What
Physicians Need to Know About Occupational Cadmium Exposure
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David
Valiante
NJ Dept. of Health and Senior
Services
The Occupational
Health Service of the New Jersey Department of Health is involved in surveillance
of workers exposed to cadmium. The surveillance program involves collection
of data from clinical laboratories and hospitals and identification of
workplaces using cadmium. Follow-up is done with reported individuals,
their physicians, unions, and employers.
(609) 984-1863
A detailed guide
for physicians and other health care providers entitled Medical Surveillance
Guidelines for Workers Exposed to Cadmium is available at no cost.
US Department of
Labor, Occupational Safety and Health Administration (OSHA)
(202) 219-4667
(Publications office)
Copies of the Cadmium
Standard (Federal Register,September 14, 1992)
and publication 3136 Occupational Exposure to Cadmium are available
at no cost from OSHA.
Enforcement of the
Cadmium Standard is performed by OSHA Area Offices. In New Jersey
these are:Avenel (908) 750-3270, Parsippany (201) 263-1003, Hasbrouch
Heights (201) 228-1700, and Marlton (609) 757-5181.
US Department of
Health and Human Services, Public Health Service,Agency for Toxic Substances
and Disease Registry
(ATSDR).
(404) 639-6204
ATSDR publishes
a series of Case Studies in Environmental Medicine, including one
on Cadmium Toxicity (#10). Continuing education credit is available
to health professionals who use these monographs and complete the post
test.
Quebec Toxicology
Center, Interlaboratory Comparison Program.
(418) 654-2254
An Interlaboratory
comparison program for toxic substances in human biological fluids, including
an OSHA Cadmium Proficiency Testing Program, is operated by the
Quebec Toxicology Center (QTC). A list of proficient laboratories is available
from QTC upon request.
The Occupational
Safety and Health Administration (OSHA)of the U.S. Department of Labor
has promulgated a new OSHA Cadmium Standard.
As a physician you have primary responsibility for evaluating cadmium
toxicity if you are involved in a medical surveillance of workers currently
or previously exposed on the job to cadmium.
For More
Information Contact:
The
Cadmium Project
Occupational Health Service
(609) 984-1863
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- Refining and smelting
- Electroplating
using cadmium
- Making nickel-cadmium
batteries
- Welding, burning,
torch-cutting, grinding, or abrasive blasting surfaces that are either
coated with cadmium plating or paint containing cadmium
- Soldering with
silver solder or brazing (for hobbies too!)
- Making or using
cadmium pigments for coloring plastics, ceramic glazes, paints,
and enamels.
- Making or using
cadmium stabilizers, catalysts, or phosphors
- Cleaning up or
working with hazardous wastes such as flash
- Wrecking and demolition
where cadmium is present
- Making or using
colored decals containing cadmium
- Recycling cable
coated with plastic containing cadmium
What are the health implications
of cadmium exposure?
Adverse effects of
excessive cadmium exposure may include:
Acute
Effects
Exposure to high air
levels may result in delayed (4-10hours)pneumonitis, and/or pulmonary edema.
Chronic
Effects
The principal target
organ is the kidney. Toxic effects, generally seen after 6-10 years exposure,
may include:
- proximal tubular
dysfunction, with excretion of low molecular weight proteins;
- Fanconi syndrome
(amino aciduria, glycosuria, phosphaturia, renal tubular acidosis);
- hypercalciuria
with nephrolithiasis;
- renal insufficiency;
- osteomalacia.
Reported pulmonary
effects include emphysema and pulmonary fibrosis.
Epidemioligic data
suggests an excess risk of prostatic and respiratory cancers in exposed
workers.
What is
the treatment of cadmium intoxication?
Acute effects: supportive therapy
Chronic effects:Removal
from exposure usually halts
disease progression.
Chelation is not recommended.
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- Familiarity with
the OSHA Standard and its Appendices
A, D, and F;
- Familiarity with
employees' duties, exposures, personal
protective equipment, previous medical results;
- Administration
of required medical examinations and biological monitoring tests. Frequency
of testing depends upon results;
- Completion of
a written medical opinion concerning employees' risk from further cadmium
exposure and whether individuals should be removed from exposure;
- Provision of
results to employees; and
- Selection of
a proficient laboratory to analyze biological
monitoring samples.
- MEDICAL AND
WORK HISTORY,
including use of potentially nephrotoxic drugs;
- SMOKING HISTORY
- PHYSICAL EXAMINATION
with emphasis blood pressure, lungs and urinary system, and prostate
palpitation for males over 40;
- BIOLOGICAL
MONITORING, including:
- cadmium in
urine (CdU), cadmium in blood (CdB), beta-2-microglobulin in urine
(B2-M).
- blood urea
nitrogen , complete blood count, serum creatinite
- urine albumin,
glucose, proteins;
- CHEST X-RAY;
and
- PULMONARY FUNCTION
TESTS.
Under the OSHA Cadmium
Standard, an employee is assigned a category A if monitoring results for
all three markers fall at or below those shown in the chart below; B if
any fall within the
range shown; and C if any fall above the levels shown. Biological monitoring
and medical examinations become more frequent with each higher category.
Medical removal is discretionary for category B and mandatory for category
C.
Biological
Marker Monitoring
Result Categories |
|
A |
B |
C |
Cadmium
in urine (CdU) (ug/g creatinine)
B2-microglobulin (B2-M) (ug/g creatinine)
Cadmium in blood (CdB) (ug/liter whole blood) |
<3
<300
<5
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>3 &<15
>300 &
<1500
>5 &
<15
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>15
>1500
>15
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Employers must control
employees' exposure to cadmium to safe levels through he use of:
- Regulated areas
- Engineering controls
- Work practices
- Protective clothing
- Showers, locker
rooms, lunch rooms
- Exposure monitoring
- Employer information
and training
- Recordkeeping
- Emergency and
compliance plans
- Good housekeeping
This paper appears in the eLCOSH website with the permission of the author
and/or copyright holder and may not be reproduced without their consent.
eLCOSH is an information clearinghouse. eLCOSH and its sponsors are not
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