Medical Toxicology of Occupational and Environmental Exposures, Volume 1 E-Book

Donald G. Barceloux

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 3172

Veröffentlichungsjahr: 2025

Beschreibung

Medical Toxicology of Occupational and Environmental Exposures is the only reference which comprehensively covers the clinical, analytical, and monitoring information needed by clinicians, students and investigators with interests in metals, radiation, and cancer. The information in all chapters is presented in a cogent, standardized format which greatly simplifies the use of the text as a reference. Reviewed by a distinguished panel of well-known toxicology experts, the information is critically evaluated and authoritative. The interdisciplinary, evidence-based approach is designed to reach beyond clinical settings to increase the scientific understanding of those in associated fields (analytical laboratories, universities, federal and state regulatory and environmental agencies) involved with decisions regarding metals, radiation, and chemical carcinogens. The consistent and concise style allows the reader to quickly locate the appropriate information necessary for informed decisions regarding the sources, host susceptibility, dose-response, clinical effect, health surveillance, and management of exposures to these substances. Additional information is readily available to the interested reader through the detailed bibliography at the end of each chapter.

Volume 1 "Metals and Metalloids: Clinical Assessment, Diagnostic Tests, and Therapeutics" is written to be clinically-oriented with a consistent template, allowing easier access to detailed information on specific metals.

Leseprobe

Table of Contents

Cover

Table of Contents

Title Page

Copyright

Dedication

Foreword

Preface

Acknowledgments

Review Panel

Volume 1 Metals and Metalloids: Clinical Assessment, Diagnostic Tests, and Therapeutics

Chapter 1 Aluminum

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 2 Antimony

Antimony and Antimony Salts

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Stibine Gas (Antimony Hydride)

Stibine Gas

References

Chapter 3 Arsenic

Elemental and Inorganic Arsenic

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Gallium Arsenide

Physiochemical Properties

Exposure

Environmental Fate

Toxicokinetics

Histology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Organic Arsenic

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Arsine

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 4 Antimony

Elemental Barium and Poorly Absorbable Barium Salts

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Absorbable Barium Salts

History

Physiochemical Properties

Exposure

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 5 Beryllium

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 6 Bismuth

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 7 Boron and Boron Compounds

Boron and Borates

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Boric Acid

History

Physiochemical Properties

Exposure

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Boranes

Physiochemical Properties

Exposure

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 8 Cadmium

History

Physiochemical Properties

Exposure

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 9 Chromium

Trivalent

History

Physicochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Hexavalent

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 10 Cobalt

History

Physicochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 11 Copper

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 12 Germanium

History

Physicochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 13 Gold

History

Physiochemical Properties

Exposure

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Presentation

Diagnostic Testing

Treatment

References

Chapter 14 Indium

History

Physiochemical Properties

Exposure

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 15 Iron

History

Physiochemical Properties

Exposure

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 16 Antimony

Elemental and Inorganic Lead

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Organic Lead

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 17 Lithium

History

Physiochemical Properties

Exposure

Environment Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 18 Magnesium

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 19 Manganese

Elemental and Inorganic Manganese

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Potassium Permanganate

Physiochemical Properties

Exposure

Dose Effect

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Treatment

Organic Manganese

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Clinical Response

References

Chapter 20 Mercury

Elemental Mercury

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Inorganic Mercury

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Organic Mercury

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 21 Molybdenum

History

Physiochemical Properties

Exposure

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 22 Nickel

Inorganic Nickel

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Nickel Carbonyl

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 23 Phosphorus and Phosphorus Compounds

Elemental Phosphorus and Bisphosphonates

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Phosphoric Acid and Phosphorus Salts

Physiochemical Properties

Exposure

Toxicokinetics

Clinical Response

Diagnostic Testing

Health Surveillance

Phosphides and Phosphine Gas

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 24 Platinum and Related Metals

Platinum

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Carcinogenicity

Diagnostic Testing

Health Surveillance

Treatment

Palladium

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Rhodium

Physiochemical Properties

Exposure

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 25 Potassium

History

Physiochemical Properties

Exposure

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 26 Rare Earth Elements

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 27 Selenium

Elemental and Inorganic Selenium

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Organic Selenium

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 28 Silver

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 29 Tellurium

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 30 Thallium

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 31 Tin

Metallic and Inorganic Tin

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

Organic Tin

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 32 Titanium

History

Physiochemical Properties

Exposure

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 33 Tungsten

History

Physiochemical Properties

Exposure

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 34 Vanadium

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histsopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 35 Zinc

History

Physiochemical Properties

Exposure

Environmental Fate

Dose Effect

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Chapter 36 Zirconium

History

Physiochemical Properties

Exposure

Environmental Fate

Toxicokinetics

Histopathology and Pathophysiology

Clinical Response

Diagnostic Testing

Health Surveillance

Treatment

References

Index

End User License Agreement

List of Tables

Chapter 1

Table 1.1 Physical properties and identifying information of aluminum and a...

Table 1.2 Estimated aluminum concentration in selected foods. (Adapted from...

Table 1.3 Regulations and guidelines for aluminum exposure.

Chapter 2

Table 2.1 Physical properties and identifying information of antimony and a...

Table 2.2 Physical properties and identifying information of stibine gas.

Chapter 3

Table 3.1 Physical properties and identifying information of elemental arse...

