Fluoride and Bromide Overview
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Questions and Answers

What is a common treatment method for acute mercury poisoning?

  • Corticosteroid therapy
  • Gastric lavage (correct)
  • Administration of activated charcoal
  • Oral hydration therapy

    • What is a symptom of chronic mercury poisoning related to the central nervous system?

  • Increased appetite
  • Personality changes (correct)
  • Improved coordination
  • Enhanced cognitive ability

    • How do mercurial diuretics function in the body?

  • They promote sodium and water reabsorption.
  • They enhance the secretion of potassium.
  • They inactivate specific renal tubule enzymes. (correct)
  • They stimulate the absorption of sodium ion.

    • Which agent is considered superior for chelating in chronic mercury poisoning?

    <p>N-acetyl- D,L- penicillamine</p> Signup and view all the answers

    Which of the following is a disadvantage of organic mercurial diuretics?

    <p>Poor absorption from the gastrointestinal tract</p> Signup and view all the answers

    What is one of the primary uses of fluoride in medicine?

    <p>Inhibition of dental cavity development</p> Signup and view all the answers

    How is lithium primarily excreted from the body?

    <p>Urine</p> Signup and view all the answers

    What therapeutic effect does bromide have when given in large doses?

    <p>Narcotic type effect</p> Signup and view all the answers

    What possible complication arises from the use of bromide?

    <p>Bromism</p> Signup and view all the answers

    What effect does sodium intake have on lithium accumulation in the body?

    <p>Accelerates lithium accumulation</p> Signup and view all the answers

    What is a known benefit of fluoride in relation to bone health?

    <p>Facilitates calcium deposition in hard tissues</p> Signup and view all the answers

    What treatment is recommended for bromism?

    <p>Administration of sodium chloride</p> Signup and view all the answers

    Which condition is lithium carbonate commonly used to treat?

    <p>Manic depressive disorder</p> Signup and view all the answers

    What is the primary mechanism by which lead can cause chronic lead poisoning?

    <p>Precipitation of proteins via sulfhydryl group binding</p> Signup and view all the answers

    Which treatment is typically used immediately after acute lead poisoning from oral ingestion?

    <p>Sodium or magnesium sulfate</p> Signup and view all the answers

    What body system is mainly affected by chronic lead poisoning in children?

    <p>Nervous system</p> Signup and view all the answers

    Which of the following chelating agents is used as a follow-up treatment for chronic lead poisoning?

    <p>Pencillamine</p> Signup and view all the answers

    Where does lead primarily accumulate in the body over time?

    <p>Bone, teeth, and hair</p> Signup and view all the answers

    What is the most serious symptom of lead poisoning?

    <p>Encephalopathy</p> Signup and view all the answers

    What type of mercury is considered relatively non-toxic?

    <p>Metallic mercury</p> Signup and view all the answers

    Which two organs primarily concentrate toxins when mercury is absorbed?

    <p>Kidneys and liver</p> Signup and view all the answers

    What is the usual dosage range for Aurothioglucose injection?

    <p>10 to 50 mg weekly</p> Signup and view all the answers

    Which of the following accurately describes the use of soluble aluminum compounds in the cosmetic industry?

    <p>Act as astringent and antiseptic in deodorants</p> Signup and view all the answers

    What condition can occur as a result of prolonged use of silver preparations?

    <p>Chronic argyria</p> Signup and view all the answers

    What is one of the toxic effects of barium cation when absorbed systemically?

    <p>Convulsions</p> Signup and view all the answers

    How is barium poisoning typically treated?

    <p>Oral sodium or magnesium sulfate to precipitate barium sulfate</p> Signup and view all the answers

    What role does the cardiovascular musculature play in the effects of barium cation toxicity?

    <p>Causes stimulation leading to hypertension</p> Signup and view all the answers

    What source is a major cause of lead poisoning today?

    <p>Industrial and automobile fumes</p> Signup and view all the answers

    What was a traditional use for lead salts in medicine?

    <p>Topical astringents</p> Signup and view all the answers

    What is the recommended dosing regimen for lithium carbonate in manic patients?

    <p>300 to 600 mg three times a day</p> Signup and view all the answers

    Which condition is a contraindication for the use of lithium carbonate?

    <p>Impaired renal function</p> Signup and view all the answers

    What potential endocrine effect can lithium carbonate have on a patient?

