Clinical and Forensic signs resulting from exposure to toxic elements

Abstract

Heavy metals are natural components of the earth's crust and their properties and toxicity have been recognized for thousands of years. Nowadays, most of the use of heavy metals is related to the industry and presents as a major source of environmental and occupational pollution. This results in several potential exposures coming from natural sources (through contamination), industrial processes, commercial products, among others. The toxicity of most metals accrues from their highly reactive nature resulting in the formation of complexes with intracellular compounds that impair cellular pathways leading to dysfunction and apoptosis. The most commonly involved organ systems include the nervous system, gastrointestinal, hematopoietic, renal and dermatological. This manuscript aims to collect the clinical and forensic signs related to the poisoning by heavy metals such as thallium, lead, copper, mercury, iron, cadmium and bismuth, as well as other elements such as arsenic, selenium and fluor. Furthermore, their main sources of occupational and environmental exposure are highlighted in this review. The importance of rapid recognition is related to the fact that, through a high degree of suspicion, the clinician could start a treatment, even before the toxicological results are available, which can make a huge difference in these patients outcomes.