What is Nickel Toxicology?
Nickel is a sturdy, shiny, and silver-looking metal that was discovered by Axel Fredrik Cronstedt in 1751. It has been used for over 1700 years to make metal mixtures, also known as alloys. This metal is naturally found in the soil and water. It’s also manufactured for industrial uses like coating other metals, making stainless steel, creating alloys, and rechargeable batteries because it’s resistant to rust.
It’s in the air we breathe, the groundwater we use, and the soil we walk on. The amount of nickel in these places can change due to things like the breakdown of rocks, weather conditions, and pollution from factories. We also take in nickel when we eat certain foods like cereals, chocolate, teas, and legumes, and drink water. It can even come from kitchen utensils and pipelines. But don’t worry, usual levels of nickel intake are not harmful because our bodies absorb very little of it. In fact, the U.S. Environmental Protection Agency doesn’t have any specific rules about nickel levels. Nickel doesn’t play a clear role in our bodies and there’s no required dietary amount for it.
However, taking a large amount of nickel at once can be harmful. This can happen through different routes, like medical injections, eating or drinking, breathing in, or through the skin. One particular form of nickel, known as nickel carbonyl, is especially harmful and can cause symptoms like irritation in the breathing tubes. This usually happens at workplaces where nickel is used a lot.
Regular exposure to nickel can also cause health issues over time, like sinusitis (inflammation of the sinuses), work-related asthma, and dermatitis (skin inflammation). Long-term exposure has also been linked to the development of lung and nose cancers.
What Causes Nickel Toxicology?
Nickel carbonyl, a colorless to yellowish liquid that can sometimes have a musty or sooty smell, is known to cause serious health problems from workplace exposures. This substance, which is hard to detect at harmful levels, was discovered by Ludwig Mond. He found it forms when nickel and carbon monoxide react together.
This reaction, known as the Mond process, is used to purify nickel so it can be added onto surfaces. However, nickel carbonyl can also be produced, and it’s harmful if breathed in or absorbed through the skin.
Nickel carbonyl is often used in industries, mainly as a catalyst – a substance that speeds up chemical reactions – in processes that involve plastics, petroleum, or steel plating.
Meanwhile, nickel is a common cause of skin irritation, known as contact dermatitis. It’s used in a range of everyday items, including household products, clothes, cosmetics, medical equipment, and jewelry. Nickel can react with sweat to produce nickel salts that can be absorbed by the skin, leading to an allergic reaction that can last indefinitely once it develops.
Risk Factors and Frequency for Nickel Toxicology
Although nickel is found in soil, water, and our diets, the highest risk of exposure comes from workplaces. Occupations that involve nickel refining, such as battery manufacturing, stainless steel making, welding, and petroleum refining, often carry this risk. There’s a lot of industrial use of nickel all over the United States, even though there’s only one active nickel mine in Michigan. There have been serious incidents of nickel poisoning in the past. For example, in 1953, two people at a Texas refinery died from inhaling nickel carbonyl.
In 1987, an event at a Canadian electroplating plant caused 20 employees to fall ill after drinking contaminated water from a fountain. Thankfully, there were no deaths and the symptoms such as nausea, vomiting, and abdominal pain disappeared within 3 days.
Nickel is also a common cause of contact dermatitis, particularly in developed countries. It’s present in many household items like jewelry, cosmetics, clothes, and cleaning products. About 10% of women show sensitivity to nickel, which is often linked with ear piercing.
Even dental materials and surgical implants contain nickel. Exposure to this could lead to the body developing a hypersensitivity reaction, resulting in a distinctive red, blistering, itchy rash. Usually, this rash stays around the exposure site but can spread around the body with continuous exposure or through implants.
Signs and Symptoms of Nickel Toxicology
Nickel poisoning should be suspected if someone is showing signs of lung, heart, or brain problems and has been exposed to nickel. These problems are mostly linked to workplace exposure, so it’s crucial to consider the person’s occupation. Symptoms like headaches, dizziness, difficulties breathing, and chest pain can occur. At first, the symptoms might be mild but they can get severely worse over time and result in mental confusion or the need for breathing assistance. Being exposed to a certain level of nickel carbonyl in the air (50 mg/m3) can cause these symptoms.
If someone accidentally eats or drinks something with nickel in it, they can experience nausea, vomiting, diarrhea, and stomach pain. If they’ve ingested between 0.5 and 2.5 grams of nickel, it could cause these symptoms. Nickel can sometimes be found in tap water from old or renovated pipes, so it’s important to know the age and condition of the person’s home.
