This module aims to cover the toxicology of the following common or important chemicals:
• Heavy Metals:
• Lead
• Arsenic
• Thallium
• Mercury
• Other heavy metals including bismuth, cadmium and copper
• Products of combustion
• Cyanide
• Carbon Monoxide
• Smoke Inhalation


• At the end of these modules, students should be able to:
  • Understand the epidemiology of poisoning by these agents.
  • Discuss the target organs and clinical effects of poisoning by these agents.
  • Describe the general management of poisonings by these agents.
  • Understand the issues with decontamination.
  • Understand the advantages and problems with the use of chelating agents.
  • In addition to specific objectives in each section

Reading Complete List

This list is a cumulative list of all the references in the above modules, the relevant references appear in each section

  1. Mudipalli A Lead hepatotoxicity & potential health effects.Indian J Med Res. 2007 Dec;126(6):518-27 (fulltext)
  2. Cunningham G.Lead--toxicology and assessment in general practice.Aust Fam Physician. 2007 Dec;36(12):1011-3 (fulltext)
  3. Riddell TJ, Solon O, Quimbo SA, Tan CM, Butrick E, Peabody JW.Elevated blood-lead levels among children living in the rural Philippines.Bull World Health Organ. 2007 Sep;85(9):674-80 (fulltext)
  4. Miranda ML, Kim D, Galeano MA, Paul CJ, Hull AP, Morgan SP. The relationship between early childhood blood lead levels and performance on end-of-grade tests.Environ Health Perspect. 2007 Aug;115(8):1242-7 (fulltext)
  5. Kosnett MJ, Wedeen RP, Rothenberg SJ, Hipkins KL, Materna BL, Schwartz BS, Hu H, Woolf A.Recommendations for medical management of adult lead exposure.Environ Health Perspect. 2007 Mar;115(3):463-71 (fulltext)
  6. Dona A, Dourakis S, Papadimitropoulos B, et al. Flour contamination as a source of lead intoxication. Clin Toxicol. 1999;37:109-12.
  7. Rojas-Marcos I, Gorriz M, Santafosta E, et al. Cerebellar oedema and sideroblastic anaemia. Lancet. 2002;360:2046.
  8. Campbell C, Osterhoudt KC. Prevention of childhood lead poisoning. Curr Opin Pediatr. 2000;12:428-37.
  9. Rogan WJ, Dietrich KN, Ware JH, et al. The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. N Eng J Med. 2001;344:1421-6.(fulltext)
  10. Rosen JF, Mushak P. Primary prevention of childhood lead poisoning – the only solution. N Eng J Med. 2001;344:1470-1.
  11. Kalia K, Flora SJ. Strategies for safe and effective therapeutic measures for chronic arsenic and lead poisoning. J Occup Health. 2005 Jan;47(1):1-21 (fulltext)
  12. Amster E, Tiwary A, Schenker MB.Case report: potential arsenic toxicosis secondary to herbal kelp supplement.
    Environ Health Perspect. 2007 Apr;115(4):606-8. (fulltext)
  13. Pi J, Yamauchi H, Sun G, Yoshida T, Aikawa H, Fujimoto W, Iso H, Cui R, Waalkes MP, Kumagai Y.Vascular dysfunction in patients with chronic arsenosis can be reversed by reduction of arsenic exposure.Environ Health Perspect. 2005 Mar;113(3):339-41.(fulltext)
  14. Isbister GK, Dawson AH, Whyte IM. Arsenic trioxide poisoning: a description of two acute overdoses. Hum Exp Toxicol 2004;23:359-364.
  15. Graeme KA, Pollack CV, Pollack CVJ. Heavy metal toxicity. Part I: arsenic and mercury. J Emerg Med. 1998;16:45-56.
  16. Wax PM, Thornton CA. Recovery from severe arsenic-induced peripheral neuropathy with 2,3-dimercapto-1-propanesulphonic acid. J Toxicol Clin Toxicol. 2000;38:777-80.
