Metal toxicity ormetal poisoning is thetoxic effect of certainmetals that accumulate damageecosystems, plants and animals, including human health.^[1][2][3] Environmental pollution withheavy metals can result in contamination ofdrinking water, air, and waterways, accumulating in plants, crops,seafood, and meat.^[3] Such pollution may indirectly affect humans via thefood chain and through occupational or domestic exposure by inhalation, ingestion, or contact with the skin.^[1][3]

At low concentrations, heavy metals such ascopper,iron,manganese, andzinc areessential nutrients obtained through the diet supporting health, but have toxicity at high exposure concentrations.^[2] Other heavy metals having no biological roles in animals, but with potential for toxicity includearsenic,cadmium,lead,mercury, andthallium.^[1][2][4]

Some metals are toxic when they formpoisonous soluble compounds which interfere withenzyme systems, such assuperoxide dismutase,catalase, orglutathione peroxidase.^[1] Only soluble metal-containing compounds are toxic by formingcoordination complexes, which consist of a metal ion surrounded byligands.^[1] Ligands can range from water inmetal aquo complexes to methyl groups, as intetraethyl lead.

Toxic metal complexes can be detoxified by conversion to insoluble derivatives or by binding them in rigid molecular environments using chelating agents. An option for treatment of metal poisoning may bechelation therapy, which involves the administration ofchelation agents to remove metals from the body.^[3]

Heavy metals are found throughout natural ecosystems, including rocks, soils, and water, and originate from diverse sources, such as natural weathering, erosion,mining, industrial and urban runoff, sewage,pesticides on crops, metal pipes carrying potable water, traffic pollution,coal-burning emissions, and various other industrial and urban outputs.^[1][5]

Toxic metal particles in ecosystems may remain for hundreds or even thousands of years, with potentially millions of people exposed to high concentrations at some point in their lives.^[5] Commonly, there is no visible evidence of metals pollution in soil or water.^[5]

When metal toxicity in the environment is suspected, pathologies in fish, clams, and insects may serve as signals for contamination and toxicities.^[5] Physiological mechanisms of metal toxicity may have a spectrum of effects, ranging from changes in behavior to death of small animal species.^[5]

Artisanal small-scalegold miners are at high risk to exposure of metal toxicants.^[6] While there is a wide array of hard metals that are toxic,mercury poses the greatest risk from inhalation and ingestion from environmental contamination.^[7]

Mercury is commonly used in small scale gold mining. To do this, large amounts of mercury are usually mixed with gold-containing materials to create a gold-mercury alloy called amalgam.^[8] To separate the gold, the amalgam is heated in a furnace causing the mercury to vaporize.^[8] During this process, miners are directly exposed to mercury vapors, and surrounding communities may be indirectly exposed through contaminated air, water, and soil.^[6]

Continuous high levels of mercury vapor inhalation can cause a variety of health effects. Inhalation may result in tremors, mood swings, muscle weakness, memory loss, or headaches.^[7][8] Prolonged exposure can lead to kidney damage, respiratory failure, and even death.^[9] Ingestion of mercury through contaminated water, food, or soil pose great risk to pregnant women and their developing fetuses.^[6] When born, this can impair the infants' cognitive functions, memory, language development, and fine motor skills.^[9]

Despite its widespread use across countries, mercury exposure in artisanal small-scale gold mining is preventable.^[7] Mercury-free techniques like directsmelting result in gold recovery without the need of mercury resulting in the elimination of mercury.^[10] In this method, borax is used to decrease the viscosity and melting temperature of non-gold minerals so they can be easily separated from the gold.^[10] This not only results in improved worker and community health but also lower in cost and eco-friendly.^[11][6]

Arsenic exposure remains a major concern in agricultural communities that rely on untreatedgroundwater for crop irrigation and drinking. Studies have found higher urinary arsenic levels among farm workers exposed to contaminated well water and pesticides.^[12]

People who work as welders can be exposed to metal fumes because welding uses extremely high heat, which turns the metal into very small airborne particles.^[13] These fumes often contain metals likemanganese,chromium,nickel, andlead, depending on the materials being welded.^[14] Breathing in these particles over time can lead to different health issues, including neurological symptoms associated with manganese^[14]and lung irritation from the fumes. Stainless steel welding can also create hexavalent chromium^[14], which is a known carcinogen.^[14] Exposures to metals are regulated in most countries. In the US, theOccupational Safety and Health Administration (OSHA) setspermissible exposure limits for metals found in welding fumes, while the National Institute for Occupational Safety and Health (NIOSH) identifiesrecommended exposure limits.^[13][14] Using some industrial hygiene controls such as local exhaust ventilation, fume extraction systems, respirators, and routine air monitoring can help protect welders from harmful metal exposure.^[13] Because welding is widely used in construction and manufacturing and many more occupations, controlling metal fumes is essential for maintaining worker health and safety.

