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

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].
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