| Metal | Clinical Features | Pathophysiology | Diagnosis | Treatment |
|---|---|---|---|---|
| Arsenic |
Acute: Nausea, vomiting, abdominal pain, Garlic‑like odor on breath, QT prolongation Chronic: Peripheral polyneuropathy, Hyperkeratosis, Mees lines (white bands across nails) |
Induction of oxidative stress in endothelial cells and disruption of ATP production | Arsenic studies in 24-hour urine collection | Dimercaprol, Succimer |
| Lead |
Neuro: Cognitive impairment, Encephalopathy, Peripheral neuropathy (e.g., wrist drop) GI: Colic, Purple-blue line on gums (Lead/Burton line) Heme: Anemia, Basophilic stippling Renal: Nephropathy |
Inhibition of delta-aminolevulinic acid dehydratase → disruption of heme synthesis | Blood Lead Level (BLL) | Dimercaprol, Edetate calcium disodium (EDTA), Succimer |
| Iron | Nausea, vomiting, diarrhea, GI bleeding (hematemesis), Renal/Liver failure | Free radical formation/lipid peroxidation → cell death | Serum iron concentration | GI decontamination, Deferoxamine |
| Mercury |
Elemental: Cough, dyspnea Chronic: Erethism, gingivostomatitis Inorganic: Hemorrhagic gastroenteritis, ATN Organic: Ataxia, tremor |
Irreversible inhibition of selenoenzymes | Blood mercury / 24hr urine (non-organic) | Dimercaprol, Succimer |
| Chromium | Contact dermatitis, Ulcerations of nasal septum, Welder's lung, Lung cancer | Hexavalent compounds → intracellular accumulation | Blood/Urine | Stop exposure |
| Gold | Hypersensitivity, Pruritus, Dermatitis, Metallic taste, Nephrotoxicity | Gold nanoparticles → oxidative damage | Clinical | Penicillamine, Dimercaprol, Stop therapy |
| Copper | Abdominal pain, Vomiting, Hemolysis, Liver/Renal failure | Catalyzes formation of reactive oxygen species | Blood/Urine | Penicillamine, Trientine |