| Chromium is primarily used for making steel and other alloys. In the form of chromate, it is used in making bricks for metallurgical furnaces. Chromium compounds are employed in chrome plating, the manufacture of pigments, leather tanning, wood treatment, and water treatment.
Workers in industries that produce chromium-containing products are exposed to possible toxic levels. Other occupations that expose workers to chromium are painting, maintenance and servicing of copying machines and disposal of toner powders from these machines, battery makers, candle makers, dye makers, printers, and rubber makers.
Chromium compounds vary greatly in toxicity depending on the chemical state (valence) and solubility. Health and exposure standards (e.g., American Conference of Governmental Industrial Hygienists [ACGIH]) are divided into categories: 1) Chromium metal and alloys (including stainless steel); 2) Divalent chromium compounds (e.g., chromous chloride, chromous sulfate); 3) Trivalent compounds (e.g., chromic oxide, chromic sulfate, chromic chloride); and 4) Hexavalent compounds (e.g., chromates, dichromates). Certain hexavalent compounds are considered carcinogenic and these compounds tend to be of low solubility in water. Hence the hexavalent compounds are further subdivided into water soluble (e.g., chromic acid) and water insoluble compounds (e.g., zinc chromate).
Acute overexposure health effects include irritation of the mucous membranes. Ulceration or perforation of nasal mucosa of septum is possible. Gastrointestinal complaints, decreased sense of smell and yellow staining of the teeth and tongue can occur. High doses can cause renal disorders and liver failure. Chromium is a sensitizer and can cause allergic contact dermatitis in susceptible individuals. Chromium is an acknowledged human carcinogen. Long term effects include increased risk of lung, sinus, and gastrointestinal cancers. |
Source: Medical Disability Advisor
| History: Water soluble hexavalent chromium compounds are severe irritants of the upper tract, lungs and skin. They are associated with effects such as ulcerations of the skin and nasal mucosa, rhinitis, nosebleed, asthma, pulmonary edema, dermatitis (both irritant and allergic), erosion and discoloration of the teeth, and kidney damage. Symptoms such as vomiting, diarrhea, and liver failure can lead to anemia and the blood may have trouble clotting. Physical exam: Patients may experience wheezing and rales on lung exam secondary to edema. Ulcerations can be seen when the skin is examined. When looking at the mouth the discolored teeth can be viewed. Tests: Chromium levels can be measured in blood, urine and hair. However, there are significant limitations in using any of these tests to determine if an individual has excessive chromium exposure or health effects related to chromium. Background chromium levels in air, food and water, and individual variation in metabolism of chromium makes it difficult to interpret results. Differential diagnosis must be considered when using any of these tests to establish if an individual has had excessive exposures or problems related to chromium.
Diagnosis of chromium dermatitis requires patch testing for allergy. |
Source: Medical Disability Advisor
| Patients with contact dermatitis or true asthma will often require job transfer because of sensitivity to even small exposures. Water, thiosulfate or phosphate buffer can be used to rinse the chromic acid burn. Holes in the skin and nose will heal once exposures are reduced. Chromic acid burns can be treated with topical and systemic chelating agents. Chromic acid burns may need to be treated with peritoneal dialysis or by hemodialysis 24 hours after the burn occurs. Rapid wide excision is recommended then skin grafting if the burn covers more than 2% total body surface area (Laws). Hexavalent chromium ingestion needs nasogastric tube placed quickly for aspiration. |
Source: Medical Disability Advisor
| The prognosis for recovery is good where the individual has received prompt, effective, and appropriate treatment. Symptoms may disappear when exposure is eliminated and proper worker protection provided.
Exposure to chromium fumes can cause metal fume fever. Severe cases of exposure can cause convulsions and death. Chromium toxicity may cause adverse effects in the kidney (nephritis) and liver, and in the immune system. Chronic exposure has been associated with cancer of the lung, skin ulcers, and dermatitis. |
Source: Medical Disability Advisor
| Any toxic condition caused by chromium may warrant rehabilitation if the condition results in general weakness and/or affects the respiratory system. Once initial symptoms are stabilized and a physician determines no contraindications for physical activity, a gradual strengthening program is initiated by the rehabilitation professional.