  17. Luong KV, Nguyen LT. Organic arsenic intoxication from bird's nest soup. Am J Med Sci. 1999;317:269-71.
  18. Brodkin E, Copes R, Mattman A, Kennedy J, Kling R, Yassi A.Lead and mercury exposures: interpretation and action. CMAJ. 2007 Jan 2;176(1):59-63. (fulltext)
  19. Baughman TA. Elemental mercury spills.Environ Health Perspect. 2006 Feb;114(2):147-52. (fulltext)
  20. Clarkson TW, Magos L, Myers GJ. The toxicology of mercury - current exposures and clinical manifestations. N Eng J Med. 2003;349:1731-1737. (fulltext)
  21. Nierenberg DW, Nordgren RE, Chang MB, et al. Delayed cerebellar disease and death after accidental exposure to dimethylmercury. N Eng J Med. 1998;338:1672-6.(fulltext)
  22. Khordi-Mood M, Reza A, Sarraf-Shirazi AR, Balali-Mood M. Urinary Mercury Excretion Following Amalgam Filling in Children. Clin Toxicol. 2001;39:701-705.
  23. Brent J. Toxicologists and the Assessment of Risk: The Problem with Mercury. Clin Toxicol. 2001;39:707-10.
  24. McFee RB, Caraccio TR. Intravenous mercury injection and ingestion: clinical manifestations and management. Clin Toxicol. 2001;39:733-8.
  25. Ho BS, Lin JL, Huang CC, Tsai YH, Lin MC. Mercury vapor inhalation from Chinese red (Cinnabar). Clin Toxicol. 2003;41:75-8.
  26. Atsmon J, Taliansky E, Landau M, Neufeld MY. Thallium poisoning in Israel. Am J Med Sci. 2000;320:327-30.
  27. Misra UK, Kalita J, Yadav RK, Ranjan P. Thallium poisoning: emphasis on early diagnosis and response to haemodialysis. Postgrad Med J. 2003;79:103-105.
  28. Clarkson TW.Metal toxicity in the central nervous system.Environ Health Perspect. 1987 Nov;75:59-64 (fulltext)
  29. Moore D, House I, Dixon A. Thallium poisoning. Diagnosis may be elusive but alopecia is the clue.BMJ. 1993 Jun 5;306(6891):1527-9 (fulltext) see also visual function in thallium (fulltext)
  30. Kelleher P, Pacheco K, Newman LS.Inorganic dust pneumonias: the metal-related parenchymal disorders.Environ Health Perspect. 2000 Aug;108 Suppl 4:685-96.(fulltext)
  31. Kaye P, Young H, O'Sullivan I.Metal fume fever: a case report and review of the literature.Emerg Med J. 2002 May;19(3):268-9.
  32. Satarug S, Moore MR.Adverse health effects of chronic exposure to low-level cadmium in foodstuffs and cigarette smoke. Environ Health Perspect. 2004 Jul;112(10):1099-103.(fulltext)
  33. O'Connor HJ, Dixon MF, Grant AC, Sooltan MA, Axon AT, Henry JA.Fatal accidental ingestion of Clinitest in adult.J R Soc Med. 1984 Nov;77(11):963-5.(fulltext)
  34. Takeda T, Yukioka T, Shimazaki S.Cupric sulfate intoxication with rhabdomyolysis, treated with chelating agents and blood purification.Intern Med. 2000 Mar;39(3):253-5.(fulltext)
  35. Erikson KM, Thompson K, Aschner J, Aschner M. Manganese neurotoxicity: a focus on the neonate.Pharmacol Ther. 2007 Feb;113(2):369-77 (fulltext)
  36. Cherian MA, Richmond I.Fatal methane and cyanide poisoning as a result of handling industrial fish: a case report and review of the literature. J Clin Pathol. 2000 Oct;53(10):794-5 (fulltext)
  37. Geller RJ, Barthold C, Saiers JA, Hall AH.Pediatric cyanide poisoning: causes, manifestations, management, and unmet needs. Pediatrics. 2006 Nov;118(5):2146-58. (fulltext)
  38. Baud FJ, Borron SW, Bavoux E, Astier A, Hoffman JR.Relation between plasma lactate and blood cyanide concentrations in acute cyanide poisoning.BMJ. 1996 (fulltext)
  39. Cummings TF. The treatment of cyanide poisoning. Occup Med (Lond). 2004;54:82-5.
  40. Sauer SW, Keim ME. Hydroxocobalamin: improved public health readiness for cyanide disasters.Ann Emerg Med. 2001 Jun;37:635-41.
