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Chapter: Modern Medical Toxicology: Chemical Poisons: Heavy Metals

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Antimony - Chemical Poisons

The important derivatives of antimony include antimony oxide, antimony trichloride (butter of antimony), antimony sulfide, potassium antimony tartrate (tartar emetic), stibine gas and antimonials used in therapeutics.

Antimony

The important derivatives of antimony include antimony oxide, antimony trichloride (butter of antimony), antimony sulfide, potassium antimony tartrate (tartar emetic), stibine gas and antimonials used in therapeutics.

Uses

·              Alloys

·              Plating

·              Pigments

·              Batteries

·              Ant paste (insecticide)

·              Matches

·              Therapeutics: In the past, tartar emetic was quite popular as an emetic, diaphoretic, and indirect expectorant. Today virtually the only indication for the use of antimonials in medicine is leishmaniasis for which relatively safe pentavalent antimony compounds are used such as sodium stibogluconate and meglumine antimoniate.

·              Antimony trichloride and stibine (which is a gas) are mainly encountered in the industry.

·              Antimony sulfide may be used as kohl to darken the eyebrows, or as collyrium for the eyes in place of lead sulfide (surma).

Clinical Features

·      Ingestion of antimony compounds produces abdominal pain, vomiting, diarrhoea, haematemesis, dermatitis, EEG changes, oliguria, and renal and hepatic failure.

·              Exposure to the dust and fumes may cause gingivitis, rhinitis, chest tightness, shortness of breath, bronchitis, pulmonary oedema, headache, and dizziness.

·      Inhalation of stibine gas (released when antimony alloys are treated with acids) causes respiratory irritation, vomiting, headache, haemolytic anaemia, haematuria, myoglobinuria, and renal failure.

·      Signs and symptoms of chronic exposure may include ECG changes, laryngitis, tracheitis, bronchitis, pneumo-nitis, pneumoconiosis, ulceration of the nasal septum and larynx, and contact allergy to metal. Skin contact with antimony compounds can cause papules and pustules around sweat and sebaceous glands. QT prolongation and T wave changes have been reported on ECG.

·      Side effects associated with pentavalent antimonial therapy include arthralgias, myalgias, and EEG changes, and are usually reversible.

·      Antimony has been found to cause premature births and spontaneous abortions in women, along with growth retardation in children. Russian studies have suggested that workers exposed to antimony have shown sexual dysfunc-tion in males and increased incidence of gynaecological problems in females.

Treatment

·      Chelation with BAL (as in arsenic poisoning).* It is given intramuscularly for 10 days. However, DMSA may be more effective. D-penicillamine is less effective but may be useful. EDTA is not effective.

·      Haemodialysis.

·              Stomach wash may help if the patient is seen early, in the case of oral ingestions.

 

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