    <p>Myxoedema due to deficient thyroid function</p> Signup and view all the answers

    Why should lithium levels be monitored in patients on a salt-restricted diet?

    <p>Decreased sodium intake can lead to increased toxicity</p> Signup and view all the answers

    What is a primary therapeutic use of gold in medicine?

    <p>Management of rheumatoid arthritis</p> Signup and view all the answers

    What adverse effects can result from gold toxicity?

    <p>Skin, mucous membrane, joints, blood, kidney, liver, and nervous system issues</p> Signup and view all the answers

    How does gold compound therapy benefit treatment of rheumatoid arthritis?

    <p>It stabilizes lysosomal membranes, reducing enzymatic breakdown of joint tissues</p> Signup and view all the answers

    In which condition is gold contraindicated?

    <p>Disseminated lupus erythematosus</p> Signup and view all the answers

    What is the effect of fluoride on bones?

    <p>Facilitates calcium deposition in hard tissues</p> Signup and view all the answers

    What is a significant risk associated with the prolonged use of bromide?

    <p>Bromism</p> Signup and view all the answers

    How does sodium intake influence lithium levels in the body?

    <p>Accelerates lithium accumulation</p> Signup and view all the answers

    What is the primary method of excretion for bromide from the body?

    <p>Urine</p> Signup and view all the answers

    What effect does lithium have on the central nervous system?

    <p>Acts as a CNS depressant</p> Signup and view all the answers

    What can be used to treat bromism in patients?

    <p>Sodium chloride</p> Signup and view all the answers

    What notable feature of fluoride relates to its absorption?

    <p>Approximately 95% is absorbed</p> Signup and view all the answers

    What is a characteristic of the manic depressive reaction treated with lithium?

    <p>Fluctuations between extreme emotions and behaviors</p> Signup and view all the answers

    What is the primary rationale for discontinuing lithium carbonate treatment after 14 days?

    <p>If a satisfactory response is not obtained.</p> Signup and view all the answers

    Which of the following is a potential complication of long-term lithium carbonate use?

    <p>Diabetes insipidus.</p> Signup and view all the answers

    Which mechanism explains the action of gold in treating rheumatoid arthritis?

    <p>Stabilization of lysosomal membranes.</p> Signup and view all the answers

    What renal condition is a contraindication to the administration of gold compounds?

    <p>Chronic kidney disease.</p> Signup and view all the answers

    Which condition is characterized by the destruction of normal synovial membranes and joint fusion over time?

    <p>Rheumatoid arthritis.</p> Signup and view all the answers

    How does lithium toxicity typically correlate with sodium intake in patients?

    <p>Lithium toxicity increases with low sodium intake.</p> Signup and view all the answers

    Which of the following describes the effect of lithium on neurotransmitters during manic episodes?

    <p>It alters the metabolism of norepinephrine and serotonin.</p> Signup and view all the answers

    What is the primary mode of administration for therapeutic gold compounds?

    <p>Intramuscularly weekly.</p> Signup and view all the answers

    What is the potential side effect of using silver preparations over an extended period?

    <p>Argyria</p> Signup and view all the answers

    How is barium sulfate utilized in medical applications?

    <p>As a radiopaque agent in X-ray studies</p> Signup and view all the answers

    What is the mechanism of action of soluble aluminum compounds in cosmetics?

    <p>They act as astringents</p> Signup and view all the answers

    What is a significant risk associated with barium cation toxicity?

    <p>Cardiac arrest</p> Signup and view all the answers

    Which treatment is effective for removing the discoloration caused by silver preparations?

    <p>6% sodium thiosulfate and 1% potassium ferricyanide</p> Signup and view all the answers

    How does lead typically exhibit absorption and excretion characteristics?

    <p>Slowly absorbed and excreted reasonably well</p> Signup and view all the answers

    What is the adverse systemic effect associated with the use of barium chloride?

    <p>Cardiac stimulant leading to arrhythmias</p> Signup and view all the answers

    What is a significant effect of chronic mercury poisoning on neurological health?

    <p>Impaired cognitive function and personality changes</p> Signup and view all the answers

    Which of the following treatment options for acute mercury poisoning is aimed at reducing the mercuric cation to form a less soluble compound?

    <p>Sodium formaldehyde sulfoxylate</p> Signup and view all the answers

    Which compound is primarily responsible for the discoloration known as argyria?

