Poisoning and Toxicity

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Poisoning and toxicity occurs when individuals drink, eat, breathe, inject, or touch enough of a chemical (also called a poison or toxin) to cause illness or death. A poison is any substance that is harmful to the body when eaten, breathed, injected, or absorbed through the skin. Any substance can be poisonous if enough is taken.

Poisoning is the most common cause of nonfatal accidents in the home. More than two million people suffer some type of poisoning each year in the United States. Drugs, including prescription, over-the-counter (OTC), and illegal drugs, are the most common source of serious poisonings and poisoning-related deaths. Most poisonings involve everyday household items such as cleaning supplies, drugs, cosmetics, and personal care items. Other common poisons include gases, agricultural products, plants, industrial chemicals, vitamins, and foods (such as raw or undercooked meats). However, almost any substance ingested in sufficiently large quantities can be toxic. Infants and young children are especially vulnerable due to their weight and size.

The dangers of poisoning range from short-term illness to brain damage, coma, and death. Some poisons in very small amounts can cause illness or injury. Some poisons cause immediate injury, such as battery acid or household cleaners. Other poisons may take years of exposure to create a health problem, such as heavy metals (lead, arsenic, mercury). The Centers for Disease Control and Prevention (CDC) defines a poisoning that occurs by accident as "unintentional poisoning" and a poisoning that results from a conscious, willful decision (such as suicide or homicide) as "intentional poisoning." Unintentional poisoning includes the use of drugs or chemicals for recreational purposes in excessive amounts, such as an overdose. Unintentional poisoning also includes the excessive use of drugs or chemicals for non-recreational purposes, such as by an infant or child. Intentional poisonings include suicide, such as medication overdosage.

Poisoning is a significant global public health problem. According to the CDC, 32,691 deaths were reported in 2005 as a result of poisoning. Of these, 23,618 (72%) were reported as unintentional, 5,833 (18%) were reported as intentional, and 3,240 (10%) were of undetermined intent. In 2004, 95% of unintentional and undetermined poisoning deaths were caused by drugs, most commonly opioid pain medications, cocaine, and heroin. In the same year, 75% of intentional poisoning suicides were caused by illegal and legal drugs. The CDC also reports that men were 2.1 times more likely to die from unintentional poisoning and 1.3 times more likely to die from intentional poisoning than women.

Young children are particularly vulnerable to accidental poisoning in the home, as are elderly people, often from confusion. Hospitalized people and industrial workers are also vulnerable to accidental poisoning by drugs errors and from exposure to toxic chemicals, respectively.

The damage caused by poisoning depends on the poison, the amount taken, and the age and underlying health of the person who takes it. Some poisons are not very potent and cause problems only with prolonged exposure or repeated ingestion of large amounts. Other poisons are so potent that just a drop on the skin can cause severe damage.

On average, poison centers nationally handle one poison exposure every 14 seconds.

Most poisonings involve everyday household items such as cleaning supplies, drugs (prescription, over-the-counter, and illegal), cosmetics, and personal care items.

Heavy metal poisoning:

Aluminum poisoning: Many of the symptoms of aluminum toxicity mimic those of Alzheimer's disease and osteoporosis ("thinning" of the bones). Colic (excessive crying in infants), digestive problems, interference with the metabolism of calcium, extreme nervousness, anemia, headaches, decreased liver and kidney function, memory loss, speech problems, and aching muscles can all be caused by aluminum toxicity.

Aluminum is excreted by the kidneys, therefore toxic amounts can impair kidney function. Aluminum can also accumulate in the brain causing seizures and reduced mental alertness.

Arsenic poisoning:The first sensations of arsenic poisoning include a metallic taste in the mouth, excessive saliva production, and problems swallowing. The next stage is to suffer vomiting and diarrhea coupled with garlic-like breath, stomach cramps, and excessive sweating. As the poison's effects progress, the patient will suffer seizures and go into shock, dying within a few hours. If death does not occur at this stage, it will happen after a few days when the kidney fails.

Lead poisoning: There are many different health effects associated with elevated blood lead levels. Young children under the age of six are especially vulnerable to lead's harmful health effects, because their brains and central nervous system are still being formed. For them, even very low levels of exposure can result in reduced IQ, learning disabilities, attention deficit disorders, behavioral problems, stunted growth, impaired hearing, and kidney damage. At high levels of exposure, a child may become mentally retarded, fall into a coma, and even die from lead poisoning.

Mercury poisoning: Mercury poisoning is the negative effects on human's nervous system and other bodily systems due to the over-exposure of mercury. Today, people are more aware of the dangers of mercury and many of its uses have been discontinued. However, mercury exposure is still an occupational hazard for people in many industries and mercury is present in the environment around us. There is also the risk of exposure due to a thermometer breaking or mercury leaking out of a thermostat or any number of mercury-containing devices. If mercury vapor is inhaled, as much as 80% may enter the bloodstream.

Carbon monoxide poisoning:

Early symptoms of carbon monoxide poisoning such as headaches, nausea, and fatigue, are often mistaken for the flu because the deadly gas goes undetected in a home. Prolonged exposure can lead to brain damage and even death.

