What is Antimony Toxicity?
Antimony (Sb) is a type of metal that is similar to arsenic. This metal has been used since the ancient Chaldean civilization, as proven by artifacts uncovered during exploration. Asian and Middle Eastern cultures also used antimony in cosmetics, although it was replaced with lead due to its scarcity. Antimony was also used in medical treatments, being applied on the skin to treat skin conditions and diseases like herpes and leprosy, and even mental conditions like mania and epilepsy. It was also taken orally as a medication for fever, pneumonia, congestion, inflammation, and for sedation.
However, the use of antimony stopped after it was found to be toxic. Nowadays, it is mainly used in medicine to treat diseases caused by parasites, like leishmaniasis and schistosomiasis, and as part of treatments for substance misuse. In these cases, antimony works by inhibiting an enzyme that the parasite uses to protect itself.
Usually, forms of antimony that have combined with other substances, known as pentavalent antimony compounds, are used because they are generally safe, effective, and affordable. The purest form of antimony, which is called elemental antimony, doesn’t have many industrial uses because it is difficult to shape and is usually found mixed with other metals like copper, lead, and tin. However, compounds of antimony can be used for many other things, such as producing textiles, ceramics and pigments, making fireworks, and acting as a catalyst in chemical reactions.
Elemental antimony is hard to find as it quickly changes into antimony oxide or antimony trioxide. Antimony is often found in minerals, especially one called stibnite. It can form compounds in two states, either with three atoms (trivalent) or five atoms (pentavalent). It’s worth noting that antimony could be a public health concern because it is found in high levels in the soil around firing ranges and mines. Moreover, it can have harmful impacts if it finds its way into our water supply or commercial food products due to flaws in manufacturing processes or seeping from packaging materials.
Among all antimony compounds, the most toxic one is stibine, a foul-smelling colorless gas that is released when recharging lead storage batteries. Stibine can also be produced if you are using drain cleaners that contain sodium hydroxide and it comes into contact with antimony.
What Causes Antimony Toxicity?
You can be exposed to antimony, a kind of metal, and its harmful effects typically by breathing in dust particles or fumes that contain it. People who work in electronic waste recycling or smelting are at high risk of exposure; this is because antimony is often found in ore that also contains arsenic, so these workers are usually exposed to both.
Antimony is frequently found in the urine samples of people who work in refineries, chemical manufacturing, and battery manufacturing.
Exposure to stibine, a compound formed from antimony and hydrogen, is common during battery charging. Also, antimony is present in cigarette smoke, so smokers are more likely to experience its harmful effects. For this reason, people who maintain and clean drains are advised not to use cleaners that contain sodium hydroxide, because this substance can release hydrogen ions in situations where antimony is present and can be harmful.
Even if you’re not working with antimony, you can still be exposed to it if you live near sources of the metal. It can get into the air, soil, and vegetation, and then find its way into the food, water, or contaminated soil or dust that you ingest.
Antimony can also be harmful if you take certain medicinal compounds that contain it. These compounds are not commonly used in countries with abundant resources, so doctors there may be unfamiliar with how to correctly give and adjust doses. It’s worth noting though, overdosing on antimony is rare and typically happens due to a treatment that discourages people from consuming alcohol.
Risk Factors and Frequency for Antimony Toxicity
Antimony toxicity is uncommon and may not be reported or diagnosed frequently. A research conducted by the National Institute for Occupational Safety and Health from 1981 to 1983 suggests that over 486,000 workers were exposed to antimony and its compounds. However, details such as how frequently and for how long the workers were exposed, and the concentration of antimony, were not given. Battery workers, interestingly, had antimony levels in their urine that were 5 times higher than other workers. In China, people involved in electronic waste recycling showed highest levels of antimony in their hair.
No studies have compared the impact of antimony toxicity between children and adults. However, studies on rats indicate that antimony can be passed on from mother to child during pregnancy and through breastfeeding. When children were given a weight-based dose of meglumine antimoniate, a medication for the disease leishmaniasis, their antimony levels in the blood were significantly lower than adults. Additionally, children’s bodies got rid of antimony more quickly than adults.
Signs and Symptoms of Antimony Toxicity
If you think you may have been exposed to antimony, a type of chemical, it’s important for your doctor to know how it happened. This could include understanding how long you were exposed, the concentration of the exposure, whether there were multiple sources of exposure, and other diseases or health habits like kidney or liver disease, heart disease, HIV, or smoking. If a person purposely took this substance, it’s also important for the doctor to know, especially if the person intended to hurt themselves or someone else. Symptoms could include eye pain or irritation, skin rash, nose or throat irritation, nosebleeds, loss of appetite, nausea, vomiting, diarrhea, blood in vomit or stool, abdominal pain, breathing trouble, cough, chest pain, heartbeat irregularities, decreased urine, ringing in the ears, or dizziness.
