Nickel toxicity - Revision history

Danbot: Remove refs with incorrect PMIDs (verified against PubMed)

2026-03-22T10:24:50Z

Remove refs with incorrect PMIDs (verified against PubMed)

← Older revision		Revision as of 10:24, 22 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*Nickel is a white, lustrous metal~~<ref>Sunderman FW Jr. A review of the metabolism and toxicology of nickel. Ann Clin Lab Sci. 1977;7(5):377-398. PMID 199128</ref>~~		*Nickel is a white, lustrous metal
	*Has extensive industrial and occupational uses, especially in the production of metal alloys		*Has extensive industrial and occupational uses, especially in the production of metal alloys
	*Elemental nickel, as well as nickel oxide and sulfate compound exposures, are common during the incineration, smelting, and refining of metal ores		*Elemental nickel, as well as nickel oxide and sulfate compound exposures, are common during the incineration, smelting, and refining of metal ores

Danbot: Add peer-reviewed reference

2026-03-22T10:09:12Z

Add peer-reviewed reference

← Older revision		Revision as of 10:09, 22 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*Nickel is a white, lustrous metal		*Nickel is a white, lustrous metal<ref>Sunderman FW Jr. A review of the metabolism and toxicology of nickel. Ann Clin Lab Sci. 1977;7(5):377-398. PMID 199128</ref>
	*Has extensive industrial and occupational uses, especially in the production of metal alloys		*Has extensive industrial and occupational uses, especially in the production of metal alloys
	*Elemental nickel, as well as nickel oxide and sulfate compound exposures, are common during the incineration, smelting, and refining of metal ores		*Elemental nickel, as well as nickel oxide and sulfate compound exposures, are common during the incineration, smelting, and refining of metal ores

Elcatracho: /* See Also */

2021-03-09T06:55:38Z

Elcatracho: /* Chelation */

2021-03-09T06:54:06Z

Chelation

← Older revision		Revision as of 06:54, 9 March 2021
Line 67:		Line 67:
	===Chelation===		===Chelation===
	*If severe poisoning from nickel carbonyl is suspected give 1 gram diethyldithiocarbamate (DDC) in divided doses (not available in the United States)		*If severe poisoning from nickel carbonyl is suspected give 1 gram diethyldithiocarbamate (DDC) in divided doses (not available in the United States)
	*There is limited evidence for the use of disulfiram in the treatment of nickel carbonyl. No established dosing exists; however, disulfiram is metabolized to two molecules of DDC. Contact your local toxicologist for further guidance in the use of chelators. It is important to note that chelation with disulfiram in the setting of nickel carbonyl is not standard of care.		*There is limited evidence for the use of [[disulfiram]] in the treatment of nickel carbonyl. No established dosing exists; however, disulfiram is metabolized to two molecules of DDC. Contact your local toxicologist for further guidance in the use of chelators. It is important to note that chelation with disulfiram in the setting of nickel carbonyl is not standard of care.

	==Disposition==		==Disposition==

Rossdonaldson1 at 22:37, 12 August 2018

2018-08-12T22:37:28Z

← Older revision		Revision as of 22:37, 12 August 2018
Line 22:		Line 22:
	* Sequelae include a prolonged neurasthenic syndrome		* Sequelae include a prolonged neurasthenic syndrome

	~~==Differential Diagnosis==~~
	===Nickel contact dermatitis===		===Nickel contact dermatitis===
	* Basal cell carcinoma		* Basal cell carcinoma
	* Other type IV delayed hypersensitivity immune reactions		* Other type IV delayed hypersensitivity immune reactions

	===Nickel ~~carbonyl~~===		==Differential Diagnosis==
			===Nickel Carbonyl Differential===
	''Nickel carbonyl exposures should be considered in all relevant occupational or industrial exposures presenting with significant pulmonary, cardiac, or neurological findings. Other occupational and toxicological exposures that should be considered.''		''Nickel carbonyl exposures should be considered in all relevant occupational or industrial exposures presenting with significant pulmonary, cardiac, or neurological findings. Other occupational and toxicological exposures that should be considered.''
	* Manganese		* Manganese
Line 44:		Line 44:
	''Diagnostics should be directed based on symptoms. Non-carbonyl nickel exposures are typically benign and limited to skin complaints; these may require no further work up.''		''Diagnostics should be directed based on symptoms. Non-carbonyl nickel exposures are typically benign and limited to skin complaints; these may require no further work up.''
	Nickel carbonyl exposures require more intensive evaluations including but not limited to:		Nickel carbonyl exposures require more intensive evaluations including but not limited to:
	* ~~Blood~~ gas analysis, CXR in the setting of shortness of breath		* [[Arterial blood gas]] analysis, [[CXR]] in the setting of shortness of breath
	* EKG		* [[EKG]]
	* Liver enzymes		* Liver enzymes
	* Serum electrolytes, including serum creatinine		* Serum electrolytes, including serum creatinine

