No proven antidote is available for chromium poisoning. Acute poisoning is often fatal regardless of therapy. Treatment in cases of acute high-level chromium exposure is usually supportive and symptomatic.
Fluid and electrolyte balance is critical.
Affected patients should be monitored carefully for evidence of
- gastrointestinal bleeding,
- hemolysis,
- coagulopathy,
- seizures, and
- pulmonary dysfunction [Geller 2001].
Appropriate supportive measures may include ventilatory support, cardiovascular support, and renal and hepatic function monitoring.
When renal function is compromised, maintenance of adequate urine flow is important. Progression to anuria is associated with poor prognosis [Meditext 2005].
Induction of vomiting is contraindicated, owing to the potential corrosive effects of the chromium compounds and the potential for rapid deterioration of the patient [Geller 2001; Meditext 2005].
Gastric lavage with magnesium hydroxide or another antacid might be useful in cases of chromium ingestion.
The efficacy of activated charcoal has not been proven.
Orally administered ascorbic acid was found to be protective in experimental animals and was reported beneficial in at least one patient after chromium ingestion; however, no clinical trials have been conducted to confirm the efficacy of this treatment [Bradberry and Vale 1999].
Exchange transfusion was effective in reducing blood chromium levels 67% in one case of chromium poisoning, using 10.9 L of blood [Kelly, Ackrill et al. 1982]. Existing evidence does not allow the conclusion that exchange transfusion generally should be employed, however [Geller 2001].
Hemodialysis and charcoal hemoperfusion do not substantially enhance chromium removal from the body if renal function remains normal [Ellis, Brouhard et al. 1982]. However, if renal failure ensues, hemodialysis may be necessary for management of the renal failure itself [Schiffl, Weidmann et al. 1982; Geller 2001].
Chelation with ethylenediaminetetraacetic acid (EDTA) does not seem to be of clinical benefit [Geller 2001].
If the eyes and skin are directly exposed, flush with copious amounts of water.
Several case reports suggest that topical ascorbic acid is effective in the management of chromium dermatitis but this has not been confirmed in controlled clinical trials [Bradberry and Vale 1999]. The ulcers heal in several weeks without specific treatment.
Ethylenediaminetetraacetic acid (EDTA) ointment 10% might facilitate removal of chromate scabs [Geller 2001; Lewis 2004].
Weeping dermatitis can be treated with 1% aluminum acetate wet dressings, and chrome ulcers can be treated with topical ascorbic acid [Geller 2001; Meditext 2005]. |