Radon poisoning:

No immediate symptoms of radon poisoning are present. Radon exposure contributes to 7,000-30,000 lung cancer deaths each year. Smokers are at higher risk of developing radon-induced lung cancer.

Other chemical poisoning:

Chronic exposure is chemical poisoning that occurs slowly and insidiously over a prolonged period of time. Many chronic, degenerative diseases have been linked to environmental pollution or poisoning. The list may include cancer, memory loss, allergies, multiple chemical sensitivity, chronic fatigue syndrome, infertility in adults, learning and behavioral disorders, developmental abnormalities, and birth defects in children.

Drug poisoning:

The effects vary depending on the type of drug and how it is taken. When the individual calls the emergency services, give as much information as possible. While waiting for help to arrive, look for containers that might help the individual to identify the drug.

Drugs that can cause poisoning and toxicity include: painkillers such as aspirin, acetaminophen (Tylenol?), or opiates (such as morphine); nervous system depressants and tranquillizers including barbiturates and benzodiazepines; stimulants and hallucinogens (such as lysergic acid diethylamide or LSD); amphetamines; and chemotherapeutic medications such as anthracycline chemotherapy drugs, including doxorubicin (Adriamycin?). Doxorubicin use may lead to heart toxicity. Bleomycin (Blenoxane?) use may lead to lung damage. Nerve toxicity may occur as a result of chemotherapy use. Lithium may cause thyroid and kidney toxicity. Methotrexate (Rheumatrex?) and lometrexol toxicity both may cause folic acid to be depleted from the body. Cyclosporine (Sandimmune?) may cause kidney toxicity in organ transplant patients.

Acute Poisoning:

In many cases, the identity of the poison is known to the patient or the parents of the affected child. If a poisoning is suspected, the individual or a caretaker should immediately call a local Poison Control Center (1-800-222-1222) for advice. If instructed by the Poison Control Center to get medical help, the individual or their caretaker should bring a sample of the poison to the doctor's office or emergency room. Emergency 911 should be called if the individual or child is in immediate danger.

Chronic Poisoning:

Chronic environmental poisoning is more difficult to diagnose. To find out if environmental pollution is causing a person to be sick, a doctor will conduct a thorough physical exam of the patient. The doctor also obtains a thorough medical history with detailed information concerning the food and water sources, as well as the nature of the person's work or the place where they live. Lab tests may include blood and urine tests and hair sample analysis. In addition, liver and kidney function tests are also conducted to see if these organs are affected. The doctor also inquires about other diseases the patient may have developed recently.

For acute poisoning, 911 or a local poison control center (1-800-222-1222) should be called immediately. The toll-free number is a national hotline launched nationwide in 2002 by the American Association of Poison Control Centers (AAPCC) to provide 24-hour poison treatment and prevention services. If a child is suspected of eating or drinking hazardous chemicals, parents should look for the container and call for instructions. Patients or parents of the poisoned child should wait for instructions before administering anything by mouth. Treatment of a particular poison depends on the identity of the poison and how the poison was absorbed into the body.

Inhaled poisons: Treatment of inhaled poison includes bringing the individual out and away from the area contaminated with poisonous gas. The individual should be given oxygen and other respiratory support as necessary.

Skin and eye contamination: If an individual's skin comes into contact with toxic chemicals, the contaminated clothing should be removed, the chemical carefully brushed off the skin, and the body flushed with running water to dilute the poison. The wounds, if any, should be covered with sterile gauze or cloth. If serious, the person will usually be transferred to the hospital for the treatment of a chemical burn. If toxic or caustic chemicals get in the eyes, the affected person should remove glasses or any contact lenses from the eyes immediately, rinse the eyes well with clean water or normal saline solution, and go to the emergency room for further treatment or observation.

Ingested poisons: Depending on the specific type of ingested poisons, syrup of ipecac, activated charcoal, and/or pumping the contents of the stomach out can be used.

Formerly, it was recommended to keep a bottle of syrup of ipecac on hand in order to induce vomiting in case of poisoning. Recent research, however, shows no benefit from this practice. In addition, the research shows that the medicine is not always administered properly.

Activated charcoal is also an effective treatment for many chemical poisons. It can absorb poisons quickly and in large amounts. In addition, it is nontoxic, may be stored for a long time, and can be conveniently given at home. Charcoal works by binding to irritating or toxic substances in the stomach and intestines. This prevents the toxic drug or chemical from spreading throughout the body. The toxic drug or chemical and the activated charcoal will be excreted in the stools without harming the body.

Charcoal should not be used to treat poisoning caused by corrosive products, such as lye or other strong acids, or petroleum products, such as gasoline, kerosene, or cleaning fluids. Charcoal may make the condition worse and delay the diagnosis and treatment. In addition, charcoal is also not effective if the poison is lithium, cyanide, iron, ethanol, or methanol.

Gastric lavage may also be used to treat chemical poisoning under certain circumstances. This procedure is done by healthcare professionals in emergency rooms only. Lavage fluids (saline water or water) are given through a large tube down the patient's throat and the stomach contents are pumped out. This procedure is repeated many times until the physician is confident that most of the toxic substance is removed. Then a specific antidote for the chemical or activated charcoal can be given to absorb the rest. Sometimes, antidotes are available to neutralize poison and render it harmless. The following are some of the common antidotes: naloxone (Narcan?) - used for opiate (including morphine, methadone or heroin) overdose; atropine - used for organophosphate (insecticide) poisoning; acetylcysteine used for acetaminophen (Tylenol?) toxicity; and Digoxin Immune Fab (Digibind?) used for digoxin toxicity.