  41. Mannaioni G, Vannacci A, Marzocca C, et al. Acute cyanide intoxication treated with a combination of hydroxycobalamin, sodium nitrite, and sodium thiosulfate. J Toxicol Clin Toxicol. 2002;40:181-3.
  42. Baud FJ, Borron SW, Mégarbane B, et al. Value of lactic acidosis in the assessment of the severity of acute cyanide poisoning. Crit Care Med 2002;30:2044-2050.
  43. Bhowmik D, Mathur R, Bhargava Y, et al. Chronic interstitial nephritis following parenteral copper sulfate poisoning. Ren Failure. 2001;23:731-735.
  44. Kilburn KH, McKinley KL. Persistent neurotoxicity from a battery fire: is cadmium the culprit? South Med J. 1996;89:693-8.
  45. Buge A, Supino-Viterbo V, Rancurel G, Pontes C. Epileptic phenomena in bismuth toxic encephalopathy. J Neurol Neurosurg Psychiatr. 1981;44:62-7.
  46. Barnhart S, Rosenstock L. Cadmium chemical pneumonitis. Chest. 1984;86:789-91.
  47. Merchant J, Webby R. Metal fume fever: A case report and literature review. Emerg Med. 2001;13:373-375.
  48. Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, Orme JF Jr, Thomas FO, Morris AH Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning N Engl J Med 347:1057, October 3, 2002 (fulltext) plus correspondence (fulltext)
  49. Yeoh MJ, Braitberg G. Carbon monoxide and cyanide poisoning in fire related deaths in Victoria, Australia. J Toxicol Clin Toxicol 2004;42:855-863.
  50. Scheinkestel CD, Bailey M, Myles PS, et al. Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial. MJA. 1999;170:203-210. (fulltext)
  51. Thom SR. Hyperbaric oxygen for acute carbon monoxide poisoning. N Eng J Med. 2002;347:1105-1106.
  52. Scheinkestel CD, Jones K, Myles PS, et al. Where to now with carbon monoxide poisoning? Emerg Med Australasia. 2004;16:151-154.
  53. Emerson G. The dilemma of carbon monoxide poisoning. Emerg Med Australasia. 2004;16:101-102.
  54. Weaver LK, Hopkins RO, Chan KJ, et al. Carbon Monoxide Research Group, LDS Hospital, Utah in reply to Scheinkestel et al. and Emerson: The role of hyperbaric oxygen in carbon monoxide poisoning. Emerg Med Australasia. 2004;16:394-399.
  55. Juurlink DN, Buckley NA, Stanbrook MB, et al. Hyperbaric oxygen for carbon monoxide poisoning. The Cochrane Database of Systematic Reviews. 2005, Issue 1. Art. No.: CD002041.pub2. DOI: 10.1002/14651858.CD002041.pub2.
  56. Langford RM, Armstrong RF.Algorithm for managing injury from smoke inhalation.BMJ. 1989 Oct 7;299(6704):902-5. (fulltext)
  57. Reske A, Bak Z, Samuelsson A, Morales O, et al. Computed tomography - a possible aid in the diagnosis of smoke inhalation injury? Acta Anaesthesiol Scand. 2005;49:257-60.
  58. Thompson JT, Molnar JA, Hines MH, et al. Successful management of adult smoke inhalation with extracorporeal membrane oxygenation. J Burn Care Rehabil. 2005;26:62-6.
  59. Park GY, Park JW, Jeong DH, Jeong SH. Prolonged airway and systemic inflammatory reactions after smoke inhalation. Chest. 2003;123:475-80.
  60. Hantson P, Butera R, Clemessy J, et al. Early complications and value of initial clinical and paraclinical observations in victims of smoke inhalation without burns. Chest. 1997;111:671-675.
  61. Murakami K, Traber DL.Pathophysiological basis of smoke inhalation injury.News Physiol Sci. 2003 Jun;18:125-9.(fulltext)
  62. American Burn Association. Inhalation injury: diagnosis. J Am Coll Surg 2003;196:307-12.