Chromium Toxicity

Healthy Lungs
Men's Health
Contributed byKrish Tangella MD, MBAFeb 01, 2019

What are the other Names for this Condition? (Also known as/Synonyms)

  • Chromium Poisoning
  • Heavy Metal Poisoning - Chromium
  • Poisoning due to Chromium

What is Chromium Toxicity? (Definition/Background Information)

  • Chromium Toxicity is a condition caused by excess amounts of chromium in the body. Chromium (Cr) is a type of heavy metal that is used in many industrial applications
  • A primary risk factor for Chromium Toxicity is the exposure environment; industrial welders are at a high risk due to the nature of their work environment. Repeated exposure to chromium through oral ingestion, skin contact, or inhalation causes poisoning
  • The signs and symptoms of Chromium Toxicity comprise nausea, vomiting, diarrhea, fever, renal failure, and severe gastrointestinal irritation or ulcers. The condition is diagnosed by complete medical history and physical exam, and through tests to establish chromium levels in the body
  • The possible complications of Chromium Toxicity include increased blood and tissue acidity, inadequate blood supply to tissues that result in shock and kidney diseases. One of the physical effects of this heavy metal poison is the presence of “chrome holes”, which are persistent ulcers due to skin contact caused by toxic hexavalent chromium compounds
  • Acute Chromium Toxicity is generally treated by removing the affected individual from the source of the exposure, and then relying on urinary and fecal mechanisms to clear the body of the toxin. The prognosis depends heavily on when the individual is removed from the source of toxicity. Prolonged exposure may make the prognosis worse
  • Chromium Toxicity can be prevented by using personal protective equipment in environments where exposure to hexavalent chromium is high, by practicing proper hand hygiene, and by avoiding food and water consumption at the work site

Who gets Chromium Toxicity? (Age and Sex Distribution)

  • Children and adults can be affected by Chromium Toxicity
  • However, adults who are commonly exposed to chromium are affected the most. This usually occurs from working in the metal industry or using spray paints
  • Both males and females are affected and no particular preference is observed
  • The condition is seen to affect all races and ethnic groups

What are the Risk Factors for Chromium Toxicity? (Predisposing Factors)

The major risk factor associated with Chromium Toxicity is exposure conditions.

  • Individuals are at higher risk if the working conditions include direct exposure to hexavalent chromium and its compounds
  • The general population may be at risk through inhalation of (chromium-contained) ambient air, and ingestion of contaminated (chromium-contained) food and/or water

It is imperative to mention that having a risk factor does not necessarily indicate that an individual will develop Chromium Toxicity. A risk factor increases the probabilities of ascertaining the condition relative to someone without those risk factors. Some risk factors are more significant than others. 

What are the Causes of Chromium Toxicity? (Etiology)

The cause of Chromium Toxicity is generally due to repeated exposure either through oral ingestion (acute) or skin contact and inhalation (which is mostly chronic).

  • Exposure may be caused by a variety of chromium compounds or environmental conditions
  • Once in the body, hexavalent chromium is absorbed into the bloodstream, and it gets accumulated in the body tissue

Note: Hexavalent chromium is absorbed more readily by the body than other forms of chromium (such as trivalent chromium).

What are the Signs and Symptoms of Chromium Toxicity?

The signs and symptoms of Chromium Toxicity depend on whether the exposure occurred through oral ingestion, chronic inhalation, or skin contact.

Common signs and symptoms of Chromium Toxicity ingested orally include:

  • Severe gastrointestinal irritation or ulcers
  • Nausea, vomiting, and diarrhea
  • Fever
  • Vertigo
  • Cramping of muscles
  • Intravascular hemolysis
  • Circulatory collapse
  • Liver damage

Common signs and symptoms of Chromium Toxicity due to chronic inhalation or skin contact include: 

  • Eczematous dermatitis: A skin condition causing itchy skin rashes
  • Edema (fluid accumulation in the body)
  • Nasal ulcers
  • Rhinitis and sinusitis
  • Keratitis (inflammation of the cornea)
  • Gingivitis and periodontitis - conditions affecting the teeth and gums
  • Lesions “chrome holes” in the fingers, knuckles, and forearms
  • Bronchitis: Inflammation of the airways causing cough and mucus production
  • Skin sensitization

How is Chromium Toxicity Diagnosed?