Chronic chemical poisoning:Treatment of chronic chemical poisoning involves identifying the poison, eliminating the source of poison from the patient's environment, and symptomatic treatment of the condition. Chelation therapy can be used to remove heavy metals, such as lead, iron, mercury, copper, nickel, zinc, cadmium, beryllium, and arsenic. This treatment uses chelating agents, such as ethylenediamine tetraacetic acid (EDTA) and dimethylsuccinate (DMSA), to bind and precipitate metals and remove them from the body.

Note: Poisoning is considered a medical emergency. Individuals who have been poisoned should contact a poison control center immediately and consult with their healthcare provider.

Strong scientific evidence:

Calcium: Calcium is the most abundant mineral in the human body and has several important functions. More than 99% of total body calcium is stored in the bones and teeth where it supports the structure. The remaining 1% is found throughout the body in blood, muscle, and the intracellular fluid. Calcium is needed for muscle contraction, blood vessel constriction and relaxation, the secretion of hormones and enzymes, and nervous system signaling. A constant level of calcium is maintained in body fluid and tissues so that these vital body processes function efficiently. Hyperphosphatemia (high phosphate level in the blood) is associated with increased cardiovascular mortality in adult dialysis patients. Calcium carbonate or acetate can be used effectively as phosphate binders. Use may increase calcium-phosphate products in blood. Treatment of high blood phosphorous levels should only be done under the supervision of a qualified healthcare professional.

Calcium gluconate is used in the treatment of hypermagnesemia (high magnesium level in the blood). Case studies suggest intravenous calcium can aid in the improvement of symptoms. Treatment of magnesium toxicity should only be done under the supervision of a qualified healthcare professional.

Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, high levels of parathyroid hormone, bone tumors, digitalis toxicity, ventricular fibrillation, kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or irregular heartbeat. Calcium appears to be safe during pregnant or breastfeeding women; talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.

Good scientific evidence:

Calcium: Calcium gluconate may aid in antagonizing the cardiac toxicity and arrhythmia (abnormal heart rhythm) associated with hyperkalemia (high potassium level in the blood), provided the patient is not receiving digitalis drug therapy. Treatment of hyperkalemia should only be done under the supervision of a qualified healthcare professional.

Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, high levels of parathyroid hormone, bone tumors, digitalis toxicity, ventricular fibrillation, kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or irregular heartbeat. Calcium appears to be safe during pregnant or breastfeeding women; talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.

Chelation: EDTA chelation became well known during the 1950s, when it was proposed as a method to cleanse the blood and blood vessel walls of toxins and minerals. For many years, chelation therapy has been used with calcium disodium EDTA to treat heavy metal toxicity. It is still an accepted medical therapy for lead toxicity, and several studies report lower levels of lead in the blood and slower progression of kidney failure. Chelation therapy may also be used to treat iron, arsenic, mercury, or cobalt poisoning. However, some research results are mixed. More studies are needed to clarify.

Avoid in patients taking anticoagulants or antiplatelets. Avoid during root canal therapy. Avoid if pregnant or breastfeeding.

Unclear or conflicting scientific evidence:

Calcium: A chelating treatment of calcium has been suggested to reduce blood levels of lead in cases of lead toxicity. Reduced symptoms have been observed in most, but not all, patient case reports and case histories. Adequate calcium intake appears to be protective against lead toxicity. Treatment of lead toxicity should only be done under supervision of a qualified healthcare professional.

Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, high levels of parathyroid hormone, bone tumors, digitalis toxicity, ventricular fibrillation, kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or irregular heartbeat. Calcium appears to be safe during pregnant or breastfeeding women; talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.

Chlorophyll: Chlorophyll is a chemoprotein commonly known for its contribution to the green pigmentation in plants, and is related to protoheme, the red pigment of blood. It can be obtained from green leafy vegetables (broccoli, Brussels sprouts, cabbage, lettuce, and spinach), algae (Chlorella and Spirulina), wheat grass, and numerous herbs (alfalfa, damiana, nettle, and parsley). Yusho poisoning is caused by ingestion of rice oil contaminated with polychlorinated biphenyls, specifically polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs). A chlorophyll-rich diet may increase PCDF and PCB elimination, but further high quality research is needed.

Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressants or antidiabetes agents. Avoid if pregnant or breastfeeding.

Clay: Clay lozenges have been used historically in the treatment of mercuric chloride poisoning and were officially mentioned in several European pharmacopoeias, including the Royal College, until the middle 19th Century. However, there is not enough scientific evidence to recommend the use of clay by mouth for mercuric chloride poisoning at this time, as there is a risk of clay itself containing contaminants.

There is a lack of reports of allergy to clay in the available scientific literature. However, in theory, allergy/hypersensitivity to clay, clay products, or constituents of clay may occur. Avoid if pregnant or breastfeeding.

