chronic cobalt poisoning

The friction releases tiny metal particles into your bloodstream that could trigger a hypersensitive immune response in your body. With chronic systemic exposure, cobalt accumulates in tissue, again primarily the liver and kidney, and the cobalt level will be elevated in the serum, whole blood, and urine[9]. Since 2006, there have been increasing reports in the literature of patients with cobalt alloy-containing metal prostheses developing systemic symptoms of cobalt toxicity, termed athroprosthetic cobaltism[13]. Unfortunately, her story is one lived by the many who cope with neurological issues as a result of cobalt toxicity. Instead, if there is a gradual increase in circulating cobalt metal ion concentrations or there are concerning systemic symptoms, the patient should be promptly evaluated by an orthopedic surgeon for appropriate further medical action. 7. Studies of whole-body retention of inorganic cobalt in physiologically normal adult human males after intravenous injection demonstrated that approximately 40% of the dose was eliminated within the first 24 hours, 70% by one week, after one month 20% was retained, and after one year 10% was retained[7-8]. The neurological symptoms that occur with cobalt metal poisoning include: tremors The goal of total hip replacement is to maintain a functional joint while simultaneously delaying the need for surgical revision or replacement for as long as possible. Queally JM, Devitt BM, Butler JS, et al. Sometimes, metal particles (cobalt) are released … Acute poisoning is likely to occur through the oral route, whereas chronic poisoning is mainly from inhalation or skin contact [Meditext 2005]. The neurological symptoms that occur with cobalt metal poisoning include: In fact, if any part of an artificial hip contains chrome or cobalt materials, the patient is at risk for higher metal levels in the blood and neurological symptoms as a result. Orthopaedic metals and their potential toxicity in the arthroplasty patient: a review of current knowledge and future strategies. This type of implant is an artificial hip socket that is created by fitting a metal ball into a metal cup. Instead, he attributed the slightly elevated serum cobalt metal ion level to mild leeching of cobalt from the prosthetic hip, a common occurrence in patients with prosthetic hips. Hip Arthoplasty with the articular surface replacement (ASR) system: survivorship analysis and functional outcomes. Toxins include organic solvents (with high blood-brain permeability) and metals (with sometimes poorly understood mechanisms of neural uptake). Nearly 400,000 hip arthroplasty procedures are performed annually in the United States, and over the past decade, there has been an increasing trend of utilizing cobalt alloy-containing metal-on-metal prosthetic hip joints[1]. Instead, the toxicologist alluded to the fact that the patient was not taking his pain medication and was endorsing symptoms of worsening anxiety and depression, medical conditions he was diagnosed with prior to his bilateral hip replacements in 2008. Quesada MJ, Marker DR, Mont MA. Chronic cobalt poisoning may cause polycythemia, hyperplasia of the bone marrow and thyroid gland, pericardial effusion, and damage to the alpha cells of the pancreas. Cobalt poisoning is a common problem in patients with artificial hips. At the time of revision increasing concentrations of the alloy elements cobalt, chromium, and molybdenum were measured in the serum and liquor. Exposure to chromium, cobalt, and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty. 8. In addition, he noted that the patient lacked other symptoms of systemic cobalt toxicity including hypothyroidism and cardiomyopathy. 2008 Oct 23:69-73. Cobalt ions induce chemokine secretion in primary human osteoblasts. Cobalt poisoning symptoms may include: Orthopaedic metals and their potential toxicity in the arthroplasty patient: a review of current knowledge and future strategies. Mayo Medical Laboratories interpretive handbook: interpretive data for diagnostic laboratory tests. Cobalt, Chromium, and Nickel Concentrations in Body Fluids of Patients with Porous-Coated Knee of Hip Prostheses. Chronic Toxic Encephalopathy . This value was not derived from a comparison of symptomatic to asymptomatic patients with cobalt alloy-containing metal-on-metal prostheses, and thus does not serve as a threshold value to evaluate for systemic cobalt toxicity. J Orthop Res. ELEVATED BLOOD COBALT LEVELS IN A PATIENT WITH BILATERAL METAL-ON-METAL HIP PROSTHESES. 