    <p>Silver sulfide (Ag2S)</p> Signup and view all the answers

    Which treatment approach is generally considered less effective for chronic mercury poisoning compared to a newer alternative?

    <p>Dimercaprol</p> Signup and view all the answers

    What primary function do mercurial salts serve when used as diuretics?

    <p>Preventing sodium ion reabsorption</p> Signup and view all the answers

    Which of the following is a critical aspect of managing chronic mercury poisoning?

    <p>Removing the source of mercury exposure</p> Signup and view all the answers

    What is the primary mechanism of action that leads to reversible lead anemia?

    <p>Inhibition of heme synthesis in immature red cells</p> Signup and view all the answers

    Which of the following is a method used to manage acute lead poisoning after ingestion?

    <p>Using sodium or magnesium sulfate to precipitate lead</p> Signup and view all the answers

    Which organ is initially affected by lead absorption in the body?

    <p>Erythrocytes and soft tissue</p> Signup and view all the answers

    What is considered the most severe consequence of lead poisoning in children?

    <p>Encephalopathy with a high fatality rate</p> Signup and view all the answers

    Which factor contributes to lead being considered non-toxic once deposited in the bone?

    <p>It remains immobile and inactive in the bone</p> Signup and view all the answers

    Which of the following does NOT cause toxicity similar to lead due to cysteine sulfhydryl group binding?

    <p>Sodium sulfate</p> Signup and view all the answers

    What is typically the first step in treating chronic lead poisoning?

    <p>Chelation therapy with Dimercaprol</p> Signup and view all the answers

    Which tissue does inorganic mercury primarily concentrate in once absorbed into the body?

    <p>Kidney</p> Signup and view all the answers

    Study Notes

    Fluoride

    • Fluorides are commonly used for their ability to prevent dental cavities.
    • About 95% of ingested fluoride is absorbed by the body, with the remainder excreted in feces.
    • Approximately 50% of ingested fluoride is excreted in the urine.
    • Sodium fluoride has a wide therapeutic index, indicating a large difference between effective and toxic doses.
    • Studies suggest fluoride may reduce the prevalence of osteoporosis.
    • Fluoride facilitates calcium deposition in hard tissues like teeth and bones, leading to higher levels of visible aortic calcification in low fluoride areas

    Bromide

    • Bromides were first used medicinally in 1853 for their epileptic effects.
    • Low doses of bromide (0.5-2 gm) cause central nervous system depression.
    • Higher doses (4-8 gm) suppress all reflexes and induce narcotic effects.
    • Bromides are helpful for epilepsy due to their ability to depress motor areas of the brain, an effect achieved with higher doses.
    • Bromides are rapidly absorbed and mainly excreted in urine.
    • Repeated bromide doses can lead to accumulation, displacing chloride ions with bromide ions.
    • Bromide use has ceased due to the risk of bromism (bromide poisoning).
    • Treatment for bromism involves administering sodium chloride (6 gm daily in divided doses) or ammonium chloride.

    Lithium

    • Lithium is easily absorbed from the intestines and accumulates in the body.
    • Lithium accumulation is influenced by sodium intake, with decreased sodium intake accelerating accumulation, and potentiating toxicity.
    • Treatment for lithium intoxication involves stopping lithium administration and increasing sodium intake.
    • Lithium acts as a central nervous system depressant and possesses diuretic properties.
    • Lithium salts have been used historically as central nervous system depressants.
    • Lithium urate, highly water soluble, has been used to assess uric acid's ability to enhance urea toxicity in guinea pigs.
    • Lithium carbonate is administered orally for treating manic depressive disorder.
    • Manic depressive reaction is characterized by extreme emotional and behavioral fluctuations, including hyperactivity, paranoia, and increased suicide risk.
    • Treatment with lithium carbonate includes phenothiazine tranquilizers and electroshock therapy.
    • Lithium carbonate is given orally in doses of 300-600 mg three times a day to manic patients; if no improvement occurs within 14 days, treatment should be discontinued.
    • Lithium carbonate is contraindicated in patients with impaired renal function.
    • Lithium can cause diabetes insipidus (increased urination without glucose in the urine), interfering with vasopressin action.
    • Since lithium toxicity increases with decreased sodium intake, close monitoring is necessary for patients on salt-restricted diets or diuretic medications.
    • Lithium's mechanism of action in manic episodes is linked to its effects on Na, K, Mg, and Ca balance, and its influence on neurotransmitter metabolism, particularly norepinephrine and serotonin.
    • Lithium carbonate can affect thyroid function, potentially leading to myxoedema (deficient thyroid function), reduced protein-bound iodine levels, and increased iodine uptake.
    • Lithium is associated with a reduction in atherosclerotic heart disease.