Folate (folic acid): Folate and folic acid are forms of a water-soluble B vitamin. Folate occurs naturally in food, and folic acid is the synthetic form of this vitamin. Folate may lower blood arsenic concentrations and thereby contribute to the prevention of arsenic poisoning. Additional research is needed in this area.

Avoid if allergic or hypersensitive to folate or any folate product ingredients. Use cautiously if receiving coronary stents or with anemia or seizure disorders. It is recommended that pregnant women consume 400 micrograms of folate daily in order to reduce the risk of fetal defects. Folate is likely safe if breastfeeding.

Iron: Iron deficiency may increase the risk of lead poisoning in children. However, the use of iron supplementation in lead poisoning should be reserved for those individuals who are truly iron deficient or for those individuals with continuing lead exposure, such as continued residence in lead-exposed housing.

Iron is a trace mineral, and hypersensitivity is unlikely. Avoid with known allergy/hypersensitivity to products containing iron. Avoid excessive intake. Avoid iron supplements with blood disorders that require frequent blood transfusions. Use iron supplements cautiously with a history of kidney disease, intestinal disease, peptic ulcer disease, enteritis, colitis, pancreatitis, hepatitis, alcoholism, or with a history of heart disease. Use cautiously in those who plan to become pregnant, or in those older than age 55. Pregnant or breastfeeding women should consult their healthcare professionals before beginning iron supplementation.

Reishi: Reishi mushroom (Ganoderma lucidum), also known as ling zhi in China, grows wild on decaying logs and tree stumps. Reishi occurs in six different colors, but the red variety is most commonly used and commercially cultivated in East Asia and North America. Ganoderma lucidum has shown a beneficial effect in treating Russula subnigricans (RSP) poisoning in limited study. Further well-designed clinical trials are needed to confirm these results.

Avoid if allergic or hypersensitive to any constituents of Ganoderma lucidum or any member of its family. Use cautiously with diabetes, blood disorders (including hemophilia), low blood pressure, or ulcers. Reishi is likely safe when consumed in amounts generally found in foods in non-allergic pregnant or breastfeeding women.

Safflower: Based on preliminary study, safflower (Carthamus tinctorius) oil may effectively remit the symptoms of neurotoxicity from lithium. However, more studies are needed to better understand safflower's effect on lithium toxicity.

Avoid if allergic/hypersensitive to safflower, safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants (blood thinners) or anti-platelet drugs, immunodepressants or pentobarbital. Use cautiously with diabetes, low blood pressure, liver problems, bleeding disorders, or skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.

Spirulina: The term spirulina refers to a large number of cyanobacteria or blue-green algae. Spirulina extract plus zinc may be useful for the treatment of arsenic poisoning. Additional research is needed to confirm early study findings.

Avoid if allergic or hypersensitive to spirulina or blue-green algae. Use cautiously with phenylketonuria, autoimmune diseases, bleeding disorders, diabetes, osteoporosis or if taking products containing the blue-green algae species Anabaena spp., Aphanizomenon spp., and Microcystis spp. Use cautiously in underweight patients or in those taking antiobesity agents or appetite suppressants. Use cautiously if consuming a high-protein diet. Avoid in children and pregnant or breastfeeding women.

Zinc: Limited available study has shown that a combination of spirulina extract plus zinc may be useful for the treatment of chronic arsenic poisoning with melanosis and keratosis. More research is needed to confirm the effects of zinc alone.

Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride because evidence of safety and effectiveness are currently lacking. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.

Traditional or theoretical uses lacking sufficient evidence:

Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs, (e.g. liver and kidney). Although copper has been suggested as a potential treatment for pyrrolizidine alkaloid toxicity and may theoretically decrease cadmium absorption, reliable studies are currently lacking.

Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states, including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The U.S. Recommended Dietary Allowance (RDA) is 1,000 micrograms for pregnant women. The U.S. RDA is 1,300 micrograms for nursing women.

Detoxification therapy: Detoxification is a broad concept that encompasses many different modalities and substances used in cleansing the body's systems and organs. Many different techniques, including chelation therapy, colonic irrigation, supplementation, herbs, foods, and cleansing diet, hydrotherapy, probiotics, sauna, and exercise, may be used during detoxification therapy. Detoxification therapy has been suggested as a potential treatment for heavy metal toxicity, but research is currently lacking in this area.

In cases of illness the various forms of detoxification should be used under professional guidance.

Selenium: Selenium is a mineral found in soil, water, and some foods. Selenium has been proposed as a potential treatment for arsenic poisoning, although reliable evidence is currently lacking in this area.

Avoid if allergic or sensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.

Avoid eating contaminated fish, especially fish that comes from known contaminated areas or a lot of big fish, such as shark, swordfish, or tuna, which tend to contain higher amounts of mercury than smaller fish. According to healthcare professionals, pregnant women should not consume more than seven ounces of tuna per week. Mercury can cause brain damage in the developing fetus. It is best to avoid eating shark, swordfish, king mackerel, or tilefish because they contain high levels of toxins.

Paint may contain lead and cadmium that can harm a developing fetus and cause learning disabilities in small children. It is important not to paint or remodel a home while pregnant or when the children are still small. If the individual lives in a home built before 1960, it is very likely that it contains some lead paint. Homes built between 1960 and 1978 may also contain lead paint, but are very unlikely to do so. In 1978, the Consumer Product Safety Commission finally issued its ban against lead-based paint. If an individual lives in a home built before 1978 that also has been allowed to deteriorate for a few years, lead-contaminated dust may be a problem. To find out if a home contains lead paint or a lead-based paint hazard, hire a professional.

