. 2018 Jun 5;8(3):169–188.

Table 3.

Typical toxicities of the most encountered metals and metalloids, and their treatment

Metal	Acute	Chronic	Toxic concentration	Treatment
As	Nausea, vomiting, “rice-water” diarrhea, encephalopathy, multi-organ dysfunction syndrome, long QT syndrome, painful neuropathy	Diabetes, hypopigmentation/hyperkeratosis, cancer: lung, bladder, skin, encephalopathy	24 h urine: ≥50 µg/L urine, or 100 µg/g creatinine	BAL (acute, symptomatic)
				Succimer
				DMPS (Europe)
Cr	GI hemorrhage, hemolysis, acute renal failure (Cr⁶⁺ ingestion)	Pulmonary fibrosis, lung cancer (inhalation)	No clear reference standard	N-cetylcysteine (experimental)
Co	Beer drinker’s (dilated) cardiomyopathy	Pneumoconiosis (inhaled); goiter	Normal excretion: 0.1-1.2 µg/L (serum) 0.1-2.2 µg/L (urine)	NAC
Co	Beer drinker’s (dilated) cardiomyopathy	Pneumoconiosis (inhaled); goiter	Normal excretion: 0.1-1.2 µg/L (serum) 0.1-2.2 µg/L (urine)	CaNa₂ EDTA
Hg	Elemental (inhaled): fever, vomiting, diarrhea, acute lung injury; Inorganic salts (ingestion): caustic gastroenteritis	Nausea, metallic taste, gingivostomatitis, tremor, neurasthenia, nephrotic syndrome; hypersensitivity (Pink disease)	Background exposure “normal” limits: 10 µg/L (whole blood); 20 µg/L (24-h urine)	BAL
				Succimer
				2,3-dimercapto-1-propane-sulfonic acid
Pb	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 µg/dL	BAL
				CaNa₂ EDTA
				Succimer