Heavy metal

toxicity

 Reinsch test
 Chelators.
 Reinsch test

 the classical Reinsch test is :

an adequate presumptive procedure to indicate

whether or not heavy metals are present in
biological samples.
Reinsch test

 The procedure is based on the fact that copper will be

displaced by elements below it in the electrochemical
series.

 Antimony, arsenic, bismuth and mercury will deposit on a

copper wire or copper strip and the resulting discolored
copper is an indication of a positive result.
Advantages of Reinsch
test:

 This screening test is rapid, sensitive, reliable, and can be

used on

 biological fluids or tissue homogenates without extensive

preliminary treatment.

 The test is sensitive to approximately 0.5 mg/L of arsenic,

1.0 mg/L of antimonyand bismuth and 2.5 mg/L of
mercury.
Disadvantages;

 It is a qualitative test only (Not quantitative)

 Can't differentiate between acute and chronic poisoning.

 Reagent used:

1. Hcl: diluted and pure

2. H2O before Hcl
3. Decanitation
4. Descend of cu foil
5. Drying.
Definition of sublimation:

 Transfer of a substance from a solid state to a

gas state without passing into a liquid state.
Precautions of sublimations:
1. Dry and clean sublimation tube
2. Weak and blue flame
3. Heat base of tube only
4. The tube should be inclined at 45 o
5. Opening of tube not facing anyone
Confirmatory tests of heavy
metal detection:

1. Atomicabsorption spectrophotometry

2. Gas chromatography (GC)

3. Liquid chromatography

4. High performance liquid chromatogrphy .(HPLC)

Mercury crystals:

 Sublimation tube of

 Reinsch test

 Crystals: Black spherical

globules of variable sizes

 Poison is mercury , reagent

is hydrochloric acid.
 2010

MERCURYblack spherical
globules of various sizes
  Arsenic crystals:
Sublimation tube of

Reinsch test

Crystals: Tetrahedral
&octahedral crystals of
variable sizes

Poison is arsenic , reagent is

hydrochloric acid..
2010
Chelators (Metals antidotes)
These are chelating agents which combine with
metals forming non toxic compounds that are
rapidly excreted in urine.
An ideal chelating agent would have the
following properties

 Possesses high water solubility.

 Resistance to metabolic degradation.

 Forming tight bonds with metals that are soluble and non
toxic at physiological pH values.

 Has a greater affinity for the metal than the ligands of

tissue.

 Able to penetrate into tissue areas of metal storage.

 Has low affinity for calcium.

 BAL [British anti-lewisite, Dimercaprol]
 Types:

• Oil

• Ointment

• Eye drops

 Mechanism of action:

 Metals bind to SH- containing respiratory enzymes  (lead to its

inactivation)

 BAL has 2- SH groups  can attract the metals that have a

great affinity for SH group., forming non toxic rapidly excreted
com pound.
 Dose:

• 2.5mg/kg/6hrs for 2 days

• 2.5 mg/kg/12hrs for 1 week [I.M]

 Uses:

To chelate:

• Lead

• Arsenic

• Mercury

• Gold

• Bismuth
Disadvantages

 It is not used in iron toxicity, as the iron – BAL complex is

toxic

 Hemolysis in G6-PD deficient patients

 ++B.P and ++temp

 DMSA [Dimercap to succinic acid]
 Is an analogue of BAL.

 Dose:

10mg/kg/8 hrs for 5 dys

10mg/kg/12 hrs for 2 weeks [orally]

 Uses:

To chelate:

• Lead

• Arsenic

• Mercury
 Advantages:

1) It can be used in iron toxicity.

2) No Hemolysis in G-6 PD deficient patients

3) Less toxic

4) Has minimal effect on essential elements

EDTA [Ethylene diamine tetra acetic
acid]

 Types:

1) Ca disodium EDTA.

2) Disodium EDTA

3) Dicobalt EDTA

[Kelocyanor]
Mechanism of action

 Ca disodium EDTA combines with metal nontoxic and

rapidly excreted compound [the metal replace calcium]

 Ca salt is used to prevent hypocalcaemia which can

occur due to the high affinity of EDTA to Ca lead to Ca
loss in the excreted compound
 Dose:

1 gram in 250 saline twice daily for 5 days.[IV infusion]

 Uses:

1) Calcium disodium EDTA is used in Lead poisoning

2) Disodium EDTA is used in digitalis poisoning

3) Dicobalt edta is used in cyanide poisoning

 Another Chelators
 Deferoxamine [Desferal]

Used to treat iron toxicity.

It readily competes for the iron of ferritin and hemosiderin, but the iron of
transferrin is minimally affected. The iron of cytochromes and
hemoglobin is inaccessible to deferoxamine.

Dose: available as 500 mg ampoules one gram followed by ½ g/4 hrs for
2 days.

 Penicillamine [Curprimine]

It is prepared by hydrolic degradation of penicillin.

Uses: Used to treat lead, mercury, zinc and copper.

Dose : 1capsule (250mg)/ 6 hrs for 20 days on empty stomach to avoid

interference by dietary metals.