Long-term exposure to nickel can cause stuffy nose, bronchitis, and asthma. It has also been known to increase risk of nose and lung cancer. Prolonged exposure can result in a skin rash mostly around the area that was in contact with nickel. The rash typically comes in the form of small red bumps that can be very itchy. Recent changes in piercings or jewelry should be noted as these could be nickel sources.
Testing for Nickel Toxicology
If your doctor is trying to determine if you have nickel toxicity, it’s a somewhat tricky process. This is mainly because testing tools are limited. To start, your doctor will ask about your history – things like where you live and work and whether you might have been exposed to metals – to get an idea of whether nickel might be the issue. Particular signs that could point to nickel toxicity include problems with your lungs or digestive system, if you’ve recently inhaled or swallowed something that might contain nickel.
Nickel can end up in various parts of the body, but the easiest and most reliable way to check for it is by looking at samples of your blood or urine. In your average person, blood tests show around 0.3 micrograms of nickel for every litre of blood. But if you’ve been in contact with a larger than normal amount of nickel – for example, through your job or environment – you might have as much as 8 micrograms per litre. When looking at your urine, more than 10 milligrams of nickel per litre could mean you’ve been exposed to too much nickel and that your doctor needs to look into it further.
Sometimes, doctors can spot signs of nickel exposure by running other tests, too. For example, an X-ray of your chest might show fluid buildup around the lungs, irregular shadowy lines, or a speckled pattern; these are hints that your lungs could be affected. And an electrocardiogram (ECG – a test that charts your heartbeat) could show an unusually fast heart rate and damage to the heart muscle – these are signs that your heart could be affected. Both of these could suggest nickel toxicity.
If your doctor thinks you might have a skin reaction (or dermatitis) to nickel, they might use a patch test to determine the cause. Here, diluted allergens are placed on your skin using adhesive patches, typically on your back, and kept there for 48 hours. After that time, the patches are removed and your skin is examined for any signs of an allergic reaction, like redness, swelling, or a particular type of rash.
One specific type of patch test is the dimethylglyoxime (DMG) spot test, which you can buy without a prescription. If you have an allergy to nickel, applying DMG to your skin will cause it to turn pink. Patch tests like these can help your doctor identify if you’re allergic to anything, suggest the best kind of treatment, and help you learn what things to avoid touching in the future.
Treatment Options for Nickel Toxicology
When someone experiences nickel toxicity, which means they’ve been overexposed to nickel, the first steps in treatment involve removing the person from the source of exposure and cleaning any nickel off their skin and clothes. If the exposure is causing symptoms like trouble breathing, doctors can provide treatments like bronchodilators (medicines that help open up the airways), supplemental oxygen to help the person breathe, and steroids to reduce inflammation.
In certain cases, where tests show high levels of nickel in a person’s urine, a treatment called diuresis may be used. Diuresis involves giving the person fluids, which helps their kidneys produce more urine to speed up the removal of nickel from their body. While there’s a process called hemodialysis that can also help remove certain substances from a person’s body, it doesn’t work for nickel since it binds tightly to proteins in the blood.
Some reports suggest that a treatment called chelation therapy might be helpful in cases of nickel toxicity. Chelation therapy involves giving the person a medication that can bind to the nickel in their body and help remove it. Diethyldithiocarbamate (or DDC) is considered a possible treatment for acute poisoning with a compound called nickel carbonyl. However, the use of DDC and other chelation therapies for nickel toxicity still requires further research.
If DDC isn’t available, a medication called disulfiram might be another option. The body metabolizes disulfiram into two molecules of DDC. A case report showed that a patient who developed pneumonitis (inflammation of the lungs) after exposure to nickel carbonyl responded well to treatment with disulfiram. It’s important to note, though, that this is based on a single case and more investigation is needed.
For a condition called nickel dermatitis, which is an itchy, inflamed skin reaction to contact with nickel, the focus of treatment is managing symptoms. This can involve using topical corticosteroids to reduce skin inflammation, as well as moisturizers to soothe the skin. Additionally, people can take preventive steps like avoiding objects containing nickel and applying protective creams or wearing gloves and other protective equipment to limit nickel exposure.
Overall, healthcare providers play a key role in teaching their patients about these treatment options and preventive measures to help improve their health and quality of life.
What else can Nickel Toxicology be?