A dominant kind of metal toxicity is arsenic poisoning, which mainly arises fromground water naturally containing high concentrations of arsenic in the supply of drinking water.^[1][2]

Lead poisoning, in contrast to arsenic poisoning, is caused by industrial materials, such asleaded gasoline and lead leached fromplumbing.^[1][2][3] Use of leaded gasoline has declined precipitously since the 1970s.^[15][16]

Some metal elements are required for life, although they may be toxic in high exposure amounts.^[1][2][3] Included arecobalt,copper,iron,manganese,^[21]selenium,^[22] andzinc.^[23] Excessive absorption of zinc can suppress copper and iron absorption. The free zinc ion in solution is highly toxic to bacteria, plants, invertebrates, and fish.^[24]

No global mechanism has been identified for the toxicities of these metal ions. Excessive exposure, when it occurs, typically is associated with industrial activities.

• Beryllium poisoning is attributed to the ability of Be²⁺ to replace Mg²⁺ in some enzymes.^[25] Be has been classified by one agency as a carcinogen.^[26]
• Cadmium poisoning came into focus with the discovery of theItai-itai disease due to cadmium contaminated waters resulting from mining in theToyama Prefecture starting around 1912.^[27] The term refers to the severepains (Japanese:痛い,romanized: itai) people with the condition felt in the spine and joints. Cd²⁺ is thought to accumulate in the kidneys, where it tightly binds to the sulfur incysteine-containing proteins.^[28]
• Lithium toxicity arises from overdose of lithium-containing drugs.^[29]
• Mercury poisoning came into sharp focus with the discovery ofMinamata disease, named for the Japanese city ofMinamata. In 1956, a factory in the city releasedmethylmercury in theindustrial wastewater resulting in thousands of deaths and many other health problems.^[30] This incident alerted the world to the phenomenon ofbioaccumulation. While all mercury compounds are toxic,organomercury compounds are especially dangerous because they are more mobile.Methyl mercury and related compounds are thought to bind to the sulfur of cysteinyl residues in proteins.^[31]

• Silver poisoning,^[33] likelithium poisoning, arises from misapplication of medications. A dramatic symptom of "argyria" is that theskin turns blue or bluish-grey.^[34]
• Thallium poisoning has been observed on several occasions, and it is well known thatthallium compounds are highly toxic. Nonetheless, incidents of thallium poisoning are few.^[35] Tl is located on the periodic table near two other highly toxic metals, mercury and lead.
• Tin poisoning from tin metal, its oxides, and its salts are "almost unknown"; on the other hand certainorganotin compounds are almost as toxic ascyanide. Such organotin compounds were once widely used asanti-fouling agents.^[36]

Chelation therapy is a medical procedure that involves the administration ofchelating agents to remove or deactivate heavy metals from the body.^[3] Chelating agents are molecules that form particularly stablecoordination complexes with metal ions.^[3] Complexation prevents the metal ions from reacting with molecules in the body, and enable them to be dissolved in blood and eliminated in urine.^{[3][37][38][39]}

It is difficult to differentiate the effects of low level metal poisoning from the environment with other kinds of environmental harms, including nonmetal pollution.^[1] Generally, increased exposure to heavy metals in the environment increases the risks for several diseases.^[1] Despite a lack of evidence to support its use, some people seekchelation therapy to treat a wide variety of conditions such asautism,cardiovascular disease,Alzheimer's disease, or any sort ofneurodegeneration.^[37]

Treatment ofautism by chelation therapy has been promoted byalternative medicine practitioners based on an unsupported hypothesis that autism is a result of heavy metal poisoning. This hypothesis likely emerged from the more specific claim that autism was caused by the preservativethiomersal, which in the past has been used in multi-dose vials ofvaccines. Despite extensive study, no connection has been found between vaccines and autism diagnosis rates.^[40][41] Despite this lack of evidence, thimerosal was removed from vaccines out of an abundance of caution by 2001; autism diagnosis rates did not decrease in response to the exclusion of thimerosal, disproving the association.^[42][43] Regardless of the removal of thimerosal and the evidence that it never influenced autism in the first place, the idea of heavy metal exposure causing autism has persisted, and thus has the use of chelation therapy as treatment. Systematic reviews of available evidence do not support the use of chelation therapy for autism,^[44][45] and at least one child has died due to errors in administration of chelation therapy for this purpose.^[46][47][48]

• Dartmouth Toxic Metals Superfund Research Program
• Toxic Metals (OSHA)

• Metals
• Element toxicology
• Toxic effects of metals
• Toxicology

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