NONESSENTIAL IONS
Bromism- dullness and
1. FLUORIDE (F-)
- Anticariogenic action
- Uses: preventing tooth decay
- Sources- water supply containing fluoride
- many reports indicated that fluoride
reduces the prevalence of
osteoporosis
- Visible aortic calcification were
actually higher in low fluoride
area(0.15-0.3 ppm) than High fluoride
area(4-5.8 ppm) because fluoride
facilitate calcium deposition in hard
tissues rather than soft tissues
Toxicity:
a. Sodium Fluoride
-safe in 2.2 mg a day for prevention of
caries
-acute lethal dose of 4 g
-in toxic dose may cause general
protoplasmic poison that inhibit
enzyme activity
b. Fluorosis
-destruction of tooth enamel caused
by ingestion of excessive fluoride
* Wine fluorosis
- caused by wine containing Fluoride
in 15-75 ppm concentration
- can cause fluoride-induced arthritic
changes
Sx: Calcification of Periarticular (near joint)
ligament- restrict movement in hands,
shoulders and hip joints
2. BROMIDES (Br-)
- First introduced for their Antiepileptic effect
- In small doses(0.5-2g) cause
depression of CNS, large doses(4-8g)
depress all reflexes and cause narcotic
type of effect
- Bromides usefulness in epilepsy
depend on their ability to depress the
motor areas of the brain, an effect
brought about by large doses.
- Are rapidly absorbed and are excreted
mainly in urine
- Administer NaCl to hasten elimination
of Bromide
- Bromo Seltzer -relieve nervous
tension due to phenacitin, caffeine &
acetaminophen
Toxicity:
a.
weakness due to excessive intake of
bromide sedatives
Sx: Insomnia, Restlessness,
Dizziness, Weakness, Headache, skin rash
Txt: administration of sodium
chloride (5gm daily in divided doses) or
ammonium chloride may also be used.
3. LITHIUM (Li)
- Depressant in CNS
- Diuretic action
- -Lithium is toxic ( 0.5-1.5 mEq is satisfactory
range)
- is readily absorbed from
intestine, accumulates in the body.
The extent of its accumulation
depends on sodium intake (decrease
sodium intake accelerate lithium
accumulation) and potentiate toxicity.
- Lithium intoxication is treated with adequate
Sodium intake
Lithium Carbonate
- DOC for mania
- contraindicated with renally impaired
patients
- medication is stopped if there are no
satisfactory response within 14 days
- toxicity may affect thyroid function and
cause Myxedema
4. GOLD (Au)
Beginning of modern gold therapy
-Koch's discovery that gold cyanide was
effective(in-vitro) against the tubercle
bacillus
Therapeutic gold compounds-administered
intramuscularly
Orally administered gold-poorly and
erratically absorbed
Toxicity involves the skin, and mucuous
membranes, joints, blood, kidney, liver, and
nervous tissue
Treatment: DIMERCAPROL
Uses:
-treatment of RA(a chronic inflammatory
disorder that mainly attacks joints and their
surrounding structures eg. muscles, tendons,
and other connective tissues)
-used also in nondisseminated lupus
erythematosus but is contraindicated in
disseminate lupus
Gold SHOULD NOT be given to people with Toxicity:
renal disease, history of infectious hepatitis, Symptoms begin with gastric pain
skin or blood disorders, diabetes, developing to severe vomiting and diarrhea
hypertension or CHF and there may be skeletal muscle cramps
Chronic poisoning is difficult to detect
OFFICIAL GOLD COMPOUNDS: Treatment: Gastric lavage, saline cathartics,
a. AUTROTHIOGLUCOSE (C6H11AuO5S) use of dimercaprol
-MW: 392.18
-odorless or nearly odorless yellow powder Patients ingesting Arsenic chronically for 2-5
-stable in air years may develop HYPERPIGMENTATION
-unstable in long standing If ingestion continues for 3-10 years,
-freely soluble in water PERMANENT KERATOSIS can develop
-insoluble in acetone, alcohol, chloroform,
6. ANTIMONY (Sb-Stibium)
and ether
(Gk. word: anti, monos -- "a metal not found
-Administered as SUSPENSION IN OIL
alone")
*Aurothioglucose Injection (Solganol)
Antimony is a naturally occurring metal
it uses sesame oil with 2% aluminum
typically found in ore deposits
monostearate
-silvery, lustrous gray metal
Sources:
b. GOLD SODIUM THIOMALATE
Meats, tobacco, flame retardants in textiles,
(C4H3AuNa2O4S.H2O)
mordant in dyeing processes, metal work
-MW: 408.09
factories, rubber processing, mining,
-white to yellowish white, odorless, fine
hazardous waste sites.