If someone is suspected to have nickel toxicity, it can seem a lot like other conditions that affect the respiratory or digestive systems. This could be because they inhaled or swallowed something with nickel in it. It’s crucial to gather a detailed history from the patient. This information should include possible exposures to nickel, their job, any family history of related conditions, and when the symptoms began. Several possible diagnoses need to be considered:
- Bronchitis
- Pneumonitis
- Chronic obstructive pulmonary disease
- Pneumonia
- Pulmonary edema (fluid in the lungs)
- Pneumothorax (collapsed lung)
- Pulmonary embolism (blood clot in the lungs)
- Acute respiratory distress syndrome
- Medication overdose, for example from acetaminophen
- Viral or bacterial gastritis/gastroenteritis
- Crohn’s disease or ulcerative colitis
- Diverticulitis
- Cholecystitis (inflammation of the gallbladder)
- Gastroesophageal reflux disease
- Peptic ulcer disease
- A swallowed foreign body
What to expect with Nickel Toxicology
The effects of acute nickel exposure can vary greatly depending on the intensity and duration of the exposure. The reaction can range from limited and manageable with outpatient treatment to necessitating hospitalization and close monitoring.
In the case of exposure to a specific type of nickel called nickel carbonyl, symptoms can appear within an hour of exposure and get much worse within the next 48 hours. Over 1 to 2 weeks, conditions such as scarring of the lungs (pulmonary fibrosis), pneumonia-like symptoms (consolidation), and swelling of the brain (cerebral edema) can develop. Therefore, it’s important to keep an eye on these potential complications and provide suitable medical care and monitoring based on the severity and development of symptoms.
While some patients with acute nickel exposure can recover completely, others may experience long-term effects like neurasthenic syndrome, an old term often related to chronic fatigue. Consumption of nickel can sometimes result in fatalities, even in minimal cases like a young child.
The symptoms and progression of nickel toxicity depend on how much nickel was ingested. The more severe the symptoms and outcome usually indicate a higher exposure to nickel.
When it comes to skin exposure (dermal) to nickel, the allergic response can last a long time and is often lifelong. Once a person becomes allergic to nickel, future exposures – even to tiny amounts – can cause an allergic reaction. However, it’s crucial to note that the strength of the reaction can change depending on the frequency and duration of exposure. Prolonged breaks between exposures could potentially lead to a subdued allergic response, but the allergy to nickel usually persists.
Possible Complications When Diagnosed with Nickel Toxicology
If you breathe in nickel, you might experience symptoms like lung inflammation, heart inflammation, changes in mental state, and extreme weakness. These symptoms could persist for several months even after you’ve been checked and treated by a doctor. If you’re exposed to nickel in the air over a long period of time, you might develop serious conditions like cancer in your breathing passages, damage to your lungs called emphysema, and an unusual increase in a certain type of white blood cell in your lungs called eosinophils. These conditions would require additional treatment and monitoring.
In 1990, a cancer research organization called the International Agency for Research on Cancer (IARC) determined that all types of nickel, except for metallic nickel, can cause cancer in people.
Here’s a quick breakdown of the potential effects of nickel inhalation:
- Inflammation of the lungs (pneumonitis)
- Inflammation of the heart (myocarditis)
- Changes in mental state
- Profound weakness
- Long-term effects can lead to cancer in the respiratory tract
- Damage to the lungs (emphysema)
- An increase in a certain type of white blood cell in the lungs (pulmonary eosinophilia)
Preventing Nickel Toxicology
Nickel is a common material that we come into contact with regularly in our environment. When people get skin irritation or rashes due to constant exposure to nickel, this condition is known as contact dermatitis. The main way to deal with this issue is to remove whatever is causing the nickel contact, like jewellery or coins. Applying creams that reduce inflammation and help to moisturize and soothe the skin can also help to alleviate symptoms and aid skin recovery.
People who work with nickel, like in a factory or a lab, should take special care as nickel carbonyl, a type of nickel, can be extremely harmful. This substance can dissolve in the lungs, which could lead to health problems that affect the whole body. Therefore, understanding the working environments and identifying possible sources of nickel exposure is crucial for prevention. It’s important to address these issues for a safer workspace and to minimize the risk of health problems related to nickel.
If someone suspects that they’ve swallowed nickel or inhaled it, they should immediately call 911 to be taken to the nearest hospital. Quick medical help is needed to evaluate and manage any potential harm caused by nickel.
If a workplace might be exposing workers to nickel, reaching out to the Occupational Safety and Health Administration (OSHA) could be of great help. OSHA specializes in assessing and investigating workplace risks, ensuring safety at work, and setting up preventive measures.
The Poison Control Center is also a great resource if one has any concerns about contact with nickel. This center is open 24/7, and its trained staff can provide guidance, coordinate efforts, and share information to assist with issues related to exposure to nickel.