    Gold

    • Gold is used in the treatment of rheumatoid arthritis.
    • Therapeutic gold compounds are administered intramuscularly.
    • Oral administration of gold is poorly absorbed and irritating.
    • Gold rapidly enters the plasma and remains bound to albumin for several days, leading to weekly administration.
    • Gold toxicity affects the skin, mucous membranes, joints, blood, kidneys, liver, and nervous system.
    • Treatment of toxicity involves stopping gold administration, providing supportive care, and using dimercaprol as a chelating agent.
    • Rheumatoid arthritis is characterized by the continuous release of enzymes that break down normal synovial membranes, cartilage, muscle, and bone.
    • In advanced cases, cartilage destruction is complete, and fibrous tissue grows from the exposed bone ends.
    • Fibrous tissue can become calcified, leading to joint fusion.
    • Gold is used primarily for rheumatoid arthritis, where it stabilizes lysosomal membranes, reducing the enzymatic breakdown of joint tissues.
    • There is speculation that gold may only provide symptomatic relief.
    • Gold is used for non-disseminated lupus erythematosus but is contraindicated in disseminated lupus.
    • Gold should not be given to individuals with renal disease, previous history of infectious hepatitis, skin or blood disorders, diabetes, pregnancy, hypertension, or congestive heart failure.
    • Official gold compounds include aurothioglucose injection and gold sodium thiomalate injection.
    • Usual dosage ranges from 10 to 50 mg weekly.

    Aluminum

    • Soluble aluminum compounds possess astringent and antiseptic properties.
    • Several soluble aluminum salts are used by the cosmetic industry as deodorants due to their mild astringent action.
    • Insoluble aluminum compounds are mainly employed as non-systemic antacids.

    Silver

    • Silver is a protein precipitant.
    • The action of silver ions on tissues ranges from antiseptic, astringent, and irritant to corrosive as the concentration of free silver ions increases.
    • Silver products are used topically.
    • Long-term use of silver preparations can cause discoloration known as argyria.
    • Argyria manifests as a gray to cyanosis coloration, potentially due to silver sulfide (Ag2S) or silver ions resulting from silver reduction within tissues.
    • This tissue reduction is facilitated by light, as observed in photographic emulsions, leading to increased skin discoloration.
    • Treatment involves subcutaneous administration of 6% sodium thiosulfate and 1% potassium ferricyanide to remove the color.

    Barium

    • Barium cations are toxic systemically due to their muscle-stimulating action.
    • Stimulation of gastrointestinal musculature results in vomiting, severe colic, diarrhea, and hemorrhage.
    • Stimulation of cardiovascular musculature causes spasms of the arterioles, inducing hypertension and cardiac arrhythmias.
    • Respiratory failure, convulsions, and death from cardiac arrest are also possible.
    • Treatment for barium poisoning consists of oral administration of sodium or magnesium sulfate, followed by gastric lavage, to precipitate insoluble barium sulfate.
    • Sodium sulfate can also be administered intravenously.
    • Barium chloride has been used for complete heart block (heart beat stops) due to its potent stimulation of cardiac muscle; however, its low therapeutic index makes other treatments or procedures preferred.
    • Barium sulfate, a water-insoluble salt, is used as a radiopaque agent in X-ray studies of the gastrointestinal tract.
    • Electrocardiograms (ECG) are sometimes required for elderly patients and those with heart disease undergoing barium enemas.