Rossdonaldson1: /* Disposition */

2018-08-12T22:34:56Z

Disposition

← Older revision		Revision as of 22:34, 12 August 2018
Line 70:		Line 70:

	==Disposition==		==Disposition==
	===Non-nickel ~~carbonyl~~===		===Non-carbonyl nickel===
	Symptomatic care and discharge is acceptable in those with nickel contact dermitis. Educate on the need to avoid jewelry containing nickel.		Symptomatic care and discharge is acceptable in those with nickel contact dermitis. Educate on the need to avoid jewelry containing nickel.
	Minor respiratory symptoms may be dispositioned similar to others with reactive airway disease		Minor respiratory symptoms may be dispositioned similar to others with reactive airway disease

Rossdonaldson1: /* Differential Diagnosis */

2018-08-12T22:33:38Z

Differential Diagnosis

← Older revision		Revision as of 22:33, 12 August 2018
Line 38:		Line 38:
	* Organophosphates / carbamates		* Organophosphates / carbamates
	* Hydrocarbon aspiration		* Hydrocarbon aspiration

			{{Heavy metals list}}

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Chelation= */

2018-02-25T03:47:06Z

Chelation=

← Older revision		Revision as of 03:47, 25 February 2018
Line 63:		Line 63:
	*Hemodialysis is '''ineffective''' due to high protein binding		*Hemodialysis is '''ineffective''' due to high protein binding

	===Chelation====		===Chelation===
	*If severe poisoning from nickel carbonyl is suspected give 1 gram diethyldithiocarbamate (DDC) in divided doses (not available in the United States)		*If severe poisoning from nickel carbonyl is suspected give 1 gram diethyldithiocarbamate (DDC) in divided doses (not available in the United States)
	*There is limited evidence for the use of disulfiram in the treatment of nickel carbonyl. No established dosing exists; however, disulfiram is metabolized to two molecules of DDC. Contact your local toxicologist for further guidance in the use of chelators. It is important to note that chelation with disulfiram in the setting of nickel carbonyl is not standard of care.		*There is limited evidence for the use of disulfiram in the treatment of nickel carbonyl. No established dosing exists; however, disulfiram is metabolized to two molecules of DDC. Contact your local toxicologist for further guidance in the use of chelators. It is important to note that chelation with disulfiram in the setting of nickel carbonyl is not standard of care.

Rossdonaldson1: /* Management */

2018-02-25T03:46:58Z

Management

← Older revision		Revision as of 03:46, 25 February 2018
Line 59:		Line 59:

	==Management==		==Management==
	As with all toxicological exposures, primary efforts after patient stabilization should be directed at decontamination to prevent further exposure.~~<br />~~		*As with all toxicological exposures, primary efforts after patient stabilization should be directed at decontamination to prevent further exposure.
	Supportive care should be directed at airway support. This may include supplemental oxygen, nebulized bronchodilators, and corticosteroids.~~<br />~~		*Supportive care should be directed at airway support. This may include supplemental oxygen, nebulized bronchodilators, and corticosteroids.
	Hemodialysis is '''ineffective''' due to high protein binding~~<br />~~		*Hemodialysis is '''ineffective''' due to high protein binding
	~~<big>~~Chelation~~</big><br />~~
	If severe poisoning from nickel carbonyl is suspected give 1 gram diethyldithiocarbamate (DDC) in divided doses (not available in the United States)~~<br />~~		===Chelation====
	There is limited evidence for the use of disulfiram in the treatment of nickel carbonyl. No established dosing exists; however, disulfiram is metabolized to two molecules of DDC. Contact your local toxicologist for further guidance in the use of chelators. It is important to note that chelation with disulfiram in the setting of nickel carbonyl is not standard of care.~~<br />~~		*If severe poisoning from nickel carbonyl is suspected give 1 gram diethyldithiocarbamate (DDC) in divided doses (not available in the United States)
			*There is limited evidence for the use of disulfiram in the treatment of nickel carbonyl. No established dosing exists; however, disulfiram is metabolized to two molecules of DDC. Contact your local toxicologist for further guidance in the use of chelators. It is important to note that chelation with disulfiram in the setting of nickel carbonyl is not standard of care.

	==Disposition==		==Disposition==

Rossdonaldson1: /* Disposition */

2018-02-25T03:46:14Z

Disposition

← Older revision		Revision as of 03:46, 25 February 2018
Line 75:		Line 75:
	Admit all known or suspected nickel carbonyl exposures due to the potential for delayed pulmonary injury and ARDS		Admit all known or suspected nickel carbonyl exposures due to the potential for delayed pulmonary injury and ARDS

			==See Also==

			==References==
	[[Category:Toxicology]]		[[Category:Toxicology]]

← Older revision		Revision as of 06:55, 9 March 2021
Line 79:		Line 79:

	==See Also==		==See Also==
			*[[Heavy metals]]
			*[[Toxicology (main)]]

	==References==		==References==
	[[Category:Toxicology]]		[[Category:Toxicology]]