Limiting use of chemicals inside the house as much as possible and instead using natural alternatives, such as baking soda (as cleaner, deodorizer), distilled white vinegar (as cleaner), essential oils (as fragrances), lemon juice (as cleaner), and liquid soaps (as detergents) is important.

Ventilation inside the home may be increased with the use of fans if toxic fumes are present.

Radon and carbon monoxide testing kits are commercially available for the home or office. They may be purchased at a local home store.

Consider installing tile or wood floors in new homes instead of new carpet. Have the house tested for radon.

Avoiding toxic chemical exposure as much as possible if pregnant is important.

Healthcare professionals recommend keeping all medications, petroleum products, and cleaning products locked and away from small children as well as installing child-proof locks or gates to prevent children from finding poisons.

Avoiding mixing up household cleaning products is important. Nontoxic chemicals when mixed together can release toxic gases or cause explosion (such as Clorox? and ammonia).

Keeping all chemicals in original containers, properly identified and stored away from foods is important, as is disposing all hazardous chemicals properly according to the manufacturer's instructions.

It is best to use stainless steel, glass, or iron cookware to avoid aluminum poisoning. Stainless steel is the best choice.

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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Risk factors for poisoning are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for poisoning makes the chances of getting a condition higher, but does not always lead to poisoning. Also, the absence of any risk factors or having a protective factor does not necessarily guard against being poisoned.

Food poisoning:

Food poisoning is a common and sometimes life-threatening problem for millions of people around the world. Individuals infected with bacteria growing in contaminated food may be symptom-free or may have symptoms ranging from mild digestive discomfort to severe dehydration and bloody diarrhea. Depending on the type of infection, people can even die as a result of food poisoning.

Food poisoning tends to occur at picnics, school cafeterias, and large social functions. These are situations where food may be left un-refrigerated too long or food preparation techniques are not clean. Food poisoning often occurs from undercooked meats, shellfish, vegetables (contaminated with E. coli) or dairy products (such as mayonnaise mixed in coleslaw or potato salad) that have been out too long.

Typical symptoms include nausea, vomiting, abdominal cramping, and diarrhea that come on suddenly (within 48 hours) of consuming a contaminated food or drink. Depending on the contaminant, fever and chills, bloody stools, dehydration, and nervous system damage may follow. These symptoms may affect one person or a group of people who ate the same thing (called an outbreak).

More than 250 different diseases can cause food poisoning. The most common diseases are infections caused by bacteria, such as Campylobacter, Salmonella, Shigella, E. coli, Listeria, and botulism.

The Centers for Disease Control and Prevention (CDC) estimates that in the United States alone, food poisoning causes about 76 million illnesses, more than 300,000 hospitalizations, and up to 5,000 deaths each year. Food poisoning affects between 60-80 million people worldwide each year and results in approximately six to eight million deaths.

Worldwide, diarrhea-related illnesses caused by food and water poisoning are among the leading causes of death. Travelers to developing countries often encounter food poisoning in the form of traveler's diarrhea. Traveler's diarrhea typically develops after ingesting food or water that is contaminated with organisms from feces. These organisms are infectious agents, including various bacteria, viruses, and parasites. The most common cause of traveler's diarrhea is enterotoxigenic Escherichia coli (ETEC) bacteria.

Food poisoning can affect one person or it can occur as an outbreak in a group of people who all ate the same contaminated food.

Infants and elderly people have the greatest risk for food poisoning. Individuals are also at higher risk if they have a serious medical condition, such as kidney disease or diabetes, a weakened immune system, or they travel outside of the United States to areas where there is more exposure to organisms that cause food poisoning. Pregnant and breastfeeding women need to be especially careful.

Heavy metal poisoning:

Aluminum poisoning: Even though aluminum is not considered to be a heavy metal like lead, it can be toxic to the brain and nervous systems.

It is estimated that the normal person takes in between three and ten milligrams of aluminum per day. Aluminum is the most abundant metallic element produced by the earth. It can be absorbed into the body through the digestive tract, the lungs, and the skin. Aluminum can accumulate in the body's tissues. Aluminum is found naturally in the air, water, and soil. It is also used in the process of making cooking pots and pans, utensils, and foil. Other items, such as over-the-counter pain killers, anti-inflammatory products, and douche preparations, can also contain aluminum. Aluminum is an additive in most baking powders, is used in food processing, and is present in antiperspirants, toothpaste, dental amalgams, bleached flour, grated cheese, table salt, and beer (especially when the beer is in aluminum cans). The biggest source of aluminum, however, comes from municipal water supplies.

Excessive use of antacids is also a common cause of aluminum toxicity, especially for those who have kidney problems. Many over the counter type antacids contain amounts of aluminum hydroxide that may be too much for diseased kidneys to handle properly.

Arsenic poisoning: Arsenic is a semi-metallic naturally-occurring chemical. Arsenic is in the environment and all individuals are all exposed to small doses on a regular basis. Arsenic poisoning is difficult to detect as it is generally odorless and flavorless, meaning people have little idea when it is around.