powder
Uses:
-very soluble in water
Antimony is widely used in industry and
-insoluble in alcohol, ether, most organic
present in all kinds of everyday items
solvents
-flame retardant in products as diverse as
*Gold Sodium Thiomalate Injetion
toys, car seat covers, engine covers for light
(Myochrysine)
aircraft, clothing for kids, and uniforms for
fire fighters
NONOFFICIAL GOLD COMPOUNDS:
-Antimony alloys--being used in batteries,
a. GOLD SODIUM THIOSULFATE
low friction metals, and cable sheathing
(Na3Au(S2O2)2.2H2O)
-Antimony compounds--are used to make
-MW: 526.22
flame-proofing materials, paints, ceramic
-use in petrolatum as a test preparation to
enamels, glass and pottery.
determine the presence of contact allergy to
**The ancient Egyptians used antimony, in
gold
the form of stibnite, for black eye make-up.
Toxicity:
b. AUROTHIOGLYCANIDE
Acute oral exposure of humans and animals
(C6H5NHCOCH2SAu; Lauron)
to high doses of antimony or antimony-
-treatment of rheumatoid arthritis
containing compounds (antimonials) may
5. ARSENIC (As) cause gastrointestinal disorders (vomiting,
Protoplasmic poisons-arsenic compounds diarrhea), respiratory difficulties, and death
that injure or destroy all cells at extremely high doses
Uses:
-used in treatment of trypanosomiasis and
*Exposure to 9 milligrams per cubic meter of
amoebiasis
air (mg/m3) of antimony as stibnite for a long
-used for psoriasis
time can irritate your eyes, skin, and lungs.
-Potassium Arsenite Solution--used for
*Antimony trioxide-carcinogenic
leukemia because it lowers leukocyte count
*Antimony poisoning has also been known to
-homicidal poison
lead to Adams-Stokes syndrome
7. ALUMINUM (Al)
-soluble compounds: Astringent and
antiseptic
-soluble salts: used by cosmetic industry
as deodorants
-insoluble compounds: used as
nonsystemic antacids, since Aluminun
cation is not absorbed across intestinal
wall
8. SILVER (Ag)
-a protein precipitant
-action on tissue: Antiseptic, astringent,
irritant to corrosive as the concentration
of free silver ion increases
-Ag products: Used topically -sufficient
concentration is corrosive to the mucosa
of digestive tract -silver salts: Internal use
results in little/no systemic action
-toxic dose of AgNO3 is 10g
Toxicity: "Argyria"
-discoloration of skin in prolonged use
-color ranges from grayish to
bluish/purplish aka. "Cyanosis"
-part of pigment maybe Silver sulfide
(Ag2S) and partly metallic sulfur
-IRREVERSIBLE, although injection of 6%
Sodium thiosulfate & Potassium
Ferrocyanide subcutaneously will remove
the color
9. BARIUM (Ba)
-extremely toxic systemically due to its
muscle stimulating action
-used in complete heart block (heart beat
stops)
Treatment of Barium poisoning:
*Precipitation of insoluble barium sulfate
by oral administration of Na or Mg,
followed by gastric lavage
*NaSo4 intravenously
Barium Sulfate USP XVIII
-official barium salt
-insoluble salt used as a radiopaque in x-
ray studies of GI tract
10. CADMIUM (Cd)
- accumulates in the kidneys (1mcg) ---
implicated for HTN
Source: cigarette smoke
Toxicity: Itai-itai
- caused by drinking river water
contaminated by Cd
Sx: Severe bone pain, waddling gait,
aminoaciduria, glycosuria, severe
osteomalacia (bone softening), and multiple
pathological fractures.
Cadmium Sulfide (CdS)
- insoluble salt.
- Capsebon tx of dandruff
11. LEAD (Pb)
- toxic metal;
- used industrially in food and beverage
processing, and in medicine (e.g.,
indigestion);
- salts: used topically as astringent
(absorbed systematically), and used to
sweeten wine.
- protein precipitant: by combining with
the cysteine sulfhydryl groups of
protein
- any ROA is possible.
- If absorbed:
Pb => Erythrocytes & Soft Tissues
( e.g., kidney, liver) bone, teeth,
hair
Source: paint and automobile fumes,
earthenware utensils, cocktail glasses, and
moonshine whiskey, pewter plates and
vessels and inadequately glazed pottery.