    Lead

    • Currently, industrial and automobile fumes are the primary sources of lead poisoning.
    • Lead salts were previously used topically as astringents.
    • Oral lead is generally absorbed slowly and excreted effectively.
    • Inorganic lead cannot penetrate intact skin but can be absorbed through abraded skin.
    • Topical lead solutions used as astringents have the potential for systemic absorption.
    • Organic lead, like tetraethyl lead, readily penetrates skin.
    • Upon absorption, lead initially accumulates in erythrocytes and soft tissues, later concentrating in the kidneys. The liver also contains high levels of lead.
    • Over time, lead redistributes to bones, teeth, and hair.
    • Lead deposited in bones is considered nontoxic unless it is mobilized again.
    • Lead poisoning is thought to result from lead combining with protein sulfhydryl groups.
    • Chronic lead poisoning characteristically inhibits heme synthesis.
    • Interference with heme synthesis in immature red blood cells can lead to a reversible lead anemia.
    • Most serious lead poisoning symptoms involve encephalopathy, which is more common in children than adults, leading to brain damage with a fatality rate of about 25%.
    • About 40% of encephalopathy survivors experience mental retardation, EEG abnormalities, seizures, and optic atrophy.
    • Lead poisoning can also cause renal damage.
    • Treatment for chronic lead poisoning focuses on using chelating agents to remove accumulated lead from erythrocytes and soft tissues.
    • Dimercaprol and calcium disodium edetate are used initially, followed by pencillamine for ongoing treatment.
    • Acute poisoning from oral ingestion can be managed through:
    • Administering sodium or magnesium sulphate to precipitate the lead.
    • Following with gastric lavage.

    Mercury

    • Metallic mercury is relatively nontoxic; however, the mercurous Hg+ and mercuric Hg+2 cations are toxic, as is mercury vapor.
    • Poisoning from soluble inorganic mercury salts can be prevented by strict adherence to dosage schedules.
    • Organic mercury compounds (alkylated mercurials), particularly, are highly toxic and responsible for most reported mercury poisoning cases.
    • Mercury's toxic effects are similar to those of lead, resulting from its interaction with protein sulfhydryl groups.
    • Once absorbed, the mercuric cation primarily accumulates in the kidneys, with lower concentrations in the liver, blood, bone marrow, and other tissues.
    • Mercury is excreted through the kidneys and colon.
    • Acute poisoning typically occurs due to ingestion of soluble mercuric salts, leading to vomiting, diarrhea, diuresis (suppression of tubular reabsorption), and kidney damage.
    • Treatment of acute poisoning involves:
    • Gastric lavage.
    • Using a reducing agent like sodium formaldehyde sulfoxylate to transform the mercuric cation into a less soluble mercurous salt.
    • Utilizing chelating agents such as dimercaprol or pencillamine.
    • Chronic mercury poisoning can arise from industrial exposure, consumption of mercury-contaminated foods, and long-term exposure to topical mercurials.
    • Chronic mercury poisoning affects the central nervous system, causing behavioral and personality changes, tremors, insomnia, and ataxia.
    • Chronic mercury poisoning is more challenging to manage than acute poisoning and involves removing the mercury source, administering chelating agents, and providing symptomatic treatment.
    • N-acetyl-D,L-penicillamine has been recently proposed as a superior chelating agent than dimercaprol in chronic mercury poisoning.
    • Mercurial salts are used as:
    • Diuretics to eliminate excess body fluid caused by cardiac edema.
    • Antiseptics.
    • Parasiticides.
    • Fungicides.
    • It is proposed that mercurial diuretics interact with protein sulfhydryl groups, inactivating specific enzymes within the renal tubules. This inhibition prevents sodium ion reabsorption in the proximal tubule, inducing sodium and water diuresis.
    • Disadvantages of organic mercurial diuretics include their poor absorption from the gastrointestinal tract, necessitating parenteral administration.
    • Official mercury products include meralluride injection, sodium mercaptomerin injection, and chlormerodrin tablet, the only official mercurial diuretic administered orally.

    Fluoride

    • Fluoride has anticariogenic action (inhibits dental cavity development) and is needed for bones.
    • 95% of oral fluoride is absorbed, with the rest excreted in feces.
    • 50% of ingested fluoride is excreted in urine.
    • Sodium fluoride has a wide therapeutic index.
    • Fluoride may reduce osteoporosis prevalence
    • Fluoride facilitates calcium deposition in hard tissues such as teeth and bones, rather than soft tissues.

    Bromide

    • Bromides were previously used for their antiepileptic effects.
    • Small doses of bromide (0.5-2 gm) cause CNS depression.
    • Large doses (4-8 gm) depress all reflexes and cause narcotic effects.
    • Bromides' usefulness in epilepsy stemmed from their ability to depress motor areas of the brain, requiring large doses.
    • Bromides are rapidly absorbed and excreted mainly in urine.
    • Repeated doses accumulate, replacing chloride ions with bromide ions.
    • Bromides use has ceased due to the risk of bromism (bromide poisoning).
    • Bromism is treated with sodium chloride (6 gm daily in divided doses) or ammonium chloride.