Arsenic can kill humans quickly if consumed in large amounts, although small, long-term exposure can lead to a much slower death or other illness. Studies have linked prolonged exposure to arsenic with cancer, diabetes, thickening of the skin, liver disease, and problems with the digestive system. It has also been associated with nervous system disorders (feeling tingling or losing sensation in the limbs) and hearing difficulties.

Lead poisoning: Lead is a highly toxic substance. Lead exposure can produce a wide range of adverse health effects. Both adults and children can suffer from the effects of lead poisoning, but childhood lead poisoning is much more frequent. Over the many years since it has been known about the hazards of lead, tens of millions of children have suffered its health effects. There are estimates that more than 400,000 children under the age of six in the United States have too much lead in their blood (approximately 1.6% of the U.S. population).

In children, virtually no organ system is immune to the effects of lead poisoning. Perhaps the organ of most concern is the developing brain. Effects of lead on the brain appear to continue into the teenaged years and beyond.

Humans can be exposed to lead through deteriorating paint, household dust, bare soil, air, drinking water, food, ceramics, home remedies, hair dyes, and other cosmetics. Much of this lead is too small to be seen by the naked eye. More often than not, children with elevated blood lead levels are exposed to lead in their own home.

By far the biggest source of concern is the lead paint that is found in older houses. Until 1978, lead paint was commonly used on the interiors and exteriors of homes in the United States. While lead paint that is in intact does not pose an immediate concern, lead paint that is allowed to deteriorate creates a lead-based paint hazard. Lead-based paint can contaminate household dust as well as bare soil around the house, where children may play. A child who comes into contact, usually via hand to mouth, with lead-contaminated dust or soil is easily poisoned. The amount of lead dust equivalent to a single grain of salt for a child can register an elevated blood lead level.

Another way to become exposed to lead is leaded gasoline. Leaded gasoline is now banned in the United States, but may still be around. Leaded gasoline has been deposited into soil. The lead produced by vehicle emissions continues even today to present a hazard, as much of that lead now remains in soil where it was deposited over the years, especially near well-traveled roads and highways. Children who play in dirt contaminated by lead (whether that lead is from gasoline emissions or from deteriorated house paint) can end up with lead-contaminated soil under their fingernails or on their toys or they can track it into their homes. Even pets can come into contact with lead-contaminated soil and cause human exposure to lead. Elevated blood lead levels can easily result from these exposures.

Drinking water can also sometimes contribute to elevated blood lead levels. Lead can leach into drinking water from certain types of plumbing materials (lead pipes, copper pipes with lead solder, and brass faucets). While water is usually not the primary source of exposure to lead for children with elevated blood lead levels, it is nevertheless important to note that formula-fed infants are at an increased risk of lead poisoning if their formula is made with lead-contaminated water. Healthcare professionals recommend testing water for heavy metal contamination at a local health department if the individual has well water or lead pipes.

In adults, lead can increase blood pressure and cause fertility problems, nerve disorders, muscle and joint pain, irritability, and memory or concentration problems. It takes a significantly greater level of exposure to lead for adults than it does for children to sustain adverse health effects. Most adults who are lead poisoned get exposed to lead at work. Occupations related to house painting, welding, renovation and remodeling activities, firing ranges, the manufacture and disposal of car batteries, and the maintenance and repair of bridges and water towers are at an increased risk for lead exposure. Workers in these occupations must also take care not to leave their work site with potentially contaminated clothing, tools, and facial hair, or with unwashed hands. Lead may be spread by contact to family vehicles and ultimately to other family members.

When a pregnant woman has an elevated blood lead level, that lead can easily be transferred to the fetus, as lead crosses the placenta. In fact, pregnancy itself can cause lead to be released from the bone. Lead may be stored in the bone for decades after it first enters the blood stream. Once the lead is released from the mother's bones, it re-enters the blood stream and can end up in the fetus, causing it to be born with an elevated blood level of lead.

Exposure to lead is estimated by measuring levels of lead in the blood (in micrograms of lead per deciliter of blood). The Centers for Disease Control and Prevention (CDC) has set a level of concern for lead in children at 10 micrograms per deciliter. At this level, it is generally accepted that adverse health effects can begin to set in.

Mercury poisoning: Mercury is a neurotoxin, meaning it affects the nervous system. Mercury exposure may lead to excessive mercury levels in the body that can permanently damage or fatally injure the brain and kidneys. Mercury can also be absorbed through the skin and cause allergic reactions. Health problems caused by mercury depend on how much has entered the body, how it entered the body, how long the individual has been exposed to it, and how the individual's body responds to the mercury. People are at risk when they consume mercury-contaminated fish and when they are exposed to spilled mercury.

Mercury vapor is easily transported in the atmosphere, deposited on land and water, and then, in part, released again to the atmosphere. Trace amounts of mercury are dispersed in bodies of water, where bacteria can cause chemical changes that transform mercury to methyl mercury, a more toxic form. Exposures to mercury can result in neurological damage and even death.

For fetuses, infants, and children, the primary health effects of mercury are on nerve development. Even low levels of mercury exposure, such as may be the result of a mother's consumption of methylmercury in dietary sources (such as fish), may negatively affect the brain and nervous system. Impacts on memory, attention, language, and other skills have been found in children exposed to moderate levels in the womb.

