1. Detail the circumstances by which poisoning from these metals may occur.
2. Understand the target organs and features of toxicity of poisoning.
3. Discuss the role of enhanced elimination and chelation therapy.
4. Discuss the features and management of metal fume fever.

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A 62-year-old man is brought to hospital with a history of haematemesis and melaena. His relatives report he has been ingesting ‘large’ amounts of aspirin for the last few days. That morning he was found unresponsive and cyanotic. On arrival in the Emergency Department he is obeying commands but not verbalising. His peripheral blood pressure is unobtainable and heart rate is 80/min. Arterial blood gas shows: pH 7.34, PO2 182, PCO2 39 Bic 21.9. Family members are asked to search his bedroom and they return with a bottle of copper sulphate and a blue-green stained shirt.

1. Is the patient’s presentation consistent with copper sulphate poisoning?
2. What other diagnoses should be considered?
3. What investigations are indicated?
4. How would you proceed with management?
5. What complications may occur?
6. Is there a role for enhanced elimination or chelation if copper poisoning is confirmed?

Case report from: Schwartz E, Schmidt E. Refractory shock secondary to copper sulfate ingestion. Ann Emerg Med 1986;15:952-954

A 17-year-old girl was admitted to hospital with facial swelling and vomiting. She was unable to give a history. She had been well earlier that day at school and developed increasing oedema to the face, neck and oropharynx and hypotension. A presumptive diagnosis of angioneurotic oedema was made but she did not respond to steroids or antihistamines. One hour after admission a bottle of cadmium chloride crystals, from the school laboratory, was found in her bag.

1. Is the patient’s presentation consistent with cadmium poisoning?
2. What investigations are indicated?
3. How would you proceed with management?
4. What complications may occur?
5. Is there a role for enhanced elimination or chelation?
6. What is her prognosis?