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Toxicology

Copper & its Salts

Some debate exists as to exactly what constitutes a "heavy metal" and which elements should properly be classified as such. Some authors have based the definition on atomic weight, others point to those metals with a specific gravity of greater than 4.0, or greater than 5.0. The actinides may or may not be included. Most recently, the term "heavy metal" has been used as a general term for those metals and semimetals with potential human or environmental toxicity. This definition includes a broad section of the periodic table under the rubric of interest.��Regardless of how one chooses to define the category, heavy metal toxicity is an uncommon diagnosis. With the possible exceptions of acute iron toxicity from intentional or unintentional ingestion and suspected lead exposure, emergency physicians will rarely be alerted to the possibility of metal exposure. Yet, if unrecognized or inappropriately treated, heavy metal exposure can result in significant morbidity and mortality. This article provides a brief overview of general principles in the diagnosis and management of metal toxicity

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History

The use of copper and gold marked the transition from the Stone Age to a more modern way of life.
Ancient civilizations of Mesopotamia, & Sumeria, were the earliest to use copper and gold. This area is now in Iraq.
A copper pendant discovered in northern Iraq has been dated about 8700 B.C.
For nearly five millennia copper was the only metal known to man.
By 5000 BC, smelting of simple copper oxide ores such as malachite and azurite had started.
Word copper came from cuprum, the Roman name for the metal. Copper's symbol Cu, is an abbreviation of cuprum
Bronze industry from before 2000 B.C. are found in India. The bronze sculptures of Gandhara is of the 1st century, A.D.

Gold was discovered in about 4000 BC as second metal. By 3000 B.C., silver and lead were found Alloying of copper started with arsenic and then with tin. For many centuries, bronze reigned supreme, being used for plows, tools of all kinds, weapons, armor, and decorative objects. Though copper came from the island of Cyprus-from whence its name-and numerous other sites in the Middle East, the origin of the tin in the bronze is still a mystery

The pyramids and other great buildings of the Egyptian civilization were built of stones that had been quarried and shaped using copper tools.

While the rock used in the buildings was found nearby, the Eygptians mined copper in the Sinai Peninsula. The scale of copper mining in the Sinai reached a size that made it the first real industry of the ancient world. The Egyptians mined deposits of the green copper mineral malachite. Malachite, a copper carbonate, was prized because it was the easiest copper mineral to reduce to copper metal. The closely related blue copper carbonate mineral azurite also was discovered. Near these two copper ore minerals, the early prospectors often found another copper mineral, blue-green turquoise. Turquoise is still prized around the world as a gem stone. Ruins of the old mines, the miners' huts, and inscriptions to the Goddess Hathor, the Lady of the Turquoise, can be found to this day in the Sinai. Copper mining in the Sinai Peninsula continued until the reign of Ramses III, in 1150 B.C., over 2,000 years later.

Early metalsmiths of Sumer, Babylon, and Egypt were highly prized members of their society. Often, they were not free, owing their obedience and livelihood to temple priests and authorities. They were so valuable that invading armies made a special effort to carry them off in captivity. Metalsmiths transmitted their secrets to their children. Their guilds may have been the first trade unions in history.

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Salts

Metallic Copper is essential to normal metabolic function as a trace element But

Copper in high doses and many of its salts are poisonous

Copper Sulphate (Blue vitriol) (Nila Tutia):- large Blue crystals, freely soluble in water,having metallic taste.

Used as emetic (0.3-0.6 gm); Antidote for phosphorus poisoning; to remove excess of granulation tissue from wounds & treatment of Trachoma
It is responsible for most of cases of poisoning.

Sucking by children crystals of blue vitriol
By action of acids on copper cooking utensils

Copper carbonate;
Copper subacetate (verdigris):- Green colooured deposits on copper utensils
Clinitest tablets taken orally in largenumbers

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Acute Poisoning

Symptoms start within 15- 30 mts

G.I. Effect:-Astringent metallic taste in mouth, nausea, repeated vomiting, salivation,burning pain in abdomen, diarrhoea with much straining, signs of dehydration & Shock, cramps

Vomitus green; on adding NH₄OH it turns deep blue, bile does not.

Renal:- Oliguria, albumenuria, haematuria, uraemia, anuria
Biliary:- Biliary stasis, centrilobular necrosis, jaundice
Cardiovascular:- headache, convulsions, signs of circulatory collapse, paralysis, coma and death
Fever, muscular aches, chills, weakness, anaemia
Yellow eyes & skin

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Management

Fatal dose:- About 30 gms (15-60gms)
Fatal Period:- 1-3 days (2 hrs- many days)
Treatment:- Gastric lavage

by 1% soln of Potassium ferrocyanide

Forms insoluble cupric ferrocyanide

White of egg or milk given

forms insoluble albuminate of copper

Morphine for relief of pain abdomen
Diuretics if urine suppressed
Purgative for removal of poison from gut
Chelating agents- B.A.L given I.M. EDTA oral
Supportive care in ICU
In severe cases corticosteroid (Dexamithasone)

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Autopsy Findings

Jaundice; Greenish blue froth; Content of stomach & mucosa green
Evidence of gastroenteritis- Intestine, congested, swollen, inflamed, and excoriated haemorrhagic
Colon ulcerated & rectum may have perforation
Liver enlarged, soft & fatty
Degenerative changes in kidney, tubular necrosis, deposition of copper, & inflammation of glomeruli

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Chronic poisoning

Dust containing copper & its salts in factories using copper
Copper wire;
Food contaminated with verdigris from dirty copper utensils
Some aquarium products
Vitamin and/or mineral supplements

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Clinical Picture

Constant coppery (metallic taste) in mouth A green blue or purple line on the gum, nausea, occasional vomiting
External:-Hair, perspiration & urine may turn green.There may be dermatitis,or eczematous lesion of skin. Inflammation of conjunctiva and ulceration of cornea.
GIT:-Dyspepsia, diarrhoea, pain abdomen
Resp. System:- Laryngitis, bronchitis
Blood:- Anaemia
Liver;- jaundice
Renal damage
CNS:- Peripheral neuritis & atrophy of muscles

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Treatment

Remove the cause & source of poisoning.
General nutrition and treating symptoms
A course of BAL or EDTA
Copper utensils used for cooking and storing food should be tinned and kept scrupulously clean

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Post Mortem Finding

Fatty degeneration of Liver

Degenerative changes in kidneys

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Medico-Legal Aspects

If treated promptly and properly, copper poisoning is rarely severe
Repeated poisoning with small doses is far more dangerous to life than large dose taken once as it is likely to be vomited out.
Copper sulphate rarely used as homicidal poison because of its colour test & it emetic action.
Suicidal common where copper commercially used as in leather industry
Accidental in children and to adults due to Verdigris.

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