Table 3.2 Physical properties and identifying information of sodium arsenit...

Table 3.3 Clinical features of acute and chronic arsenic toxicity. (Adapted...

Table 3.4 Distribution of arsenic species between plasma and erythrocytes i...

Table 3.5 Speciation of arsenic in hair and nails from residents of West Be...

Table 3.6 Regulations and guidelines for inorganic arsenic exposure includi...

Table 3.7 Some physical properties and identifying information of gallium a...

Table 3.8 Physical properties and identifying information of organic arseni...

Chapter 4

Table 4.1 Physical properties and identifying information of elemental bari...

Table 4.2 Commercial uses of barium salts. (Modified from Johnson and Van T...

Table 4.3 Guidelines and regulations for exposure to metallic barium and in...

Table 4.4 Physical properties and identifying information of absorbable bar...

Table 4.5 Clinical signs and symptoms associated with acute barium toxicity...

Table 4.6 Regulations and guidelines for exposure to soluble barium salts....

Chapter 5

Table 5.1 Identifying information and physical properties of metallic and d...

Table 5.2 Commercial uses of metallic beryllium, beryllium alloys, and bery...

Table 5.3 Histological phases in chronic beryllium disease (CBD). (Kribel e...

Table 5.4 Diagnostic criteria for beryllium‐induced health effects. (Adapte...

Table 5.5 Comparison of findings in chronic beryllium disease, sarcoidosis,...

Table 5.6 Regulatory and guidelines for beryllium exposure.

Table 5.7 Occupational Safety and Health Administration (OSHA) 2017 final r...

Chapter 6

Table 6.1 Clinical features in 698 patients with bismuth encephalopathy. (A...

Chapter 7

Table 7.1 Physical properties and identifying information for boron and sel...

Table 7.2 Regulations and guidelines for exposure to boron compounds.

Table 7.3 Physical properties and identifying information of boric acid.

Table 7.4 Physical properties and identifying characteristics of borane com...

Table 7.5 Regulations and guidelines for exposure to borane compounds.

Chapter 8

Table 8.1 Physical properties and identifying information of cadmium and ca...

Table 8.2 Regulations and guidelines for exposure to cadmium and cadmium co...

Chapter 9

Table 9.1 Identifying information and physical properties of metallic, triv...

Table 9.2 Median erythrocytes and serum chromium concentrations before and ...

Table 9.3 Identifying information and physical properties of hexavalent chr...

Table 9.4 Guidelines and regulations for metallic chromium and chromium com...

Chapter 10

Table 10.1 Identifying information and physical properties of metallic coba...

Table 10.2 Commercial uses of cobalt compounds. (IARC).

16

Table 10.3 Guideline and regulatory limits for exposures to metallic cobalt...

Table 10.4 Suggested guidelines for health surveillance of hard metal worke...

Chapter 11

Table 11.1 Identifying factors and physical properties of copper and copper...

Table 11.2 Copper‐containing enzymes and their functions. (Adapted from Ste...

Table 11.3 Copper regulations and guidelines.

Chapter 14

Table 14.1 Physical and chemical characteristics of indium and indium phosp...

Table 14.2 Regulations and guidelines for exposure to indium and indium com...

Chapter 15

Table 15.1 Elemental iron content in various iron salts.

Table 15.2 Elemental iron content of representative iron products. (Manogue...

Table 15.3 Peak serum iron concentrations and expected clinical effects.

Table 15.4 Regulations and guidelines for exposure to iron and iron compoun...

Chapter 16

Table 16.1 Identifying characteristics and physical properties of lead and ...

Table 16.2 Current and previous lead uses. (Adapted from Centers for Diseas...

Table 16.3 Potential sources of childhood lead toxicity. (Adapted from Wool...

Table 16.4 Some historical average and upper range concentrations of lead c...

Table 16.5 Observed lower thresholds of blood lead levels associated with s...

Table 16.6 Summary of National Toxicology Program conclusions on the health...

Table 16.7 Relative risk of mortality in NHANES III participants categorize...

Table 16.8 Clinical features associated with grades of acute lead toxicity ...

Table 16.9 Clinical manifestations of chronic lead toxicity in adults corre...

Table 16.10 General interpretation of free erythrocyte protoporphyrin (FEP)...

Table 16.11 Approximate correlation of blood and tibial lead levels in an a...

Table 16.12 Mean lead concentrations in shed deciduous teeth from children ...

Table 16.13 Guidelines for the median lead intake when using the EPA integr...

Table 16.14 Adult parameters for the calculation of blood lead concentratio...

Table 16.15 Regulations and guidelines for inorganic lead exposure.

Table 16.16 Recommended actions for pediatric screening of confirmed venous...

Table 16.17 Medical actions required by OSHA based on blood lead levels. Th...

Table 16.18 Minimum components for medical evaluation of lead‐exposed worke...

Table 16.19 Potential sources of lead exposure. (Based on Roper).

81

Table 16.20 Simple methods to reduce lead exposure.

Table 16.21 Recommendations for chelation of symptomatic and asymptomatic c...

Table 16.22 Recommendations for chelation in lead‐exposed adults.

Table 16.23 Identifying information and physical properties of some organic...

Chapter 17

Table 17.1 Drug interactions with lithium. (Adapted from Timmer and Sands)....

