Agency for Toxic Substances and Disease Registry
Case Studies in Environmental Medicine (CSEM) 

Cadmium Toxicity
How Should Patients Exposed to Cadmium Be Treated and Managed?

Learning Objectives

Upon completion of this section, you will be able to

• describe how patients with cadmium related diseases should be treated and
• describe how patients with cadmium related diseases should be managed.

Introduction

One exposed person often signals potential or actual exposure of others with the possibility of a common exposure source. Such sources include

• the workplace,
• the drinking water supply,
• community irrigation, and
• proximity to a smelter.

Public health authorities should be notified whenever cadmium toxicity is suspected so that case-finding may be initiated and preventive measures taken.

Treatment of the Acute High-dose Exposure

The mainstay of management for most inhalation exposure victims is supportive treatment including

• fluid replacement,
• supplemental oxygen, and
• mechanical ventilation.

In cases of ingestion, gastric decontamination by emesis or gastric lavage may be beneficial soon after exposure. Administration of activated charcoal has not been proven effective.

Treatment and Management of the Chronically Exposed

For chronic poisoning victims, the most important intervention is prevention of further exposure.

Preventive measures in the workplace include

• improving ventilation by opening windows,
• installing or running an exhaust fan or a mechanical ventilation system, and
• wearing proper personal protective equipment such as respiratory protection, protective clothing, eye protection, and gloves.

Important hygiene preventive measures that are the first line of defense include

• maintaining a clean work area free of dust,
• showering and changing clothes immediately on completion of work in the jewelry area,
• disposing of the contaminated clothing at the work site,
• not tracking dust from the work area to the rest of the home,
• not smoking in the work area,
• no eating or drinking in the work area, and
• washing hands well before smoking, eating, or drinking after work or during breaks.

In addition, patient and worker education is vital in encouraging preventive behavior and in assisting early detection of cadmium toxicity. Respiratory protection should be worn in occupational or hobby settings where airborne concentrations may exceed allowable limits. Smoking, eating, and drinking in the work area should be discouraged.

Monitoring for Cadmium-Exposed Workers

OSHA requires a program of medical examination and biological monitoring for workers exposed to cadmium for 30 or more days a year at levels of 2.5 µg/m³ in air or greater. The purpose of this program is to prevent cadmium induced disease.

OSHA required medical monitoring includes

• medical and work history,
• examination of respiratory and urinary system,
• blood pressure measurement,
• chest X-ray,
• spirometry, and
• prostate exam if over 40 years of age.

Increased medical monitoring and exposure review is required if urine cadmium is greater then 3µg/gm creatinine, or whole blood cadmium if greater than 5µg/l or urine β2 microglobulin is greater than 300µg/gm creatinine. Removal from exposure is required if the urine cadmium is greater than 15 µg/gm creatinine or whole blood cadmium is greater than 15 µg/l or urine β2 microglobulin than 1,500 µg/gm creatinine. A full description of required monitoring and actions required at different cadmium levels can be found at OSHA Standards - Cadmium (www.osha.gov/SLTC/cadmium/standards.html).

Key Points

• There is no specific antidote for acute cadmium poisoning.
• Prevention of further exposure is the most important step in management of patients with symptoms suggestive of chronic cadmium intoxication.

Progress Check