    Lithium

    • Readily absorbed from the intestines and accumulates in the body.
    • Lithium accumulation is influenced by sodium intake (decreased sodium intake accelerates accumulation and increases toxicity).
    • Lithium intoxication is treated by withholding lithium and increasing sodium intake.
    • Lithium is a CNS depressant and has diuretic action.
    • Lithium salts have been used as CNS depressants.
    • Lithium urate (highly water-soluble) is used to determine if uric acid enhances urea toxicity in guinea pigs.
    • Lithium carbonate is administered orally to treat manic depressive disorder.
    • Manic depressive reaction involves emotional and behavioral extremes, characterized by hyperactivity, paranoia, and increased suicide risk.
    • Treatment for manic depressive disorder includes lithium carbonate, phenothiazine tranquilizers, and electroshock therapy.
    • Lithium carbonate is given orally in doses of 300 to 600 mg three times a day to manic patients. Treatment is discontinued if there is no satisfactory response within 14 days.
    • Lithium carbonate is contraindicated in patients with impaired renal function.
    • Lithium can cause diabetes insipidus (increased urination without glucosuria) by interfering with the action of vasopressin.
    • Lithium toxicity increases with decreased sodium intake; patients on salt-restricted diets or receiving diuretics require careful monitoring.
    • In manic episodes, lithium affects Na, K, Mg, and Ca balance. Its actions involve alterations in the metabolism of neurotransmitters, norepinephrine, and serotonin.
    • Lithium carbonate can affect thyroid function, causing myxoedema (deficient thyroid function), decreased protein-bound iodine level, and increased iodine uptake.
    • Lithium reduces atherosclerotic heart disease.

    Gold

    • Used to treat rheumatoid arthritis; administered intramuscularly as therapeutic compounds.
    • Poorly absorbed orally and is irritant.
    • Enters plasma rapidly, bound to albumin for several days, thus administered weekly.
    • Gold toxicity affects the skin, mucous membranes, joints, blood, kidney, liver, and nervous system.
    • Toxicity treatment includes: cessation of administration, supportive treatment, and dimercaprol.
    • Rheumatoid arthritis involves continual release of enzymes, breaking down synovial membranes, cartilage, muscle, and bone.
    • In advanced cases, cartilage is completely destroyed, allowing fibrous tissue to grow from exposed bone ends.
    • This fibrous tissue can become calcified, causing joint fusion.
    • Gold is primarily used to treat Rheumatoid arthritis.
    • Gold may stabilize lysosomal membranes, reducing enzymatic breakdown of joint tissues.
    • Gold may only provide symptomatic relief.
    • Gold is used for non-disseminated lupus erythematosus but is contraindicated in disseminated lupus.
    • Gold should not be administered to individuals with renal disease, a history of infectious hepatitis, skin or blood disorders, diabetes, pregnancy, hypertension, or congestive heart failure.
    • Official gold compounds include:
      • Aurothioglucose injection
      • Usual dosage range: 10 to 50 mg weekly

    Aluminum

    • Soluble aluminum compounds are astringent and antiseptic.
    • Several soluble aluminum salts are used in the cosmetic industry as deodorants due to their mild astringent action.
    • Insoluble aluminum compounds are primarily used as non-systemic antacids.

    Silver

    • Silver is a protein precipitant.
    • Silver ion's action on tissue ranges from antiseptic, astringent, and irritant to corrosive, depending on the concentration of free silver ion.
    • Silver products are used topically.
    • Prolonged use of silver preparations can cause discoloration called argyria.
    • The color ranges from gray to cyanosis. The pigment may be silver sulfide (Ag2S) or Ag ion metallic, resulting from silver reduction in tissues.
    • Reduction is facilitated by light, causing skin discoloration.
    • Treatment involves subcutaneous administration of 6% sodium thiosulfate and 1% potassium ferricyanide to remove the color.

    Barium

    • Barium cation is systemically toxic, stimulating muscle activity.
    • It stimulates gastrointestinal musculature, causing vomiting, severe colic, diarrhea, and hemorrhage.
    • CVS muscle stimulation leads to arteriole spasm, causing hypertension, cardiac arrhythmias, respiratory failure, convulsions, and death by cardiac arrest.
    • Treatment of barium poisoning involves precipitating insoluble barium sulfate by oral administration of sodium or magnesium sulfate, followed by gastric lavage.
    • Sodium sulfate can also be administered intravenously.
    • Barium chloride was used in complete heart block (heart beat stops) as a potent cardiac muscle stimulant, but other drugs and procedures are preferred due to its low therapeutic index.
    • Barium sulfate (water-insoluble salt) is used as a radiopaque in X-ray studies of the gastrointestinal tract (GIT).
    • ECGs are sometimes required for elderly patients and those with heart disease undergoing barium enemas.