Table 17.2 Clinical manifestations associated with serum lithium concentrat...

Chapter 18

Table 18.1 Average magnesium content of various foods. (Adapted from Gums).

Table 18.2 Clinical settings associated with hypermagnesemia.

Table 18.3 Clinical effects of specific serum magnesium levels. The typical...

Table 18.4 Factors altering serum magnesium concentrations. (Adapted from G...

Table 18.5 Regulations and guidelines for exposure to magnesium compounds....

Chapter 19

Table 19.1 Identifying information and physical properties of elemental man...

Table 19.2 Common uses of manganese compounds. (Based on Agency for Toxic S...

Table 19.3 Occupational and environmental exposure standards for manganese....

Table 19.4 Identifying information and physical properties of potassium per...

Table 19.5 Identifying information and physical properties of organic manga...

Chapter 20

Table 20.1 Identifying information and physical properties of elemental mer...

Table 20.2 Mercury vapor guidelines and regulations.

Table 20.3 Identifying information and physical properties of inorganic mer...

Table 20.4 Inorganic mercury guidelines and regulations.

Table 20.5 Identifying information and physical properties of organic mercu...

Table 20.6 Short‐chain alkyl organic mercury guidelines and regulations. Fo...

Chapter 21

Table 21.1 Identifying information and physical properties of molybdenum an...

Chapter 22

Table 22.1 Physiochemical properties of selected nickel compounds.

Table 22.2 Regulations and guidelines for exposure to metallic nickel and n...

Table 22.3 Identifying information and physical properties of nickel carbon...

Chapter 23

Table 23.1 Identifying information and physical properties of white phospho...

Table 23.2 Guidelines and regulations for white phosphorus.

Table 23.3 Identifying information and physical properties of common phosph...

Table 23.4 Guidelines and regulations for exposure to some phosphorus compo...

Table 23.5 Physiochemical characteristics of phosphine gas. (Based on Ameri...

Table 23.6 Guidelines and regulations for exposure to phosphine gas.

Chapter 24

Table 24.1 Identifying information and physical properties of platinum and ...

Table 24.2 Identifying information and physical properties of metallic pall...

Table 24.3 Guidelines and regulations for exposure to rhodium and rhodium c...

Chapter 25

Table 25.1 Common and chemical names of potassium‐containing potash salts. ...

Table 25.2 Drug‐induced hypokalemia and associated mechanisms of action.

Table 25.3 Clinical features of hyperkalemia. The clinical presentation dep...

Table 25.4 Dextrose administration based on initial serum glucose concentra...

Table 25.5 High‐potassium foods. (Adapted from Gennari).

29

Chapter 26

Table 26.1 Identifying information and physical properties of rare earth el...

Table 26.2 Uses for rare earth elements. (Adapted from Hirano and Suzuki).

4

Table 26.3 Maximum rare earth concentrations (C

max

) in the snow next to a R...

Table 26.4 Mean rare earth element concentrations of 14 lanthanides in seru...

Table 26.5 Analytical results from the study of urine samples from 58 healt...

Chapter 27

Table 27.1 Identifying information and physical properties of selenium and ...

Table 27.2 Guidelines and regulations for selenium compounds. (Adapted from...

Table 27.3 Identifying information and physical properties of selenocystine...

Chapter 28

Table 28.1 Identifying information and physical properties of silver and si...

Table 28.2 Identifying information and physical properties of silver and si...

Chapter 29

Table 29.1 Regulations and guidelines for exposure to tellurium and telluri...

Chapter 30

Table 30.1 Identifying information and physical properties of metallic thal...

Table 30.2 Regulations and guidelines for exposure to thallium. (Adapted fr...

Chapter 31

Table 31.1 Identifying information and physical properties of tin and inorg...

Table 31.2 Regulatory levels and guidelines for elemental and inorganic tin...

Table 31.3 Identifying information and physical properties of monomethyl‐, ...

Table 31.4 Some physiochemical properties of selected organic tin compounds...

Table 31.5 Regulations and guidelines for organic tin exposure. (Based on F...

Chapter 32

Table 32.1 Commercial uses for titanium and titanium compounds. (Adapted fr...

Chapter 33

Table 33.1 Identifying information and physical properties of elemental tun...

Table 33.2 Occupations with potential exposure to tungsten or tungsten comp...

Table 33.3 Blood tungsten concentrations in studies of patients presenting ...

Table 33.4 Urine tungsten concentrations in two studies of patients present...

Table 33.5 Guidelines and regulations for exposure to tungsten in workplace...

Chapter 34

Table 34.1 Identifying data on vanadium and vanadium compounds. (Adapted fr...

Table 34.2 Physiochemical data for vanadium and vanadium compounds. (Adapte...

Table 34.3 Regulations and recommendations for exposure to vanadium and sel...

Chapter 35

Table 35.1 Identifying information and physical properties of zinc and zinc...

Table 35.2 Uses of zinc compounds. (Adapted from Knapp et al.).17

Table 35.3 Guidelines and regulations for zinc compounds.

List of Illustrations

Chapter 3

Figure 3.1 Chemical structures of toxicologically relevant trivalent arsenic...

Figure 3.2 The classic pathway for biotransformation of inorganic arsenic. T...

Figure 3.3 Alternate biotransformation pathways for inorganic arsenic. The m...