For the individual with breathing difficulties, respiratory exercises to improve ventilation may be assigned. Rehabilitation uses several techniques to assist the muscles that aid in breathing. These may include instructing the individual to assume relaxed sitting postures, and strengthening secondary respiratory muscles.
Once breathing returns to normal, individuals rehabilitating from this toxic condition progress to strengthening and endurance exercises with aerobic-type activities that increase the individual's ability to work and helps them resist fatigue. As endurance increases without symptoms of shortness of breath, the individual begins active upper and lower extremity exercises with progressive resistance using free weights and/or weight machines. Frequency of the program may vary somewhat depending on the individual's general health. If tolerated, the individual performs strengthening exercises 3 times a week and aerobic activities on the non-strengthening days of the program.
The rehabilitation program varies for individuals affected by the toxic effects of chromium. The intensity and progression of exercises depends on the body organs affected, specifically the respiratory system, and the individual's overall health. |
Source: Medical Disability Advisor
| Patients may suffer GI bleeding, emesis, kidney or liver failure, anemia, neurological disorders and problems with coagulation from chromium that has gotten into the blood. |
Source: Medical Disability Advisor
| The current national interim primary drinking water regulation for chromium (VI) proposed by the Environmental Protection Agency (EPA) is 0.05 milligram per liter (mg/L).
Occupational Safety and Health Administration (OSHA) legal airborne permissible exposure limit (PEL) to chromium is 1 milligram per cubic meter averaged over an 8-hour work shift ("NIOSH").
The National Institute of Occupational Safety and Health (NIOSH) recommended airborne exposure limit to chromium is 0.5 milligram per cubic meter averaged over a 10-hour work shift ("NIOSH").
The American Conference of Governmental Industrial Hygienists (ACGIH) recommended airborne exposure limit to chromium is 0.5 milligram per cubic meter averaged over an 8-hour work shift ("NIOSH").
The individual should avoid skin contact with chromium and wear protective gloves and clothing. All protective clothing (suits, gloves, footwear, and headgear) should be clean, available each day, and put on before work. The individual should also wear impact-resistant eye protection with side shields or goggles. A face shield along with goggles should be worn when working with corrosive, highly irritating or toxic substances.
Where the potential for high exposure exists, a MSHA/NIOSH-approved supplied air respirator with a full face piece operated in a pressure-demand or other positive-pressure mode should be used. For increased protection, it should be used in combination with an auxiliary self-contained breathing apparatus operated in a pressure-demand or other positive-pressure mode.
Exposure to 250 mg/cubic meter is immediately dangerous to life and health. If the possibility of exposure above 250 mg/cubic meter exists, a Mine Safety and Health Administration (MSHA)/NIOSH approved self-contained breathing apparatus with a full face piece operated in a pressure-demand or other positive-pressure mode should be used.
Length and levels of chromium exposure in the workplace must be monitored. The individual may need special training to handle the chemical.
The EPA limits chromium levels in drinking water to 0.1 mg/L. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Did individual present with symptoms consistent with the diagnosis of chromium toxicity?
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Did individual have a known exposure to chromium, such as in the workplace, home, community or during recreational activities?
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Is there a genetic history for the complaint, i.e., liver or kidney abnormalities, gastrointestinal disorders, psychiatric disturbances?
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Is the clinical illness, including the history, physical examination, and laboratory findings consistent with the diagnosis of chromium toxicity?
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Is the exposure dose within the range of doses believed to cause such effects?
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Would individual benefit from consultation with a specialist?
Regarding treatment:
- Was the treatment appropriate for the type of exposure and severity of symptoms?
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Did symptoms persist?
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Were other more aggressive treatments, such as administering metal complexing agents considered?
Regarding prognosis:
- Did individual have any conditions that may complicate treatment? What was the expected outcome?
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Source: Medical Disability Advisor
| Laws, Richard. "Burns, Chemical." eMedicine. Eds. Smeena Khan-Sabir, et al. 17 Nov. 2004. Medscape. 29 Dec. 2004 <http://emedicine.com/derm/topic777.htm>. U.S. Department of Health and Human Services. NIOSH Pocket Guide to Chemical Hazards. Centers for Disease Control and Prevention, 2004. Centers for Disease Control and Prevention. 29 Dec. 2004 <http://www.cdc.gov/niosh/npg/npg.html>. |
Source: Medical Disability Advisor
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