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

Chromium Toxicity
Treatment and Management

Acute Exposure

• No proven antidote is available for chromium poisoning.
• Acute poisonings are often fatal regardless of therapy.

Treatment in cases of acute, high-level chromium exposure is usually supportive and symptomatic. Supportive measures may include ventilatory support, cardiovascular support, and renal and hepatic function monitoring. When renal function is compromised, urine alkalinization and maintenance of adequate urine flow are important. Progression to anuria is associated with poor prognosis.

If the eyes and skin are directly exposed, flush with copious amounts of water. Topical ascorbic acid has been successfully used to prevent chromium dermatitis and dermal burns caused by dichromate. The ulcers heal in several weeks without specific treatment. Ethylenediaminetetraacetic acid (EDTA) ointment 10% might facilitate removal of chromate scabs.

Gastric lavage with magnesium hydroxide or another antacid might be useful in cases of chromium ingestion. Fluid and electrolyte balance is critical. The efficacy of activated charcoal has not been proven. Hemodialysis, exchange transfusions, or chelating agents such as dimercaprol or EDTA have not been shown to be effective in the treatment of human poisoning. Orally administered ascorbic acid was found to be protective in experimental animals and was reported beneficial in at least one patient after chromium ingestion; however, no clinical trials have been conducted to confirm the efficacy of this treatment. Induction of vomiting is contraindicated.

Chronic Exposure

• Treatment consists of removal of the patient from further chromium exposure, reliance on the body's naturally rapid clearance of the metal, and symptomatic management.

In most patients with chronic, low-dose exposure, no specific treatment is needed. The mainstay of management is removing the patient from further exposure and relying on the urinary and fecal clearance of the body burden. Although normal urinary excretion is quite rapid, forced diuresis has been used. Except in the lungs, only small amounts of chromium are retained several weeks after exposure has ceased. Dermatitis and liver and renal injury will not progress after removal from exposure, and, in most cases, the patient will recover. Weeping dermatitis can be treated with 1% aluminum acetate wet dressings, and chrome ulcers can be treated with topical ascorbic acid.

If the exposure has been lengthy (i.e., 2 years to 3 years), the increased risk of lung cancer should be discussed with the patient. Although no reliable tests are currently available to screen patients for lung cancer, the physician can intervene with advice and education in smoking cessation, exposure to other known pulmonary carcinogens, and general preventive health education. Annual chest radiographs might be advisable in carefully selected cases.

Challenge

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