Chapter 4

Figure 4.1 Plasma barium concentrations in a 22‐year‐old man after ingesting...

Chapter 8

Figure 8.1 Blood cadmium elimination curve of two copper‐cadmium alloy facto...

Chapter 11

Figure 11.1 Elimination of copper from the human body.

Chapter 13

Figure 13.1 Therapeutic gold compounds.

1

. Sodium aurothiomalate (Myocrisin

®

...

Chapter 16

Figure 16.1 Three‐compartment model of lead distribution based on tracer and...

Figure 16.2 Schematic representation of the effects of lead on three lead‐se...

Chapter 17

Figure 17.1 Schematic representation of the antidiuretic effect of vasopress...

Chapter 20

Figure 20.1 Mercury transformation in air, water, and sediment. Dashed lines...

Chapter 22

Figure 22.1 Common uses of nickel. (a) Nickel use by product, (b) Nickel use...

Chapter 23

Figure 23.1 Chemical structures and relative potencies of bisphosphonate der...

Chapter 25

Figure 25.1 Early electrocardiographic changes demonstrating peaked T waves ...

Figure 25.2 QRS widening and P wave loss as serum potassium concentration ap...

Figure 25.3 Continued QRS widening as rhythm becomes more sinusoidal when th...

Chapter 27

Figure 27.1 Effect of pH and redox potential (

E

h

) on selenium speciation in ...

Figure 27.2 Inorganic and organic selenium metabolism.

Abbreviations:

dimeth...

Figure 27.3 Chemical structure of selenocysteine, selenomethionine, and othe...

Figure 27.4 Schematic representation of selenium dissipation in soil. The pr...

Guide

Cover Page

Table of Contents

Title Page

Copyright

Dedication

Foreword

Preface

Acknowledgments

Review Panel

Begin Reading

Index

End User License Agreement

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MEDICAL TOXICOLOGY OF OCCUPATIONAL AND ENVIRONMENTAL EXPOSURES

Volume 1

Metals and Metalloids: Clinical Assessment, Diagnostic Tests, and Therapeutics

DONALD G. BARCELOUX, MD, FAACT, FACMT, FACEP

CONSULTANT, MEDICAL TOXICOLOGY

DONALD G. BARCELOUX, M.D., INC.

EMERITUS PHYSICIAN

DEPARTMENT OF EMERGENCY MEDICINE

POMONA VALLEY HOSPITAL MEDICAL CENTER

POMONA, CALIFORNIA

EMERITUS PARTNER, VITUITY

EMERYVILLE, CALIFORNIA

CLINICAL PROFESSOR OF MEDICINE, 2002‐2023

DEPARTMENT OF EMERGENCY MEDICINE

OLIVE VIEW/UNIVERSITY OF CALIFORNIA AT LOS ANGELES MEDICAL CENTER

SYLMAR, CALIFORNIA

Edited by

ROBERT B. PALMER, PhD, DABAT, FAACT

ROCKY MOUNTAIN POISON AND DRUG SAFETY

DENVER, COLORADO

SECTION OF MEDICAL TOXICOLOGY

DEPARTMENT OF EMERGENCY MEDICINE

UNIVERSITY OF COLORADO SCHOOL OF MEDICINE

AURORA, COLORADO

TOXICOLOGY ASSOCIATES, PLLC

LITTLETON, COLORADO

Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.

Published simultaneously in Canada.

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Library of Congress Cataloging‐in‐Publication Data Applied for

Hardback ISBN: 9781119881247

Cover design: Wiley

To My Wife, Kimberly,

Fifty years ago, a chance meeting in the Rome Train Station led to a life full of love, companionship, and a conversation that has continued through all these years. Your counsel and support made all the difference and life worthwhile.

To my adult children (Colin and Shannon) and their spouses (Taylor and Michael),

I am proud of your accomplishments, compassion, resilience, and the knowledge the world is a better place because of your presence.

Donald G. Barceloux, MD

To My Wife, Karen,

We intended to try to benefit the professional organizations through those endless committee and board meetings. Little did I know I would be the true beneficiary. Your love, kindness, and friendship, not to mention sage counsel, far exceed anything I could have ever hoped for.

To my daughter Abigail, who knows far more about metals chemistry than I ever will, and her husband, Michael.

Your accomplishments are immense. But the real joy is the two of you falling for one another – beginning far too literally with a skydiving adventure.

Robert B. Palmer, PhD

FOREWORD

The multivolume Medical Toxicology of Occupational and Environmental Exposures covering metals, radiation, and cancer is the eagerly awaited third instalment in the seminal series of medical toxicology textbooks written by Dr. Donald G. Barceloux. The first two books focused on natural substances and drugs of abuse, respectively, and have quickly established themselves as reference works in their respective fields. The comprehensive coverage of topics coupled with a consistent and easy‐to‐follow organization of content have made them indispensable companions of physicians and researchers alike. The newest addition to the series, created by Dr. Barceloux and edited by Dr. Robert B. Palmer, is a worthy successor to the first two books. Once again, the focus is on naturally occurring and man‐made toxic threats that all medical toxicologists will have heard of but few will have had first‐hand experience with. This is precisely what makes this work so valuable.