Mercury pollution is released into the air from the burning of fossil fuels. It falls down directly onto waterways or is deposited on land where it can be washed into the water. Bacteria in the water cause chemical changes that transform mercury into methylmercury.

Fish absorb methylmercury from water as it passes over their gills and as they feed on aquatic organisms. Larger predator fish, such as swordfish and tuna, are exposed to higher levels of methylmercury from their prey. Methylmercury binds tightly to the proteins in fish tissue, including muscle. Cooking does not significantly reduce the methylmercury content of the fish.

Nearly all fish contain trace amounts of methyl mercury, some more than others. In areas where there is industrial mercury pollution, the levels in the fish can be quite elevated. In general, however, methylmercury levels for most fish range from less than 0.01-0.5 parts per million (ppm). It is only in a few species of fish that methylmercury levels reach the U.S. Food and Drug Administration (FDA) limit for human consumption of 1 part per million. This most frequently occurs in some large predator fish, such as shark, tuna, and swordfish. Certain species of very large tuna, typically sold as fresh steaks or sushi, can have levels over 1 parts per million. Canned tuna, composed of smaller species of tuna such as skipjack and albacore, has much lower levels of methylmercury, averaging only about 0.17 parts per million. The average concentration of methylmercury for commercially important species (mostly marine in origin) is less than 0.3 parts per million.

The FDA works with state regulators when commercial fish, caught and sold locally, are found to contain methylmercury levels exceeding 1 parts per million. The agency also checks imported fish at ports and refuses entry if methyl mercury levels exceed the FDA limit.

Spot-caught predator fresh-water species like pike and walleye sometimes have methylmercury levels in the 1 part per million range. Other fresh-water species also have elevated levels, particularly in areas where mercury levels in the local environment are elevated.

The FDA suggests sports fishers check with state or local governments for advisories about water bodies or fish species. These advisories provide up-to-date public health information on local areas and warn of areas or species where mercury (or other contamination) is of concern.

According to healthcare professionals, pregnant women should not consume more than seven ounces of tuna per week.

Carbon monoxide poisoning:

Carbon monoxide (or CO) is a colorless, odorless gas produced by burning material containing carbon. Carbon monoxide poisoning can cause brain damage and death. Carbon monoxide cannot be sensed or smelled, but it can kill.

Carbon monoxide is the leading cause of accidental poisoning deaths in America. The Centers for Disease Control (CDC) estimates that carbon monoxide poisoning claims about 500 lives, and causes more than 15,000 visits to hospital emergency departments annually.

Carbon monoxide is produced by common household appliances. When not properly ventilated, carbon monoxide emitted by these appliances can build up. Common causes of CO emission include: gas water heaters; kerosene space heaters; charcoal grills; propane heaters and stoves; gasoline and diesel powered generators; cigarette smoke; gasoline powered concrete saws; indoor tractor pulls; any boat with an engine; and spray paint, solvents, degreasers, and paint removers.

Radon poisoning:

Radon is a naturally occurring, odorless, and colorless gas produced by the breakdown of uranium in soil, rock, and water. Because radon is a gas, it can enter buildings through openings or cracks in the foundation. The radon gas itself decays into radioactive solids, called radon daughters. The radon daughters attach to dust particles in the air, and can be inhaled. The inhalation of radon daughters has been linked to lung cancer. Radon exposure generally occurs in the home or workplace.

Other chemical poisoning:

Chemical poisoning is a major public health concern. In 2000, an estimated 95% of all accidental or intentional poisonings were due to chemicals. Nearly 90% of these cases occurred at home. The smallest children, infants and toddlers, are at the highest risk for accidental (acute) poisoning.

There are millions of natural and synthetic chemicals in the world. Approximately 3,000 of them are known to cause significant health problems. Accidental chemical poisoning involving common household or garden products is easy to diagnose and treat, as long as it is recognized early enough. Poisoning due to daily exposure to chemicals is more difficult to diagnose and the extent of damage is more difficult to assess. Toxic chemicals can be found everywhere, such as in the home, yard, at work, on the playground, and even in foods and drinking water. Some chemical poisonings result from illegal dumping. However, many chemical poisonings occur insidiously by the supposedly harmless chemicals that individuals bring into their homes or office to make their lives more comfortable.

Household poisons include trichloroethane (spray cans, insulation, spot removers); tetrachloroethylene (dry-cleaning solutions); formaldehyde (glue, foam, preservatives, plywood, fabrics, insulation); para-dichlorobenzene (P-DCB) (mothballs, air fresheners); toluene (solvents, cleaning fluids, wood finishing products); benzene (gasoline); xylene (paints, finishing products); acetone (nail polish removers); styrene (foam, carpets, adhesives); and carbon tetrachloride (dry cleaning solutions, paint removers).

Carpet contains many chemicals capable of causing nerve damage. These chemicals are toxic to the nervous system and include acetone, benzene, toluene, phenol, xylene, decane, and hexane. Exposure can occur to the fumes released from the carpet, or walking barefoot on the carpet.