2012;432:210-215. Adverse reaction to metal debris: metallosis of the resurfaced hip. cobalt toxicity . As recently as five years ago, the medical community mostly believed that metallosis derived from metal-on-metal artificial hips. cobalt levels, it is likely that they may represent previously undescribed complications of cobalt toxicity. It has, however, been noted that tungsten carbide appears to modify the toxicity of cobalt and that cobalt alone does not have the same potent toxic effects. The signs and symptoms of Chromium Toxicity depend on whether the exposure occurred through oral ingestion, chronic inhalation, or skin contact. At least two test-confirmed symptoms that are consistent with cobalt toxicity, i.e comprehensive neuro-cognitive testing, EMG, and/or formal ophthalmologic evaluation. To this day, it is unclear whether elevated cobalt metal ion levels should be considered toxic in patients with cobalt alloy-containing metal-on-metal prostheses, especially if they are asymptomatic, since no clear correlation has even been made between cobalt concentration and physiologic effects (to be discussed later)[12]. Sometimes, metal particles (cobalt) are released … The main objective of treatment is to eliminate the exposure to cobalt and to treat the systemic symptoms supportively, such as thyroid replacement therapy, beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), diuresis, corticosteroid therapy, etc[1]. It is used by the body in small amounts as part of vitamin B-12, to help make red blood cells and maintain the nervous system. However, studies comparing the clinical and laboratory features of patients with cobalt alloy-containing metal-on-metal hip prostheses and suspected cobalt toxicity to asymptomatic patients with metal-on-metal hip prostheses have not been performed. That’s a promising sign. Serum concentrations >1 mcg/L indicate possible environmental or occupational exposure, and concentrations >5 mcg/L are considered toxic. Unfortunately, no. In general, improved case definitions, controlled studies, and improved surveillance are needed to fully elucidate the course of this relatively new disease and direct further investigations. cobalt toxicity . Breathing in this cobalt dust can lead to chronic lung problems. 2 Cobalt is employed industrially in certain grades of steel and in tungsten carbide tools, and cobalt compounds are used as pigments in paints. In the United States, the FDA defines "symptomatic patients" as patients experiencing localized symptoms, such as pain or swelling at the hip, change in walking ability, and noise from the joint, after more than 3 months following implantation of the cobalt alloy-containing metal-on-metal hip prosthesis[17]. Concentration of Wear Products in Hair, Blood, and Urine after Total Hip Replacement. The medical community has (slowly) accepted that MoM hips were a health problem and have moved away from their use. In the blood, cobalt metal ions bind to albumin with an estimated free fraction of approximately 5 to 12%[6]. We are finding cobalt poisoning in too many patients with metal-on-plastic and metal-on-ceramic hips. Multiple studies have confirmed that patients with cobalt alloy-containing metal-on-metal hip prostheses, especially bilateral and/or malfunctioning prostheses, have significantly higher concentrations of circulating cobalt metal ions, usually greater than 10 �g/L and even sometimes up to 100 times that of physiologic levels4, [14-16]. What is Arthroplasty Cobalt Encephalopathy (ACE)? Among the patients who were diagnosed with ACE, the median length of time for onset of neurological symptoms was around seven years. Cobalt poisoning can occur when you are exposed to large amounts of it. Does this settle the questions regarding artificial hip implants and metallosis? The risk to the patient occurs with any artificial hip containing a cobalt component.” Conventional wisdom has been that eliminating the metal on metal contact should eliminate the risk of metallosis, but Dr. Tower at least does not accept this thinking. Of the 57 patients with a cobalt positive test, 28 had symptoms consistent with Arthroplasty Cobalt Encephalopathy. Cobalt chromium poisoning is a risk for anyone with a metal on metal (MoM) hip replacement. Acute exposures are generally characterized by an allergic dermatitis. Cobalt is acutely toxic in large doses, and in cumulative long-term, low level exposure, i.e occupational exposure from cobalt processing plants, hard metal industry, diamond polishing, and the ceramic industry. A deficiency of cobalt, which is very rare, is also potentially lethal, leading to pernicious anemia. 09: Signs Your Artificial Hip May Be Defective, Aqueous Film-Forming Foam (AFFF) and Cancer: What You Need to Know, Physical Therapist: Problems with Metal-on-Metal Hip Failures (Part 3), Physical Therapist: What It Feels Like When Artificial Hips Fail (Part 2), Physical Therapist Discusses Hip Replacement Surgery, Recovery (Part 1). Absorption and retention of cobalt in man by whole-body counting. ACE is meant to identify a brain disease or associated neurological symptoms caused by elevated levels of cobalt from a metal artificial hip. Contributed by Jessica Dwyer, MD and Octavia Peck Palmer, PhD, http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/MetalonMetalHipImplants/default.htm. Case of cobalt poisoning. Cobalt is an essential element for health in animals in minute amounts as a component of Vitamin B12. There are no established indications for chelation therapy[1]. According to the CDC, "chronic exposure to cobalt-containing hard metal (dust or fume) can result in a serious … Letourneau EG, McCullough RS, Hollins JG. When the metal parts rub against each other, they release microscopic metal particles into the blood and surrounding tiss… Symptoms come on slowly and can include: Following a single dose of cobalt, the concentration in the blood and serum is initially high, but rapidly decreases to a low level within 24 hours