The first volume literally comprises an A–Z of all there is to know about the clinical toxicology of metals and metalloids, from aluminum to zirconium. The 36 chapters naturally include well‐known toxic metals such as arsenic, cadmium, lead, and mercury on which there is a wealth of clinical and monitoring data available. Summarizing and organizing this information makes these chapters almost textbooks in their own right, covering their subjects in a breadth and depth rarely seen in other publications. This is exemplified by the chapter on arsenic which not only covers the well‐known toxic inorganic arsenicals but also includes sections on gallium arsenide, organic arsenic, and arsine gas. Even chapters on metals that are rarely encountered in clinical practice offer a wealth of information, e.g. the chapter on beryllium boasts 167 references. And who would know where to look for information on the toxicokinetics of rare earths, or whether tellurium is a human teratogen? It is the attention to this kind of detail that sets Medical Toxicology of Occupational and Environmental Exposures: Metals and Metalloids apart.

In contrast to standard textbooks on clinical toxicology, Medical Toxicology of Occupational and Environmental Exposures: Metals and Metalloids is not only aimed at those working in the treatment of the poisoned patient. As the most comprehensive source of information in its field, it will equally be an invaluable reference for occupational physicians and hygienists as well as scientists and researchers in environmental health disciplines. Indeed, anyone concerned with the human health risk assessment and risk management of exposure to metals and metalloids, whether they work in regulatory agencies, industry, or universities, will benefit from this truly interdisciplinary work that will stand the test of time.

Martin F. Wilks MD PhD ERT FRCP (Edin) FBTS FEAPCCT

Former Director

Swiss Centre for Applied Human Toxicology

Emeritus Adjunct Professor of Toxicology

Department of Pharmaceutical Sciences

University of Basel, Switzerland

Past‐President of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT)

Secretary‐General of the Federation of European Toxicologists & European Societies of Toxicology (EUROTOX)

President‐Elect, International Union of Toxicology (IUTOX)

PREFACE

This volume, Metals and Metalloids, in the multivolume Medical Toxicology of Occupational and Environmental Exposures is a continuation of the Medical Toxicology Series that began with Medical Toxicology of Natural Substances: Foods, Fungi, Medicinal Herbs, Plants, and Venomous Animals and Medical Toxicology of Drug Abuse: Synthesized Chemicals and Psychoactive Plants. The Medical Toxicology Series provides in‐depth, evidence‐based coverage of the most important human toxins. Similar to the rest of the Medical Toxicology Series, the goal of this volume is the creation of a comprehensive and convenient reference to answer questions regarding medical toxicology issues. The volume on Metals and Metalloids presents the basic and clinical science associated with exposure to these elements and their compounds.

The reader will recognize the similarities of the template in this volume with the template in previous books in the Medical Toxicology Series. This organizational consistency allows easy location of the appropriate information necessary for decisions regarding properties, sources, effects, regulation, and management of toxic exposures to metals and metalloids. General section headings include history, identifying information, physical characteristics, exposure, environmental fate, dose effect, toxicokinetics, histopathology, clinical response, diagnostic testing, health surveillance, and treatment.

Medical toxicology is a field often dependent on relatively weak scientific evidence (case reports, case series, retrospective analyses), resulting in the increased risk of perpetuating equivocal treatment regimens and even folklore. This volume provides the relevant evidence base to determine the clinical consequences, treatment, and safety measures important for the reduction of injury from excessive exposures to metals and metalloids. References are documented to validate the information and provide sources for further inquiry. Although this unique volume provides a medical toxicologist's perspective for exposures to metals and metalloids, the coverage contains input from a variety of disciplines including other clinical specialties, public health physicians, and research scientists. Since guidelines and regulations change with time, the organizations' websites should be consulted for any updates of specific guidelines and regulations.

The choice of topics in this volume reflects our desire to expand communication between medical toxicologists and practitioners in related fields. Our hope remains that this interdisciplinary, evidence‐based approach will increase communication between traditional clinical settings and fields aligned with medical toxicology including those in laboratories, academic settings, and regulatory agencies. We anticipate this approach will encourage more inquiry into the pathophysiology, clinical effects, biomarkers, treatment, and prevention of illnesses related to metal and metalloid exposures.

Donald G. Barceloux, MD, Author

Robert B. Palmer, PhD, Editor

November 26, 2024

ACKNOWLEDGMENTS

I thank the following colleagues for their contributions to the quality, depth, and accuracy of Medical Toxicology of Occupational and Environmental Exposures: Metals and Metalloids.

John Wiley & Sons' Staff

Dr. Andreas Sendtko, Senior Managing Editor, Physical Sciences Books, whose dedication and patient guidance guaranteed the accuracy of the printing process and the quality of these books.

Bob Esposito, former Senior Editor, made our Medical Toxicology Book Series a reality by believing in the importance of a highly detailed, structured series covering the expanding field of Medical Toxicology.

Jeyabalan Jeyaraj and Jananee Sekar did an outstanding job of copyediting.

Summers Scholl, Executive Editor, was instrumental in bringing the Medical Toxicology Series to our audience.

Pomona Valley Hospital Medical Center

I admire the dedication and perseverance of the physicians, nurses, and the Emergency Department staff in times complicated by COVID‐19, difficult medical problems, and complex social issues. In particular, I appreciate the support of the physician staff including Howard Friedman; Ivan Schatz; Richard Dorosh; Ken Nakamoto, past Vice President of Medical Affairs; Ken Moore, former Medical Director Emergency Department; and James Kim, Medical Director, Emergency Department.

