Agency for Toxic Substances and Disease Registry 
Case Studies in Environmental Medicine (CSEM) 
Chromium Toxicity
How to Use This Course

Introduction

The goal of Case Studies in Environmental Medicine (CSEM) is to increase the primary care provider's knowledge of hazardous substances in the environment and to help in evaluation and treating of potentially exposed patients. This CSEM focuses on chromium toxicity.

Available Versions

Two versions of the Chromium Toxicity CSEM are available.

• The HTML version www.atsdr.cdc.gov/csem/chromium/ provides content through the Internet.
• The downloadable PDF version provides content in an electronic, printable format, especially for those who may lack adequate Internet service.

The HTML version offers interactive exercises and prescriptive feedback to the user.

Instructions

To make the most effective use of this course.

• Take the Initial Check to assess your current knowledge about chromium toxicity.
• Read the title, learning objectives, text, and key points in each section.
• Complete the progress check exercises at the end of each section and check your answers.
• Complete and submit your assessment and posttest response online if you wish to obtain continuing education credit. Continuing education certificates can be printed immediately upon completion.

Instructional Format

This course is designed to help you learn efficiently. Topics are clearly labeled so that you can skip sections or quickly scan sections you are already familiar with. This labeling will also allow you to use this training material as a handy reference. To help you identify and absorb important content quickly, each section is structured as follows:

Title

Serves as a “focus question” that you should be able to answer after completing the section

Learning Objectives

Describes specific content addressed in each section and focuses your attention on important points

Text

Provides the information you need to answer the focus question(s) and achieve the learning objectives

Key Points

Highlights important issues and helps you review

Progress Check questions

Enables you to test yourself to determine whether you have mastered the learning objectives

Progress Check answers

Provides feedback to ensure you understand the content and can locate information in the text

Learning Objectives

Upon completion of the Chromium Toxicity CSEM, you will be able to

Overview

• Explain what chromium is.

Exposure Pathways

• Identify sources of chromium exposure.
• Identify the routes of exposure to chromium.

Who Is at Risk

• Identify who is at risk of exposure to chromium.

Standards and Regulations

• Identify the OSHA permissible exposure limit (PEL) for chromium.
• Identify EPA's maximum contaminant level (MCL) for chromium in drinking water.

Biological Fate

• Explain the metabolic difference between Cr(III) and Cr(VI).

Physiologic Effects

• List and describe the physiologic effects associated with chromium exposure.

Clinical Assessment

• Describe characteristic clinical presentations of patients with acute or chronic chromium exposure.
• Identify important aspects of the exposure history.
• Describe characteristic findings on patient examination.
• Identify laboratory tests that can assist with diagnosis of chromium exposure.

Treatment and Management

• Describe the principal treatment strategies for managing chromium poisoning.

Patient Education and Counseling