Heavy metal poisoning may be acute, subacute, or chronic, and it is important for the emergency physician to recognize poisonings that are acutely life threatening. Nearly all parts of the human body are affected by heavy metals, including the cardiovascular, gastrointestinal, renal, hematologic and nervous systems. In many heavy metal poisonings, chelation therapy is the standard of care. This review details the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcomes for patients who have been exposed to arsenic, chromium, cobalt, lead, mercury, and thallium. Figures show the skin manifestations of chronic arsenic toxicity and treatment algorithms for lead exposure and thallium poisoning. Tables list the clinical manifestations of arsenic poisoning, the side effects of common chelators, systemic manifestations of lead toxicity in adults, routes of exposure and clinical manifestations of mercury poisoning, and symptoms following acute thallium overdose. This review contains 3 highly rendered figures, 5 tables, and 92 references.
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