UCLA Emergency Department Colleagues

I appreciate all our colleagues who shared their expertise and clinical experience at UCLA Conferences, especially Gregory W. Hendey, MD, Department Chair; Steven Lai, MD, Assistant Program Director, Olive View‐UCLA; Richelle J. Cooper, MD, UCLA Emergency Department Research Director; Lynne B. McCullough, MD, UCLA ED Medical Director; Pamela Dyne, MD, Associate Program Director, Olive View‐UCLA; Michael Levine, MD, Toxicology; Cynthia Koh, MD; Eric A. Savitsky, MD; Luis Lovato, MD, Informatics; and Matthew Waxman, MD.

UCLA Librarians

Writing a book series is not possible without the support of the UCLA Biomedical Library, especially Juan Jaime, Access Services Manager, UCLA Science Libraries.

DONALD G. BARCELOUX, MD

REVIEW PANEL

The critical reviews and clinical insights of the distinguished Review Panel were much appreciated as an invaluable method to validate the scientific basis of Medical Toxicology of Occupational and Environmental Exposures: Metals and Metalloids.

William Banner MD, PhD

Medical Director, Oklahoma Center for Poison and Drug Information

College of Pharmacy, University of Oklahoma

Oklahoma City, OK, USA

Ziad Kazzi, MD

Associate Professor, Department of Emergency Medicine

Emory University

Atlanta, GA, USA

Michael Brett Marlin, MD

Assistant Professor, Department of Emergency Medicine

Assistant Medical Director, Mississippi Poison Control Center

University of Mississippi Medical Center

Jackson, MI, USA

Rama B. Rao, MD, FACMT

Associate Professor of Medicine

Weill Cornell Medical College of Cornell University

Chief, Division of Medical Toxicology

Emergency Physician

New York – Presbyterian Hospital

New York, NY, USA

Shawn M. Varney, MD, FACEP, FAACT, FACMT

Professor of Emergency Medicine

Medical Director, South Texas Poison Center

University of Texas Health ‐ San Antonio

San Antonio, TX, USA

VOLUME 1METALS and METALLOIDS: CLINICAL ASSESSMENT, DIAGNOSTIC TESTS, and THERAPEUTICS

Chapter 1ALUMINUM

HISTORY

Although the identification of aluminum as a metal occurred in 1827, the Romans used alum (hydrated aluminum sulfate) for the purification of water and the preparation and staining of hides.1 In Europe, the commercial production of aluminum as a metallic pigment began shortly after the development of the Hall–Heroult electrolytic process in 1886. This process became the major industrial process for smelting aluminum by dissolving aluminum oxide (alumina from bauxite ore) in molten cryolite and electrolyzing the molten salt bath.2 The first reported case associating aluminum toxicity with memory loss, ataxia, tremor, and muscle tics occurred in 1921.3 Massive exposure to finely divided pyrotechnical aluminum flake powders during World War II in Germany caused fibrotic lung disease (aluminosis); ∼20 years later, McLaughlin et al. reported the case of a ball mill operator with an occupational exposure to aluminum and aluminum oxide (Al2O3) during the production of flake powders; he presented with pulmonary fibrosis and encephalopathy (poor memory, speech disorder, myoclonic jerks, convulsion, focal weakness).4

In the middle of the 20th century (1944–1979), aluminum powder (e.g., McIntyre powder) was released in mines as a prophylactic agent to coat silica particles and prevent silicon‐induced fibrotic reactions. Mortality studies of Australian cohorts exposed to aluminum dust prophylactically did not support the effectiveness of aluminum as a protective agent for silicosis.5 This study suggested the possibility of increased risk of cardiovascular disease and Alzheimer's disease in the exposed cohort; however, the increase was small (SMR = 1.38) and not statistically significant with wide confidence intervals. An analysis of postmortem aluminum concentrations suggested pulmonary aluminum concentrations were similar in eight workers receiving McIntyre Powder and occupationally exposed workers.6 The medical use of aluminum increased significantly in the 1950s when aluminum was prescribed as a phosphate binder to patients with chronic renal failure. By 1972, Alfrey et al. recognized an encephalopathy in patients on dialysis characterized by progressive dementia, myoclonus, facial grimacing, diffuse pain, and seizures.7 This epidemic of dialysis dementia vanished when excess aluminum was eliminated from the dialysate.8 In the early 1980s, a syndrome of encephalopathy, metabolic bone disease, and microcytic anemia occurred in dialysis‐dependent children receiving aluminum‐containing antacids.9 Calcium carbonate gradually replaced aluminum‐containing antacids in patients with chronic renal failure because of the lack of toxicity and the superior binding of calcium carbonate to phosphates compared with aluminum.10 Parenteral solutions (e.g., total parenteral nutrition) were recognized as sources of aluminum loading, particularly in children; in 1990, the US FDA recommended that the aluminum concentration of these solutions not exceed 25 μg/L followed in 2004 by a daily recommended intake of 5 μg/kg.