A diagnosis of Chromium Toxicity may involve:

  • Complete blood count
  • Liver function tests
  • Blood urea nitrogen (BUN) test
  • Creatinine test
  • Urinalysis test for chromium levels, β2-microglobulins levels, and blood or serum chromium levels
  • For possible inhalation of hexavalent chromium, a chest radiograph and pulmonary function test may be performed, to detect toxicity

Various clinical conditions and diseases can share certain signs and symptoms. It is critical to note that one’s healthcare provider may perform additional tests in order to further narrow down the diagnosis more definitively. 

What are the possible Complications of Chromium Toxicity?

The complications of Chromium Toxicity could include:

  • Skin sensitization through chronic skin exposure resulting in skin abnormalities
  • Gastrointestinal complications including diarrhea and vomiting with blood
  • Electrolyte imbalances can result in severe damage to vital organs
  • Increased blood and tissue acidity (metabolic acidosis) can cause vital organs to fail
  • Cancers of the liver and kidney
  • Lung and respiratory tract cancer
  • Diseases of the kidneys: Toxic nephritis, renal failure (usually from oral ingestion)
  • Dysfunction of the heart causing heart failure
  • Inadequate blood supply to the tissues, leading to shock

Coma and death can take place from oral ingestion of chromium.

How is Chromium Toxicity Treated?

The treatment for Chromium Toxicity is determined based on the severity of the symptoms and the mode of toxic exposure. Generally, there is no specific treatment for a chronic exposure. The most important treatment measure is removing the individual from the source of exposure.

  • For exposure through skin contact, the following treatment measures may be employed:
    • Removal from the toxic source of exposure
    • Flushing of the eyes with water, if the eyes or skin are acutely exposed
    • Antibiotic creams to avoid secondary infections in skin ulcers
  • For exposure due to oral ingestion, the following treatment measures may be employed:
    • Fluids and electrolytes may be administered to maintain electrolyte balance
    • Generally, the ingested chromium is passed out through bowel movement or urine and toxicity clearance achieved
  • For exposure through inhalation, the following treatment measures may be employed:
    • The primary goal is to remove the affected individual from the source of exposure
    • If the lungs are damaged, then breathing assistance (or oxygen) is provided
  • Any underlying complication may have to be treated on a case-by-case basis
  • Cancer treatment options, either surgical removal or radiation therapy, may be advised for those who have developed cancers (due to chronic exposure)

How can Chromium Toxicity be Prevented?

Chromium Toxicity can be prevented by eliminating exposure to sources of hexavalent chromium. The following points may be considered towards preventing poisoning by chromium compounds. 

  • Wearing personal protective equipment (PPE) is useful in protecting the lungs, eyes, mucous membranes, and skin
  • While in industry, maintain a clean work area that is dust-free
  • Regularly shower and change clothes after industrial work
  • Avoid bringing home contaminated clothes from the work site
  • Avoid eating, drinking, or smoking at the work site
  • Practice proper hand hygiene by washing hands with soap frequently
  • Ensure that industrial safety regulations for heavy metal exposure is adhered to at workplaces

What is the Prognosis of Chromium Toxicity? (Outcomes/Resolutions)

  • The prognosis for Chromium Toxicity is dependent on when the individual is removed from the potential source of toxic chromium compounds. The sooner the individual is removed, the better is the prognosis
  • The prognosis is also dependent upon the amount of chromium one is exposed to. Individuals who are exposed to large amounts of toxic chromium orally or through inhalation for longer durations have worse prognosis
  • The prognosis for lung cancer (or other cancer types) due to Chromium Toxicity depends on the stage of the cancer. If the risk for lung cancer is high, then the affected individual should be screened regularly after removal from the exposure site
  • With prompt diagnosis and treatment, individuals who have been acutely exposed to chromium compounds generally have good prognosis. In many cases of acute exposure, the body gets rid of the toxic substances through urine and through feces. Hence, adequate hydration is very crucial

Additional and Relevant Useful Information for Chromium Toxicity:

  • Research has shown that topical ascorbic acid might be effective in managing chromium-associated dermatitis
  • It has been suggested that activated charcoal might play a beneficial role in treating Chromium Toxicity
  • Animal studies have reported that developmental effects of hexavalent chromium include decreased litter size, reduced sperm count, and degeneration of seminiferous tubules (present in the testis), which can lead to fertility issues
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Krish Tangella MD, MBA

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