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

Agency for Toxic Substances and Disease Registry Chromium Toxicity
Case Studies in Environmental Medicine (CSEM)
Chronic
Exposure
Hemodialysis and charcoal hemoperfusion do not substantially enhance
chromium removal from the body if renal function remains normal [Ellis,
Brouhard et al. 1982]. However, if renal failure ensues, hemodialysis may be
necessary for management of the renal failure itself [Schiffl, Weidmann et al.
1982; Geller 2001].
Chelation with ethylenediaminetetraacetic acid (EDTA) does not seem to be
of clinical benefit [Geller 2001].
If the eyes and skin are directly exposed, flush with copious amounts of
water.
Several case reports suggest that topical ascorbic acid is effective in the
management of chromium dermatitis but this has not been confirmed in
controlled clinical trials [Bradberry and Vale 1999]. The ulcers heal in several
weeks without specific treatment.
Ethylenediaminetetraacetic acid (EDTA) ointment 10% might facilitate
removal of chromate scabs [Geller 2001; Lewis 2004].
Weeping dermatitis can be treated with 1% aluminum acetate wet dressings,
and chrome ulcers can be treated with topical ascorbic acid [Geller 2001;
Meditext 2005].
In most patients with chronic low-dose exposure, no specific treatment is
needed.
The mainstay of management is removing the patient from further exposure
and relying on the urinary and fecal clearance of the body burden.
Although normal urinary excretion is quite rapid, forced diuresis has been
used.
Except in the lungs, only small amounts of chromium are retained several
weeks after exposure has ceased.
Dermatitis, liver and renal injury will not progress after removal from
exposure, and, in most cases, the patient will recover.
If the exposure has been to high levels or lengthy, the increased risk of lung
cancer should be discussed with the patient.
Although no reliable tests are currently available to screen patients for lung
cancer, the physician can provide advice and patient education regarding
smoking cessation, avoiding or minimizing exposure to other known
pulmonary carcinogens, and general preventive health measures.
Annual chest radiographs might be advisable in carefully selected cases
[HSDB 2000; Meditext 2005].
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