due to the combination of tissue uptake, primarily in the liver and kidney, and urinary excretion. You get this after contact with a low dose over a long time. The contact form sends information by non-encrypted email, which is not secure. Cobalt is an essential, transition group metal present in trace amounts in the human diet, notably in fish, vegetables, and drinking water. The heavy metal cobalt is used in making items like jet engines and diamond polishers. According to the CDC, "chronic exposure to cobalt-containing hard metal (dust or fume) can result in a serious … Acta Orthop. J Bone Joint Surg Br 2007; 89: 567-573. Queally JM, Devitt BM, Butler JS, et al. However, caution must be applied when testing and interpreting cobalt levels in patients with cobalt alloy-containing metal-on-metal prostheses since these patients tend to have incidentally higher circulating cobalt metal ion concentrations, sometimes greater than 5 �g/L, but may not have symptoms of cobalt toxicity. 2013 Nov 13 [Epub ahead of print]. Health Phys.1972;22:359-367. Lancet 369:542-544. Alexandersson R. Blood and urinary concentrations as estimators of cobalt exposure. In these patients, they advise to consider serial cobalt metal ion testing, but also strongly advise interpretation of these levels in the context of the patient's clinical symptoms, baseline renal function, and potential alternative sources of cobalt. It happens when there’s friction between metal surfaces. The three main sources of exposure are occupational exposure, natural contaminants of drinking water (from some deep water wells) and ancient Chinese medicinal remedies containing arsenic. Increased Blood Cobalt and Chromium After Total Hip Replacement. from the Division of Toxicology at the University of Pittsburgh School of Medicine (Pittsburgh, PA, USA) proposed diagnostic criteria for arthroprosthetic cobaltism secondary to cobalt alloy-containing metal hip prostheses[18]. The clinical emergence of cobalt cardiomyopathy seems to require the coexistence of one or more cofactors, particularly a low-protein diet, thiamine deficiency, alcoholism, and hypothyroidism. Cobalt has also been used as a treatment for anemia, because it stimulates red blood cell production. It is also dependent on whether the toxic effects of cobalt are from an acute or chronic exposure These devices are made from a blend of several different metals, including chromium, cobalt, nickel, titanium and molybdenum. Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. Simonsen LO, Harbak H, Bennekou P. Cobalt metabolism and toxicology - a brief update. J Toxicol Clin Toxicol. occurred. With chronic systemic exposure, cobalt accumulates in tissue, again primarily the liver and kidney, and the cobalt level will be elevated in the serum, whole blood, and urine. This type of implant is an artificial hip socket that is created by fitting a metal ball into a metal cup. Cobalt-induced myocardial injury was also implicated in a study of hard metal workers chronically exposed to cobalt, and another study of Finnish cobalt workers revealed that cumulative cobalt exposure was associated with subclinical echocardiographic changes[6]. Chronic Toxic Encephalopathy . Vaping and Cobalt Poisoning. Chronic tungsten poisoning. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. The prognosis of Cobalt Poisoning is dependent on the amount of substance consumed, time between consumption and treatment, severity of the symptoms, as well as general health status of the patient. It has been proposed that many of the adverse effects of cobalt are secondary to its high affinity for sulfhydryl groups. Cobalt poisoning can also occur from the wear and tear of some cobalt/chromium metal-on-metal hip implants. Studies following patients with arthroprosthetic cobaltism have demonstrated symptom improvement and declining circulating cobalt metal ion levels after removal of the implanted hardware, especially in patients with endocrinopathies and cardiomyopathy. The patient's neurologic complaints are certainly found in patients with cobalt toxicity, but they are mostly subjective, non-specific, and when put in the context of the relatively low serum cobalt metal ion level, are unlikely to be the result of cobalt toxicity. There are three basic ways that cobalt can cause poisoning. Cobalt deficiency has never been described in humans, but cobalt toxicity has been well-documented. When these criteria are applied to the currently published cases of arthroprosthetic cobaltism secondary to cobalt alloy-containing metal-on-metal hip prostheses, the circulating serum cobalt metal ion concentrations are typically very high, usually approaching 100 �g/L, before systemic cobalt toxicity is objectively identified. Learmonth ID, Case CP (2007) Metallic debris from orthopaedic implants. Be fatal if not treated right away with EDTA or BAL/DMPS, titanium and molybdenum metallosis of the hip... Type of implant is an artificial hip socket that is created by a... Ophthalmologic evaluation, elevated cobalt metal poisoning include: the effects of cobalt toxicity extensive. Exposure to non-radioactive cobalt cobalt chromium poisoning can manifest with symptoms of varying degrees severity! 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