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

Cadmium Toxicity
What Health Effects Are Associated With Acute High-Dose Cadmium Exposure?

Learning Objectives

Upon completion of this section, you will be able to

• describe the health effects of acute high-dose cadmium exposure.

Introduction

Adverse effects of excessive acute cadmium exposure may include

• “food poisoning” (ingestion only),
• bronchitis (inhalation only),
• chemical pneumonitis (inhalation only), and
• pulmonary edema (inhalation only), a condition which can initially resemble metal fume fever.

Respiratory Effects

Severe, often fatal, pulmonary disease can result from brief inhalation exposure to high concentrations of cadmium compounds; however, such exposures are now very unusual.

These types of exposures can occur in occupational settings such as:

• cadmium alloy production,
• welding involving cadmium coated steel, and
• cadmium smelting and refining (Newman-Taylor 1998).

Onset of symptoms is usually delayed for 4 to 10 hours. Initial symptoms resemble the onset of a flu-like illness- chills, fever, and myalgias. Later symptoms include chest pain, cough, and dyspnea (Newman-Taylor 1998). Bronchospasm and hemoptysis may also occur. Histiologic findings in the lungs after such exposures include

• hyperemia of the trachea and bronchi,
• pulmonary edema,
• intra-alveolar hemorrhage,
• fibroblastic proliferation,
• hyperplasia of alveolar lining cells, and
• thrombosis of small blood vessels.

Differential Diagnosis

The symptoms of acute cadmium inhalation can initially resemble classic metal fume fever, a self-limited condition associated with fever, chills and possible decreases in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Although initially indistinguishable from cadmium poisoning, metal fume fever is a separate and relatively benign disorder that generally resolves within 48 hours. In contrast, patients who have more intense exposure to cadmium and do not improve after one to two days may progress in eight hours to seven days to acute chemical pneumonitis and pulmonary edema. This can result in prolonged recovery, permanent lung damage, or death (ATSDR 1999).

Gastrointestinal Effects

Cadmium ingested in high doses irritates the gastric epithelium. The most common way that acute poisoning via cadmium ingestion occurs is consumption of acidic food or beverages improperly stored in containers with a cadmium glaze (Lewis 1997). The symptoms of severe cadmium ingestion are

• nausea,
• vomiting,
• abdominal cramps and pain,
• diarrhea, and
• tenesmus (ATSDR 1999; Drebler et al. 2002).

Recovery can occur from an acute episode of poisoning with no side effects. Given a sufficient dose however, hemorrhagic gastroenteritis, liver and kidney necrosis, cardiomyopathy, and metabolic acidosis can occur (Newman-Taylor 1998).

Key Points

• Acute inhalation of cadmium may cause symptoms similar to those of metal fume fever.
• Acute oral ingestion results in severe gastroenteritis.

Progress Check