PHYSIOCHEMICAL PROPERTIES

Aluminum is the third most abundant element in the earth's crust after oxygen and silicon, comprising about 8% of the earth's crust and belonging to Group 13 (Group IIIa) along with boron, gallium, indium, and thallium.11 Most aluminum compounds are solids with high melting points. Pure aluminum is a light, malleable, silvery‐white metal that easily conducts both heat and electricity; however, the high reactivity of aluminum limits the existence of the metallic state in the earth's crust. The only natural oxidation state of aluminum is Al3+ with an ionic radius and chemical behavior similar to Fe3+. Because aluminum has a small radius and an avid affinity for oxygen, this metal exists almost exclusively as aluminum oxides (bauxite) or aluminosilicate compounds (clays, feldspars, and micas). The resistance of aluminum to corrosion results from the rapid formation of aluminum oxide following exposure to oxygen, water, or other oxidants.

The pH determines the solubility of aluminum compounds; therefore, the physiological milieu strongly affects the affinity of Al3+ for hydroxide ions and the subsequent precipitation of the complex. Only small amounts of free aluminum exist in solutions within pH 6.5–7.4. Aluminum salts of chloride, nitrate, and sulfate are water‐soluble, whereas metallic aluminum, aluminum oxide, and other aluminum salts (hydroxide, phosphate, silicate) are very poorly water‐soluble. Aluminum hydroxides and aluminum phosphates are some of the least soluble aluminum salts, but both compounds contribute to aluminum exposure.12 Aluminum oxide nanoparticles (<100 μm) more easily diffuse across biological membranes than larger particles.13 At pH 7.0, the solubility of aluminum hydroxide and aluminum sulfate is limited (2.5 mg/L);14 however, the solubility of aluminum salts increases as the pH deviates from neutral. Aluminum hydroxide binds hydrogen ions in an acid medium, whereas aluminum hydroxide releases hydrogen ions in an alkaline medium. In acidic aqueous conditions of the stomach (i.e., pH 2), aluminum occurs primarily as a monomolecular hexahydrate, Al(H2O)6, which is the “free” form of Al3+. As pH increases to near‐neutral conditions in the intestines, the insoluble precipitate (aluminum hydroxide, Al(OH)3) forms. Table 1.1 lists the physical properties and identifying information of aluminum and common aluminum salts.

EXPOSURE

Commercial Processes

Aluminum exists naturally in bauxite, cryolite, feldspars, micas, and silicates. The major source of commercial aluminum is bauxite; this mineral contains aluminum hydroxide, silica, ferrous oxide, and smaller amounts of cryolite (Na3AlF6). The production of this metal via electrolytic reduction of the raw material involves the following: 1) the refining of bauxite (Bayer Process) under high temperature, pressure, and strong caustic solution to form alumina (aluminum oxide), 2) the electrolytic reduction of the hydrate by the Hall–Heroult process to produce aluminum in the reduction cells (pots), and 3) the casting of aluminum into ingots. During this chemical process, the aluminum leaches from the bauxite as sediment containing aluminum oxide (alumina). During the electrolysis of molten cryolite, the electrothermal process produces pure aluminum that precipitates on carbon cathodes in the furnace of a carbon‐lined steel reservoir. Typically, ∼200 pots are arranged in potlines within buildings called potrooms. Prebake technology has gradually replaced the older Søderberg pots, resulting in more efficient hooding, improved fume extraction, and reduced exposure to a variety of dust, fumes, and gases. Potential exposures to chemicals during the electrolysis of aluminum include tar oils, polyaromatic hydrocarbons (3,4‐benzo(a)pyrene),15 carbon monoxide, sulfur dioxide, and airborne fluorides (F−, HF, sodium aluminum tetrafluoride).16 In a study of 17,089 aluminum smelter workers followed from 1950–2004, the incidence of lung, bladder, and buccal cancer increased significantly (P < 0.001) with exposure to benzo(a)pyrene.17

Uses

Aluminum is an extremely versatile metal with myriad of uses as a structural material in the manufacture of food containers, insulating materials, automobile and airplane manufacturing, machinery, electrical products, and cooking utensils. Because pure aluminum lacks strength, most aluminum used in metallurgy involves the production of aluminum‐based alloy castings and wrought aluminum products. The wire form of aluminum is used in welding, whereas the powder form is a constituent of paints, pyrotechnic flakes, and solid rocket propellants. Other applications for aluminum compounds include the following: antacids (hydroxide, phosphate), deodorants (chloride hexahydrate, hydroxide, phosphate, carbonate, silicate), abrasives (trioxide), petroleum cracking (anhydrous chloride), water purification (sulfate, alums), leavening agent (acidic sodium phosphate), grain fumigant (aluminum phosphide), emulsifying agent (basic sodium phosphate), acidifying agent (sulfate), anti‐caking agent (silicate), color additives (aluminum lakes), the brewing and paper industry (bentonite, zeolite), the catalyst for the manufacture of rubber and wood preservatives (chloride), glass and ceramic production (borate), soap and paint industry, and food processing. Alum is a series of double sulfate salts of monovalent cations (i.e., principally aluminum, potassium, other aluminum sulfates) used to reduce the turbidity of drinking water. The sulfate of aluminum dissolves in water to form aluminum hydroxide, resulting in precipitation along with suspended organic matter. Aluminum chloride (AlCl3) is a skin and mucous membrane irritant used as a fine powder in the petroleum cracking and polyisoprene production industries. Military applications have the greatest potential for aluminum nanoparticles, particularly coatings, fuels, and propellants.

TABLE 1.1 Physical properties and identifying information of aluminum and aluminum salts.

