulmonary fibrosis, lung cancer (inhalation) |
No clear reference standard |
| Mercury |
Elemental (inhaled): fever, vomiting, diarrhea, ALI;
Inorganic salts (ingestion): caustic gastroenteritis |
Nausea, metallic taste, gingivo-stomatitis,
tremor, neurasthenia, nephrotic syndrome;
hypersensitivity (Pink disease) |
Background exposure "normal" limits:
10 µg/L (whole blood); 20 µg/L (24 hours urine) |
| Arsenic |
Nausea, vomiting,
"rice-water" diarrhea,
encephalopathy,
MODS, LoQTS,
painful neuropathy |
Diabetes,
hypopigmentation/ hyperkeratosis,
cancer: lung, bladder, skin, encephalopathy |
24 hours urine:
≥50 µg/L urine, or
100 µg/g creatinine |
MODS, multi-organ dysfunction syndrome; MFF, metal fume fever; GI, gastrointestinal; LoQTS, long QT syndrome and a rare inborn heart condition; ALI, acute lung injury. |
