Which physical findings are characteristic of heavy metal toxicity?

Updated: Dec 31, 2020
  • Author: Adefris Adal, MD, MS; Chief Editor: Sage W Wiener, MD  more...
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The physical examination of patients with suspected metal toxicity should focus on the most commonly involved organ systems: the nervous, gastrointestinal, hematologic, [25]  renal, and integumentary systems. See the Table in Overview for common presentations of acute and chronic exposures to specific metals.

Nausea, persistent vomiting, diarrhea, and abdominal pain are the hallmark of most acute metal ingestions. Dehydration is common. Metal salts are generally corrosive.

Encephalopathy, cardiomyopathy, dysrhythmias, acute tubular necrosis, and metabolic acidosis are also commonly seen with acute, high-dose exposures to most metals.

Patients with chronic metal toxicity tend to have more prominent involvement of the central and peripheral nervous systems. However, encephalopathy and peripheral neuropathies may occur within a few hours to days of acute high-dose exposure.

A classic presentation of chronic metal exposure includes anemia, Mees lines (horizontal hypopigmented lines across all nails), and subtle neurologic findings. These findings should prompt suspicion of heavy metal toxicity in any patient regardless of chief complaint.

Because lead toxicity is relatively common, any combination of GI complaints, neurologic dysfunction, and anemia should prompt a search for lead toxicity.

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