Physical Characteristic

Aluminum

Aluminum Carbonate

Aluminum Chloride

Aluminum Fluoride

Aluminum Hydroxide

CAS RN

7429‐90‐5

53547‐27‐6

7446‐70‐0

7784‐18‐1

21645‐51‐2

Molecular formula

Al

Al

2

O

3

·

CO

2

AlCl

3

AlF

3

Al(OH)

3

Molecular weight (g/mol)

26.98

NA

133.34

83.98

78.01

Color

Silver‐white

White

White to gray‐green

White

White

Physical state

Malleable metal

Aggregates or powder

Hexagonal plates

Hexagonal crystals

Bulky powder

Odor

Odorless

NA

Pungent

NA

NA

Melting point (°C)

660

NA

192.6

1,291

300

Density (g/mL, 20°C)

2.70

NA

2.48

3.10

2.42

Water solubility

Insoluble

Insoluble

Reacts violently

a

5.59 g/L (25°C)

Insoluble

Vapor pressure

1 mm Hg (1,284°C)

NA

1 mm Hg (100°C)

1 mm Hg (1,238°C)

NA

Odor threshold

 Water

NA

NA

0.5 mg/L

NA

NA

 Air

NA

NA

NA

NA

NA

Physical Characteristic

Aluminum Nitrate

Aluminum Oxide

Aluminum Phosphate

Aluminum Sulfate

CAS RN

13473‐90‐0

1344‐28‐1

7784‐30‐7

10043‐01‐3

Molecular formula

Al(NO

3

)

3

Al

2

O

3

AlPO

4

Al

2

(SO

4

)

3

Molecular weight (g/mol)

213.00

101.94

121.95

342.14

Color

Colorless

White

White

White, lustrous

Physical state

Rhombic crystals

Crystalline powder

Infusible powder

Crystals to powder

Odor

NA

Odorless

NA

Odorless

Melting point (°C)

73

∼2,000

>1,460

770 (decomposes)

Density (g/mL, 20°C)

NA

4.0

2.56

1.61

Water solubility (25°C)

Very soluble

Soluble cold water

b

Insoluble

Very soluble

Vapor pressure

NA

1 mm Hg (2,158°C)

NA

∼0

Abbreviations: CAS RN = Chemical Abstracts Service Registry Number; NA = not available.

a Produces heat and hydrochloric acid on contact with water;

b 0.98 mg/L, insoluble in hot water.

Sources

The primary sources of exposure to this common metal for the general population are natural rather than anthropogenic processes.11 In the environment, aluminum is always found in combination with other elements (aluminosilicates, oxides, hydroxides). Exposure to Al occurs daily, primarily via food (<10 mg) and drinking water (<1 mg).18 The inhalation of airborne dust particles provides a much smaller contribution to the daily intake of Al (<0.1 mg/day). Potential sources of relative higher Al exposure for the general population include the use of aluminum‐containing consumer products (e.g., antiperspirants, antacids, cosmetics). Exposure of the general population to anthropogenic sources of aluminum is primarily indirect. These sources include increasing dissolution of aluminum in the soil as a result of acidification from acid rain and enhanced wind and water erosion from cultivated land.19

AIR

Aluminum exists in air primarily as aluminosilicates associated with particulate matter. The primary source of aluminum in the atmosphere is dust from the erosion of ores and rock material on the surface of the earth as well as volcanic activity. Only ∼13% of the aluminum present in the atmosphere is released from anthropogenic sources with the major contributors being aluminum smelting, coal combustion, and commercial production of fuel and ores.20 In urban environments, vehicle exhaust accounts for ∼1–9% of the aluminum released into the ambient air.21 Aluminum concentrations in urban air range from 0.4–10 ng/m3 compared with background levels of 0.005–0.18 ng/m3 in rural areas.22,23 Aluminum concentrations in ambient air samples from aluminum plants are several orders of magnitude higher than in typical urban settings. In a study of 235 workers employed at 15 US plants producing various aluminum products, the median concentration of respirable and total aluminum in personal breathing samples was 25 μg/m3 and 100 μg/m3, respectively.24 The percentage of particles deposited in the lungs depends on particle size; typically, about 20% of particles in the range of 0.1–0.3 μm are deposited in the alveolar region. In contrast to sparingly soluble Al particles, hygroscopic water‐soluble Al salts may increase in size in the humid environment of the respiratory tract, thereby decreasing the deposition of inhaled Al particulates in the alveolar region. Higher ambient Al concentrations may occur during aluminum smelting (mean = 310 μg/m3, range 40–900 μg/m3 in 7 UK secondary smelters),25metal inert‐gas (MIG) welding of aluminum cylinders (2,900 μg/m3),26 plants producing large flakes of pyrotechnical Al powder (5,000–21,000 μg/m3),27 and corundum (aluminum oxide) processing (1,600–7,400 μm3).28 Experimental studies suggest that fumes from MIG welding of aluminum may contain ozone up to 250 μg/m3, potentially affecting lung function.29

SOIL

The content of aluminum in the soil varies widely in different locations as a result of several factors (e.g., pH, volcanic activity). Aluminum is the third most abundant element with soil concentrations ranging from 700–100,000 mg/kg.30 The aluminum concentration in urban street dust ranges from 3.7–11.6 μg/kg.19