Removal of Exposure Source
The first step in mitigating the toxic effects of acute or chronic metal exposure is removal of the source of contamination. For acute exposures, this may involve (depending on the route of exposure) decontaminating the area of exposure, removing contaminated clothing, and/or removing the individual from the area where exposure occurred (Flora 2010).
Gastrointestinal decontamination techniques may be indicated for acute metal toxicities, although studies on their efficacy for this purpose are lacking and few consensus guidelines exist for their use in acute metal toxicity treatment. Gastric lavage (introduction of water into the stomach by a tube to wash out its contents) has been used in arsenic and lead poisonings (Tallis 1989; Rusyniak 2010; ATSDR 2007b; Caravati 2008). Emesis (induced vomiting) has also been suggested for removing metals within the stomach; however, some caustic metal compounds (mercuric oxide) may cause further damage by induced vomiting (ATSDR 2001), and emesis is not always effective for removing large amounts of solids (Manoguerra 2005). Bowel irrigation (introduction of water into the bowel to wash out its contents) may be useful for macroscopic particles of some metals (such as lead) that can easily transit through the intestines; larger particles may require surgery for removal (Roberge 1992; Rusyniak 2010; ATSDR 2007b). Activated charcoal may be effective for binding some ingested toxic metals or metal compounds (arsenic, thallium) but is ineffective for others (iron and mercury) (Worth 1984; Bateman 1999; Rusyniak 2002; Hoffman 2003; Rusyniak 2010; Manoguerra 2005).
Chelators enhance the elimination of metals (both toxic and essential) from the body. Their use to ameliorate metal toxicity has been validated by several human case reports and animal models.
Spontaneous ignition of ethanol by manganese (VII) oxide.
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