    Lead

    • Industrial and automobile fumes are current sources of lead poisoning.
    • Lead salts were used topically as astringents.
    • Oral lead is generally slowly absorbed and excreted well.
    • Inorganic lead cannot pass through intact skin but is absorbed through abraded skin. Therefore, lead solutions used as astringents could be absorbed systemically. Organic lead, such as tetraethyl lead, penetrates skin rapidly.
    • Once absorbed, lead is initially found in erythrocytes and soft tissues. Later, kidneys contain the most lead, followed by the liver. Over time, redistribution occurs with lead accumulating in bone, teeth, and hair.
    • Lead deposited in bone is considered non-toxic until mobilized again.
    • Lead poisoning
      • Lead may act as a protein precipitant by combining with the cysteine sulfhydryl groups of proteins.
      • Chronic lead poisoning manifests itself by inhibiting heme synthesis.
      • Interference with heme synthesis in immature red cells can lead to reversible lead anemia.
      • The most serious symptom of lead poisoning is encephalopathy, more common in children than adults. It involves brain damage with a fatality rate of about 25%. About 40% of survivors experience mental retardation, EEG abnormalities, seizures, and optic atrophy.
      • Renal damage can also occur.
    • Lead poisoning treatment
      • Chronic lead poisoning treatment involves using chelating agents to remove accumulated lead from erythrocytes and soft tissues.
      • Dimercaprol and calcium disodium edetate are used initially, followed by pencillamine for follow-up treatment.
      • Acute poisoning from oral ingestion is treated by:
        • Administering sodium or magnesium sulfate to precipitate lead.
        • Following with gastric lavage.

    Mercury

    • Metallic mercury is relatively non-toxic as such. Mercurous Hg+ and mercuric Hg+2 cations are toxic, and mercury vapor is also toxic.
    • Poisoning by soluble inorganic mercury salts can be avoided by adhering to strict dosage schedules.
    • Organic mercurial compounds (alkylated mercurials) are highly toxic and responsible for most reported mercury poisoning cases.
    • Mercury's toxic effects are similar to those of lead due to its combination with protein sulfhydryl groups.
    • Once absorbed, the mercuric cation primarily concentrates in the kidney, with lower concentrations in the liver, blood, bone marrow, and other tissues.
    • Excreted by the kidney and colon.
    • Acute poisoning, usually caused by ingesting soluble mercuric salts, can result in vomiting and diarrhea. Diuresis (suppression of tubular reabsorption) and kidney damage may also occur.
    • Acute poisoning treatment
      • Gastric lavage.
      • Using a reducing agent like sodium formaldehyde sulfoxylate to reduce the mercuric cation, forming a less soluble mercurous salt.
      • Employing chelating agents such as dimercaprol or pencillamine.
    • Chronic mercury poisoning can occur from industrial exposure, consuming mercury-contaminated food, and prolonged exposure to topical mercuricals.
    • It affects the CNS, causing behavioral and personality changes, tremors, insomnia, and ataxia.
    • Chronic mercury poisoning is more difficult to treat than acute poisoning and involves removing the mercury source, administering chelating agents, and providing symptomatic treatment.
    • N-acetyl-D,L-penicillamine has been recommended as a superior chelating agent compared to dimercaprol in chronic mercury poisoning.
    • Mercurial salts are used as:
      • Diuretics to rid the body of excess fluid caused by cardiac edema.
      • Antiseptics.
      • Parasiticides.
      • Fungicides.
    • Mercurial diuretics are thought to inactivate specific enzymes in the renal tubules by reacting with protein sulfhydryl groups. This prevents sodium ion reabsorption in the proximal tubule, leading to sodium and water diuresis.
    • Disadvantages of organic mercurial diuretics:
      • Poor absorption from the GIT, requiring parenteral administration.
    • Official mercury products include:
      • Meralluride Injection
      • Sodium Mercaptomerin Injection
      • Chlormerodrin Tablet: The only official mercurial diuretic administered orally.

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