Journal of the Chinese Medical Association
Volume 72, Issue 4 , Pages 219-221, April 2009

Acute Severe Chromium Poisoning After Dermal Exposure to Hexavalent Chromium

  • Chun-Chi Lin

      Affiliations

    • Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
  • ,
  • Ming-Ling Wu

      Affiliations

    • Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Medicine, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Ming-Ling Wu, Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.
  • ,
  • Chen-Chang Yang

      Affiliations

    • Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Environmental and Occupational Medicine, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
  • ,
  • Jiin Ger

      Affiliations

    • Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Medicine, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
  • ,
  • Wei-Jen Tsai

      Affiliations

    • Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Medicine, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
  • ,
  • Jou-Fang Deng

      Affiliations

    • Division of Clinical Toxicology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Medicine, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Received 23 May 2008; accepted 25 November 2008.

Article Outline

Severe acute chromium poisoning related to dermal involvement has rarely been reported in the literature. We report a case of acute severe chromium poisoning through skin exposure as a result of a chemical burn of 15% of the body surface area and multiple organ failure after short-term exposure. Medical interventions, including mechanical ventilation, continuous venovenous hemofiltration, and plasmapheresis were performed. In addition, a chelating agent, dimercapto-propane sulfonic acid, was infused intravenously, combined with intravenous N-acetylcysteine and ascorbic acid as adjuvant therapy. The patient was discharged on day 33 without long-term sequelae. The consequence of transdermal exposure of hexavalent chromium should not be overlooked.

Key Words:  acute renal failure , chromium poisoning , dermal exposure

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Barceloux DG . Chromium . J Toxicol Clin Toxicol . 1999;37:173–194
  2. Major RH . Studies on a case of chromic acid nephritis . Johns Hopkins Hosp Bull . 1922;33:56–61
  3. Terrill PJ , Gowar JP . Chromic acid burn: beware, be aggressive, be watchful . Br J Plast Surg . 1990;43:699–701
  4. Matey P , Allison KP , Sheehan TM , Gowar JP . Chromic acid burns: early aggressive excision is the best method to prevent systemic toxicity . J Burn Care Rehabil . 2000;21:241–245
  5. Wang XW , Davies JWL , Sirvent RLZ . Chromic acid burns and acute chromium poisoning . Burns . 1985;11:181–184
  6. Schiffl H , Weidmann P , Weiss M , Massry SG . Dialysis treatment of acute chromium intoxication and comparative efficacy of peritoneal versus hemodialysis in chromium removal . Mineral Electrolyte Metab . 1982;7:28–35
  7. Baranowska-Dutkiewicz B . Absorption of hexavalent chromium by skin in man . Arch Toxicol . 1981;47:47–50
  8. Laitung JK , Earley M . The role of surgery in chromic acid burn: our experience with two patients . Burns Incl Therm Inj . 1984;10:378–380
  9. Lindberg E , Vesterberg O . Urinary excretion of chromium in chromeplaters after discontinued exposure . Am J Ind Med . 1989;16:485
  10. Ellis EN , Brouhard BH , Lynch RE . Effects of hemodialysis and dimercaprol in acute dichromate poisoning . J Toxicol Clin Toxicol . 1982;19:249–258
  11. Meert KL , Ellis J , Aronow R . Acute ammonium dichromate poisoning . Ann Emerg Med . 1994;24:748–750
  12. Bradberry SM , Vale JA . Therapeutic review: is ascorbic acid of value in chromium poisoning and chromium dermatitis? . J Toxicol Clin Toxicol . 1999;37:195–200
  13. Hruby K , Donner A . 2,3-dimercapto-1-propanesulphonate in heavy metal poisoning . Med Toxicol Adverse Drug Exp . 1987;2:317–323
  14. Hantson P , Van Caenegem O , Decordier I , Haufroid V , Lison D . Hexavalent chromium ingestion: biological markers of nephrotoxicity and genotoxicity . Clin Toxicol . 2005;43:111–112

PII: S1726-4901(09)70059-0

doi:10.1016/S1726-4901(09)70059-0

Journal of the Chinese Medical Association
Volume 72, Issue 4 , Pages 219-221, April 2009