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

Agency for Toxic Substances and Disease Registry Chromium Toxicity
Case Studies in Environmental Medicine (CSEM)
Signs and
Symptoms
Acute Cr(VI) poisonings are often fatal regardless of the therapy used. The
average oral lethal dose of Cr(VI) in humans is 1-3 grams (Meditext 2005).
Systemic symptoms and death have occurred after external burns, with a
delay of onset of gastrointestinal symptoms of hours and days. Burns initially
resemble first and second degree burns, but extend to subcutaneous tissue
within a couple of days [Schiffl, Weidmann et al. 1982; Meditext 2005].
Chronic Exposure
Repeated skin contact with chromium dusts can lead to incapacitating
eczematous dermatitis with edema. Chromate dusts can also produce
irritation of the conjunctiva and mucous membranes, nasal ulcers and
perforations, keratitis, gingivitis, and periodontitis [Cohen and Costa 1998].
When a solution of chromate contacts the skin, it can produce penetrating
lesions known as chrome holes or chrome ulcers, particularly in areas where
a break in the epidermis is already present. These commonly occur on the
fingers, knuckles, and forearms. The characteristic chrome sore begins as a
papule, forming an ulcer with raised hard edges. Ulcers can penetrate deep
into soft tissue or become the sites of secondary infection, but are not known
to lead to malignancy. [Geller 2001; Lewis 2004; Meditext 2005].
Lung cancer is the most serious long-term effect [Cohen and Costa 1998;
Lewis 2004; Meditext 2005]. Apart from the carcinogenic potential,
prolonged exposure can result in bronchitis, rhinitis, or sinusitis or the
formation of nasal mucosal polyps. Besides the lungs and intestinal tract, the
liver and kidney are often target organs for chromate toxicity [Rom 2007].
Reports on adverse effects from low-level environmental exposures in human
populations are limited. Hudson County, NJ, was a major center for the
processing of chromium ore. A study using immune-function assay described
reduced production of cytokines in individuals who were exposed to
chromate [Snyder, Udasin et al. 1996]. Long-term studies in which animals
have been exposed to low levels of chromium in food or water have
produced no harmful effects [ATSDR 2000].
Key Points • Acute poisoning is likely to occur through the oral route, whereas chronic
poisoning is mainly from inhalation or skin contact.
• Severe exposures to Cr(VI) compounds are usually accidental or
intentional (suicide), and are rarely occupational or environmental.
• In occupational settings, the most commonly reported effects of chronic
chromium exposure are contact dermatitis and irritation and ulceration of
the nasal mucosa.
• Lung cancer is a potential long-term effect of chronic Cr(VI) exposure.
• Besides the lungs and intestinal tract, the liver and kidney are often
target organs for chromate toxicity from chronic exposure.
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