Neurotoxic (nerve toxic) chemicals commonly found in household cleaners include: chlorine (dishwasher detergents); ammonia (antibacterial cleaning agents); and petroleum (dish soaps, laundry detergents, floor waxes).

Yard materials that can be toxic to humans and pets include: insecticides, including chlordane, lindane, toxaphene, malathion, diazinon, and nicotine.

Rodenticides (chemicals that kill mice or rats) often contain very toxic chemicals, such as sodium fluoroacetate, phosphorus, thallium, barium, strychnine, methyl bromide, and cyanides.

Workers are often exposed to the toxic effects of various chemicals in their working environment, for example: polluted air, including workers in poorly ventilated plants which manufacture paints, insecticides, fungicides, and pesticides; radiation, including workers in poorly constructed nuclear chemical plants; contaminated environment, including miners who labor underground; obnoxious fumes, including firefighters; and skin contact with toxic chemicals, including crop pickers being accidentally sprayed with insecticides.

Highly processed or prepackaged foods that use various chemical additives to make foods look more attractive, taste better, or store for longer periods of time can be harmful. Harmful substances that can be found in foods include: monosodium glutamate (MSG), a common flavoring agent. Excessive consumption of MSG may cause hyperactivity, memory loss, or other types of brain damage. It is often associated with the so-called "Chinese restaurant syndrome" characterized by headaches, nausea, vomiting, palpitations, and flushing of skin, due to the MSG content in the food; artificial sweeteners, such as aspartame or saccharin. These sweeteners can cause a variety of health problems, including headaches (migraines included), dizziness, seizures, depression, nausea, vomiting, and abdominal cramps. Their use may be associated with hyperactivity in children. Whether or not they may increase the risk of cancer is unknown at this time. Pregnant women should definitely avoid using these sweeteners. Color additives can be found in a variety of foods including cereals, juices, candy, frozen foods, ice cream, cookies, pizza, salad dressings and soft drinks. Children and adults alike may be exposed to cancer-causing artificial colors such as Red numbers eight, nine, 19, and 37 or Orange number 17. Many of the preservatives found in foods are very hazardous. Nitrates, common preservatives in cured and luncheon meats and canned products, are known to cause cancer. In addition, a pregnant woman who consumes large amounts of nitrates (for example, through eating hot dogs or salami) may increase the risk of brain damage in her unborn child. Synthetic antioxidants are used in prepackaged foods to prevent food spoilage. Common synthetic antioxidants, such as butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT), can be found in cereals, baking mixes, or instant potatoes. These products are known to cause brain, liver, and kidney damage, as well as respiratory problems. Fruits and vegetables are healthy foods. However, they may contain dangerous herbicide and pesticide residues on the surface. Fish in contaminated lakes or rivers may contain mercury, dioxin, polychlorinated biphenyls (PCBs), or other polluted chemicals. Babies of mothers who ate contaminated fish during pregnancy have lower birth weight, smaller heads, developmental delays, and lower scores on tests of baby intelligence.

Air pollution can cause or worsen lung or heart diseases and increase the risk of cancer. Chemicals that most often cause pollution in the air and water supply include asbestos, carbon monoxide, hydrogen sulfide, lead, nitrogen oxides, halogenated hydrocarbons, and pesticides. Women exposed to high levels of air pollution, especially caused by vehicles, during the second month of pregnancy may be more likely to have children with heart-related birth defects.

Drug poisoning:

Poisoning can result from an overdose of prescribed drugs such as chemotherapy, digoxin, or lithium, or over-the-counter (OTC) medications, such as acetaminophen (Tylenol?) or aspirin. Drug poisoning can also be caused by drug abuse or drug interactions; however, not all drug interactions are poisonings.

Electrolytes are chemicals normally found in the body, such as potassium and magnesium. However, these electrolytes may also cause toxicity. Hypermagnesemia is a rare electrolyte abnormality in which the kidneys do not get rid of enough magnesium, causing a buildup of the electrolyte. Too much magnesium in the body can cause neurological, heart, and muscle damage. Hyperkalemia is too much potassium in the body. Hyperkalemia can cause a heart attack and death. Too much potassium and too much magnesium in the body can be caused by health conditions, such as kidney disease, or by taking too much of the electrolytes either as a dietary supplement or as a prescribed medication.

Alcohol poisoning:

Alcohol poisoning is a serious and sometimes deadly result of consuming dangerous amounts of alcohol. When the body absorbs too much alcohol, it can directly impact the central nervous system, slowing breathing, heart rate, and the gag reflex. This process can lead to choking, coma, and even death.

Alcohol poisoning most often occurs as a result of drinking too many alcoholic beverages over a short period of time. Binge drinking is a common cause of alcohol poisoning. Alcohol poisoning can also occur by drinking household products that contain ethyl alcohol (ethanol), or by ingesting isopropyl alcohol (isopropanol) or methyl alcohol (methanol; sometimes commonly referred to as wood alcohol).

An individual with alcohol poisoning needs immediate medical attention and should not be left alone. If alcohol poisoning is suspected, it is recommended by healthcare professionals to call the local poison control center or emergency number (911) immediately.

Other poisoning:

Other types of poisonings include snakebites, insect bites (including bees and spiders), plant poisoning (such as Digitalis sp.), and mushroom poisoning (such as Amanita muscaria or Russula subnigricans).