Cadmium

Epidemiology

  • Cadmium is a widespread environmental heavy metal contaminant
    • Present in cigarette smoke and food (from contaminated soil and water), as well as in industrial sources

Exposure via Cadmium Fume Inhalation

  • Welding: cadmium usually originates from the welding rod
  • Brazing (high-temperature soldering): cadmium usually originates from the brazing solder
  • Flame-Cutting Metal: cadmium usually originates from a metal coating
  • Molten Metal Working: with inadequate ventilation
    • Common with silver-working

Exposure via GI Cadmium Ingestion

  • Ingestion of Contaminated Food: originating from contaminated soil and water

Clinical Presentations

Cadmium Fume Inhalation

  • Epidemiology
    • Not considered a type of metal fume fever
  • Physiology
    • High-intensity inhalation of cadmium fumes -> exposure is common since cadmium fume is not acutely irritating
      • Usually associated with poor ventilation
    • Inhibition of enzymatic and pneumocyte functions
  • Clinical: onset of symptoms usually 12-24 hrs after exposure
    • Acute Pneumonitis (see Pneumonia, [[Pneumonia]])
    • Fever: may be present in some cases
    • Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])
  • Treatment
    • Chelation treatment is not effective

Cadmium Intoxication

  • Epidemiology
    • Cadmium exposure may play a more significant role in the development of CKD in the presence of co-existing diabetes or hypertension
  • Physiology
    • Renal toxicity is main end-organ toxicity: due to renal proximal tubular cadmium uptake by receptor-mediated endocytosis of filtered and metallothionein bound cadmium
    • Cadmium is released into the cytosol -> generation of reactive oxygen species and activation of cell death pathways
  • Diagnosis
    • Sublinical “Tubular Proteinuria”
  • Clinical

References

  • Biometals 2010 Oct;23(5):783-92. Epub 2010 Mar 31
  • Fatal chemical pneumonitis due to cadmium fumes. Occup. Mad. Vol. 46, No. 5, pp. 372-374,1996