Heavy Metal Poisoning

T56.0/T56.1/T56.4/T56.8/T57.0

DESCRIPTION

This includes mercury, arsenic, gold, copper, lead poisoning, thallium etc. Frequent/occupational inhalation of metal fumes and particles can cause metal fume fever, a flu-like syndrome with fever, malaise, bronchospasm, and bi-weekly variations in severity that may be mildest on the weekend and most severe on Monday or Tuesday after returning to work. This may be confused with an acute viral illness with fever, cough, sweating, myalgia, headache etc. The course of the illness is usually benign.

The management of heavy metal toxicity depends on the specific metal, route of exposure and length of time between exposure and clinical presentation of symptoms. Discuss all potential patients with the Poisons Information Helpline for further investigation, treatment options and possible referral.

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Metal	Signs and symptoms
Copper salts	GIT irritation, hepatotoxicity, and haemolysis.
Arsenic	Impairs cellular respiration, resulting in multi-organ dysfunction.
Mercury	Clinical effects depend on the route of exposure and type of mercury (inorganic versus organic).
Lead	Chronic toxicity more common. Affects nervous, gastrointestinal, renal, and haematopoietic systems.
Gold	Deposition of immune complexes in kidneys and skin; mucus membrane inflammation
Thallium	Alopecia and painful ascending peripheral neuropathy.

Table 19.6: Clinical features of heavy metal poisoning

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 2.0_27 March 2025

Chapter 19 Poisoning_19.21 Heavy Metal Poisoning