Physical symptoms of antimony poisoning can vary. It may show up as skin irritation, resulting in spots or rashes, or potentially even an allergic reaction complete with hives, eczema or bumps under the skin. It might also cause wheezing or stomach upset, or a rash resembling a reaction to touching an allergenic plant. Some may also have inflammation in the nose and throat, or painful blood clots in veins of the legs. Some patients might experience eye trouble, including blurred vision or eye discomfort.
Additional symptoms could include tenderness in the belly. Some might notice a garlic-like breath smell, though this might also be a sign of arsenic exposure. In more serious cases, gastrointestinal bleeding might be present, as indicated by blood in the stool or vomit. Heart and lung issues may also be detected through listening to a patient’s heart and breathing sounds, signs of which might include changes in the heart’s rhythm or breathing rate, a shortage of oxygen or noisy breath sounds. If there’s liver damage, patients might experience yellowing of the skin or eyes, fluid buildup in the abdomen, or changes in mental state. Bleeding disorders might be identified through pale skin or eyes, small red or purple spots on the skin, larger patches of purple discoloration, or bleeding from the gums or nose. Signs of neurological issues could be nerve damage in the hands and feet, abnormal eye movements or dizzy spells.
- Eye pain or irritation
- Skin rash or irritation
- Nose or throat irritation
- Nosebleeds
- Loss of appetite
- Nausea
- Vomiting
- Diarrhea
- Blood in vomit or stool
- Abdominal pain
- Breathing trouble
- Cough
- Chest pain
- Heartbeat irregularities
- Decreased urine
- Garlic-like breath smell
- Signs of more serious cases may include bleeding in the gastrointestinal tract, heart and lung issues
- Symptoms of liver damage
- Hematological issues
- Signs of neurological issues
Testing for Antimony Toxicity
If your doctor suspects you might have antimony poisoning, you can expect a few different tests. The tests will look at your blood count, electrolyte levels, blood sugar, kidney performance, and will also include a urine test. If the poisoning is severe or recent, the focus will be on checking for dehydration and kidney injury. If the type of antimony you might have been exposed to can break down red blood cells (stibine exposure), your doctor will also check for bilirubin, an enzyme called lactate dehydrogenase and haptoglobin (a protein) in your blood. In this case, they might also identify your blood type and cross-match it to prepare for a possible blood transfusion.
In addition to lab tests, your doctor may get an electrocardiogram, a test that records the electrical activity of your heart to check for irregular heartbeats (known medically as QT interval prolongation or dysthymias). It is also recommended to constantly monitor your heart activity. If you are having difficulty breathing or other respiratory symptoms, your doctor may order a chest X-ray. Imaging of the abdomen may be done if you complain of symptoms related to the stomach and the intestinal tract. If antimony has caused a burn-like injury, your doctor might do an endoscopy (a tube with a tiny camera is passed down your throat to examine your digestive tract) especially if you are experiencing a high-pitched crowing noise when inhaling (stridor), extreme salivation (drooling), or vomiting. A CT scan may be ordered if there is a suspicion of cancer due to your exposure to antimony.
Tests to measure the exact level of antimony in your blood are not often done right away because most hospitals can’t do these tests in-house. Under normal circumstances, antimony level in a person’s blood who has not been exposed is less than 3 mcg/L. Your doctor might also collect your urine for 24 hours to measure its antimony content, where normal levels are less than 6.2 mcg/L.
Treatment Options for Antimony Toxicity
If you think you’ve been exposed to a dangerous substance called antimony, it’s crucial to seek medical attention immediately. Experts, such as medical toxicologists or poison control centers, can offer professional advice regarding next steps. If you’re found to have antimony toxicity, the initial treatment will be supportive care, which focuses on addressing your symptoms and protecting your body’s critical functions.
Doctors will first assess your breathing and mental state. If you’re having difficulty breathing, they might perform a procedure called intubation to keep your airways open. They may also anticipate significant fluid loss and give you isotonic crystalloid solutions – a type of fluid that helps hydrate your body. Depending on the severity of your exposure, you may also need blood products if your red blood cells start to break down.
It’s important to make sure your kidneys, urine output, electrolyte levels, and liver function are closely monitored to avoid further complications. If you are feeling nauseous, antiemetics, a type of medication, can help control this symptom.
If antimony exposure is confirmed, doctors will consider decontamination, which is removing the antimony from your body. If your skin was exposed, this involves washing it with soap and water. For swallowed antimony, a gastric lavage (stomach pump) could be performed. Activated charcoal may be used to help absorb antimony from your body. If your case is severe, doctors may also recommend whole bowel irrigation – a method of cleaning your digestive tract. If you are suspected to have gastrointestinal burns, a gastroenterologist will perform an esophagogastroduodenoscopy, a procedure to examine your digestive tract.