Toxicity: Plumbism
Sx: Developmental delay, learning
difficulties, irritability, sluggishness and
fatigue, abdominal pain, Lead
encephalopathy (children), ECG
abnormalities, cerebral palsy, seizures, optic
atrophy, renal damage leading to a
hypophosphatemia, inhibition of heme
synthesis (chronic).
Tx:
Chronic: chelating agents e.g., Dimercaprol
and Calcium Disodium Edetate are used
initially, followed by Penicillamine for follow-
up treatment.
Acute: Na or MgSO4, followed by gastric
lavage.
12. MERCURY (Hg)
- metallic Hg: nontoxic
- mercurous (Hg+) and mercuric
(Hg+2): toxic.
- at 16oz: intestinal obstruction.
- salts: topical use; water insoluble,
nontoxic for short-term use on intact
skin.
 - vapor(finely divided): toxic, more
readily oxidized and is absorbed
through bronchi.
alkylated mercurials (organic mercurials):
very toxic
sulfhydryl groups: mercaptans, ability of
sulfur atoms to bind or capture mercury.
- uses: diuretics, antiseptics, parasiticudes,
and fungicides, treatment of syphilis
- If absorbed:
Mercuric cation concentrates in the
kidney (mostly) and in the liver, blood,
bone marrow, and other tissues.
It is excreted by the kidney and colon.
Toxicity:
a. Acute: ingestion of a soluble mercuric
salt.
Sx: Vomiting, severe damage to the
intestinal mucosa leading to shock and
death, Diuresis followed by renal damage.
Vomiting + diarrhea + diuresis
fluid and electrolyte imbalance.
Tx: gastric lavage, reducing agent (e.g.,
sodium formaldehyde sulfoxykate
(Na[HOCH2SO2]), chelating agents (e.g.,
dimercaprol or penicillamine)
b. Chronic: industrial exposure, eating foods
contaminated with Hg, and long-term
exposure to topical mercurials.
Sx: mimic other disorders
- affects the CNS causing behavioral
and personality changes,
decreased visual acuity, tremors,
insomnia and ataxia.
- more difficult to treat than acute
mercury
Tx: chelating agents (e.g. N-acetyl-D,L-
penicillamine)
Mercuric chloride (HgCl2; mercury,
corrosive sublimate), cause bloody diarrhea
and death by kidney failure; tx of syphilis
(orally
Calomel (Hg2Cl2; mercurous chloride)
- cathartic of choice.
Official Merallurid Sodium Chlormero
Mercury e, U.S.P. Mercaptom drin, N.F
Product VXIII erin, U.S.P., XIII
s XVIII
Molecul 610.98 MW: 606.0 367.20
ar
Weight
Chemic C16H23HgN60 C16H25HgNNa C5H11ClHgN2
al Form 7 O2 O2
Brand Mercuhydri Thiomerin Neohydrin
Name n Sodium
Occurre Meralluride * Sodium Chlormerod
nce Injection Mercaptome rin Tablets
rin Injection
* Sterile
Sodium
Mercaptome
rin
13. NICKEL (Ni)
- Internally, Nickel lowers blood
pressure and causes nephritis
o Nickel Bromide for epilepsy
o Nickel carbonate and sulfate - for
tonics and hematinic
o 1% or 2% of Nickel sulfate - for
certain parasitic skin diseases
14. BERYLLIUM (Be)
- Beryllium and its salts are very toxic.
- Beryllium salts are widely used in lamp
manufacturing. By 1949, the lamp
manufacturing industry had eliminated
beryllium as a component in
fluorescent light tubes because of
illnesses developing in their
employees.
- No specific antidotes for either acute
or chronic beryllium poisoning are
known
15. STRONTIUM (Sr)
- can replace calcium in bone formation
and has been used to hasten bone
remineralization in diseases such as
osteoporosis
- early work indicated that strontium
caused the formation of a rachitic
bone. Later work showed that if
Vitamin D, estrogens, and androgens
were also administered with strontium,
functional bone would be produced
o Strontium bromide sedative
o Strontium lactate used in the
treatment of osteoporosis
o Strontium chloride used in
dentifrice (Sensodyne) as a tooth
temperature desensitizing agent
o Strontium 90 mimics calcium
biochemistry and can be found in
those plant and animal sources (milk)
that are normally good sources of
Calcium. Once ingested, it localizes in
the bone, just like calcium