(Cr) Toxicity | ATSDR - CSEM - Agency for Toxic Substances and ...

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Agency for Toxic Substances and Disease Registry Chromium Toxicity Case Studies in Environmental Medicine (CSEM) Answers 7. The correct answer is B. Respiratory tract is a major target of inhalation exposure to chromium compounds. 8. The correct answer is C. Chromium is one of the most common skin sensitizers and often causes skin sensitizing effect in the general public. A possible source of chromium exposure is waste dumps for chromate-producing plants causing local air or water pollution. 9. The correct answer and false statement is B. Lung cancer is not the only cancer caused by Cr(VI) compounds. In addition to the lung cancer, a number of epidemiological studies of workers in chromate industries also showed significantly increased risk for nasal and sinus cancers. Page 38 of 67
Agency for Toxic Substances and Disease Registry Chromium Toxicity Case Studies in Environmental Medicine (CSEM) Clinical Assessment - History, Signs and Symptoms Learning Objectives Upon completion of this section, you will be able to • describe characteristic clinical presentations of patients with acute and chronic chromium exposure. Introduction Characteristic clinical presentations of patients with Cr(VI) compound exposure include Patient History and Physical Examination Signs and Symptoms • sinusitis, nasal septum perforation, • allergic and irritant dermatitis, skin ulcers, • respiratory irritation, bronchitis, asthma, and • lung cancer [Lewis 2004]. Often, no clear diagnostic clues exist in chromium-exposed patients. A thorough history is therefore critical in evaluating a potentially exposed person. The patient’s recent activities are important. Occupation, location of residence and workplace in relation to industrial facilities or hazardous waste sites, and source of drinking water supply should be investigated. In patients with known chronic chromium exposure, the physical examination should include evaluation of the respiratory system, kidneys, liver, and skin. Acute Exposure Acute poisoning is likely to occur through the oral route, whereas chronic poisoning is mainly from inhalation or skin contact [Meditext 2005]. Severe exposures to Cr(VI) compounds are usually accidental or intentional (suicide), and are rarely occupational or environmental. Oral intake of Cr(VI) compound may cause • intense gastrointestinal irritation or ulceration and corrosion, • epigastric pain, • nausea, • vomiting, • diarrhea, • vertigo, • fever, • muscle cramps, • hemorrhagic diathesis, • toxic nephritis, • renal failure, • intravascular hemolysis, • circulatory collapse, • liver damage, • acute multisystem organ failure, and • coma, and even death, depending on the dose [Hay, Derazon et al. 2000; Lewis 2004; Meditext 2005]. Page 39 of 67
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