In cases where you inhale a highly toxic form of antimony called stibine, immediate removal from the exposure area is critical. Medical professionals may provide high-flow oxygen to help with recovery. Some studies have suggested the use of certain medications known as chelators that bind to the antimony and assist its removal from the body, but this isn’t commonly used due to insufficient data.
Overall, the management of antimony toxicity requires a team approach. This team may include primary care doctors and medical toxicologists. Other specialists, such as eye doctors, gastroenterologists, kidney disease doctors, blood specialists, lung and heart doctors, skin care doctors, cancer specialists, hormone specialists, and nerve doctors, may also get involved, based on which body systems are affected.
What else can Antimony Toxicity be?
If someone is feeling unwell after being exposed to harmful substances, doctors need to identify if toxic elements were consumed. This situation can be complicated since there are many toxic metals like antimony, whose symptoms can be similar to other heavy metal poisoning. These metals could include:
- Arsenic
- Aluminum
- Barium
- Bismuth
- Cadmium
- Chromium
- Cobalt
- Copper
- Gold
- Iron
- Lead
- Lithium
- Manganese
- Mercury
- Nickel
- Phosphorus
- Selenium
- Silver
- Thallium
- Tin
- and Zinc
In some cases, more than one metal could be causing health problems. To determine which toxic substances are in the body, the patient’s history is examined to understand how they might have been exposed. Tests on the patient’s serum (the liquid part of the blood), urine, or hair can also detect the metal levels in their body.
What to expect with Antimony Toxicity
The outlook for antimony toxicity, or poisoning from exposure to the chemical element called antimony, largely depends on the level of exposure and the symptoms shown. Studies have shown that there is an increase in deaths related to lung cancer in workers who have been exposed to antimony compounds.
Deaths could also occur in people experiencing massive hemolysis, which involves the breakdown of red blood cells; acute renal failure, where the kidneys suddenly stop working; acute respiratory failure, where the lungs can’t provide enough oxygen to the vital organs; and acute hepatic failure, which is a loss of liver function that happens rapidly.
Possible Complications When Diagnosed with Antimony Toxicity
Antimony toxicity can cause a lot of complications because it affects many different organs in the body. Some of the most dangerous complications include life-threatening irregular heart rhythms, extensive breaking down of red blood cells, sudden respiratory failure, sudden kidney failure, and sudden liver failure. Some patients have even died due to a widespread infection caused by inflammation of the pancreas, referred to as sepsis secondary to pancreatitis.
Antimony can also lead to permanent changes in vision, lung function, and brain function. Also, patients might deal with aftermath effects of cancers linked with exposure to antimony.
Common Complications:
- Life-threatening irregular heart rhythms
- Extensive breakdown of red blood cells
- Sudden respiratory failure
- Sudden kidney failure
- Sudden liver failure
- Widespread infection due to pancreas inflammation
- Permanent changes to vision
- Permanent changes to lung function
- Permanent changes to brain function
- Aftermath effects of cancers linked to antimony exposure
Preventing Antimony Toxicity
Several groups have established rules about how much exposure to antimony, a type of chemical element, is safe in workplaces. The Occupational Health and Safety Administration (OHSA), a government agency focused on safe and healthy working conditions, has determined that workers should not be exposed to more than 0.5 milligrams of antimony per cubic meter of air over the course of an 8-hour workday. Similarly, the National Institute for Occupational Safety and Health (NIOSH), another safety agency, agrees with the OHSA’s limit for antimony but also suggests that exposure to stibine, a compound of antimony, should not exceed 0.1 milligrams per cubic meter of air during a 10-hour workday.
Workplaces can take measures to keep their employees safe from exposure, such as clearly labeling containers that contain antimony and educating employees about potential risks. Air in the workplace should be constantly tested to check the levels of airborne antimony. Facilities with emergency showers and eye washers should be provided. Workers should take showers at the end of their shifts and avoid bringing clothes that could be contaminated home. Also, regular handwashing is highly recommended.
Employees should be advised to wear personal protective equipment (PPE) if there might be exposure over the 0.5 milligrams per cubic meter limit. This could include gloves, special clothing that antimony cannot penetrate, goggles that allow air to flow through, and breathing masks.
If someone is exposed to too much antimony, they should be quickly removed from the area where the exposure occurred. They should take off any clothes that could have been contaminated, remove any contact lenses, and rinse their eyes. People nearby should be prepared to start CPR or artificial respiration if needed. After immediate first aid, the exposed person should be quickly taken to a medical facility for further examination and treatment.
