Inhalational nickel carbonyl poisoning in waste processing workers.
BACKGROUND
Nickel carbonyl is formed when carbon monoxide comes into contact with active nickel. The inhaled nickel carbonyl is rapidly absorbed and distributed mainly to the lungs, brain, adrenal glands, and kidneys. In severe cases, acute nickel carbonyl exposure has been reported to cause death.


METHODS
Descriptive study.


METHODS
Seven young men presented with fever, chills, substernal pleuritic chest pain, and exertional dyspnea. Extensive microbiological and toxicological investigations (including blood, urine, and bronchial specimens) for known pathogens and occupational toxins were performed. The clinical course and radiologic findings of each patient, including autopsy findings of three patients who died, were described.


RESULTS
Four patients received treatment in the ICU. Elevated urinary nickel concentration was detected in all patients. Results of extensive microbiological investigations were unremarkable. No patients received chelating agents. Pulmonary consolidation, edema, hemorrhage, and fibrosis were observed at autopsy in patients who died. An out-of-date chemical used during neutralization of nickel waste was implicated as the source of nickel carbonyl poisoning.


CONCLUSIONS
High mortality was reported in patients who presented subacutely following nickel carbonyl exposure. Further studies should be performed to clarify the role of chelation therapy in the subacute phases following nickel carbonyl exposure.
Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074. raymond_seet@nus.edu.sg
Raymond C S
RC
Seet
Azman
A
Johan
Cuthbert E S
CE
Teo
Siok Lin
SL
Gan
Kang Hoe
KH
Lee
D000328:Adult; D000395:Air Pollutants, Occupational / Q000506:poisoning*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000401:mortality; D016273:Occupational Exposure; D009942:Organometallic Compounds / Q000506:poisoning*; D012846:Singapore / Q000453:epidemiology
D000395:Air Pollutants, Occupational; D009942:Organometallic Compounds; C005303:nickel carbonyl