1. The Disease Definition
Cadmium is an extremely toxic metal commonly found in industrial workplaces, particularly where ore is being processed or smelted.
A. Clinical Description
Acute exposure causes pulmonary edema, which may result in death. The most serious consequence is cancer (lung and prostate). The first observed chronic effect is generally kidney damage. Cadmium also is believed to cause pulmonary emphysema and bone disease (osteomalcia and osteoporosis). The latter has been observed in
Metal fume fever may result from acute exposure. It includes flu-like symptoms of weakness, fever, headache, chills, sweating and muscular pain. Acute pulmonary edema usually develops within 24 hours and reaches a maximum by three days. If death does not occur, symptoms may resolve within a week. Excretion of excessive low molecular weight protein in the urine is usually the first symptom of chronic kidney damage.
B. Sources of Exposure
Due to its low Permissible Exposure Limit (PEL), overexposures may occur even in situations where trace quantities of cadmium are found in the parent ore or smelter dust. Cadmium is used extensively in electroplating, although the nature of the operation does not generally lead to overexposures. Several deaths from acute exposure have occurred among welders who have unsuspectingly welded on cadmium-containing alloys or worked with silver solders. Cadmium is also found in industrial paints and may represent a hazard when sprayed. Operations involving removal of cadmium paints by scraping or blasting may similarly pose a significant hazard. Cadmium is also present in the manufacture of some types of batteries. Cadmium emits a characteristic brown fume (CdO) upon heating, which is relatively non-irritating, and thus does not alarm the exposed person.
C. Population at Risk
People who work in industries that use cadmium.
D. Diagnosis, Treatment, and Prognosis
A blood test is used to determine recent exposure to cadmium. The amount in the urine shows both recent and past exposure.
There are no effective chelating agents for cadmium poisoning. Vitamin D has been used to treat “itai-itai” disease.
The mortality rate for acute cadmium poisoning is about 15 percent. Death usually occurs within four to seven days. If the patient survives, respiratory problems may persist.
E. Prevention of Exposure
Primary control should focus on inhalation. Inhaled cadmium is more readily absorbed into the body than is ingested cadmium. Intake of cadmium by ingestion and skin absorption are considered to be of relatively less importance in occupational settings.
2. Reporting Criteria
A. Disease Reporting
Cadmium poisoning is reportable if:
· Blood cadmium values are equal to or greater than 5 micrograms per liter.
· Urine cadmium values are equal to or greater than 10 micrograms per liter.
Cadmium poisoning must be reported to the Iowa Department of Public Health by the physician or other health practitioner attending the patient and by laboratories performing tests identifying the disease. Cadmium poisonings must be reported within a week to the Iowa Department of Public Health Division of Environmental Health by the physician or health practitioner attending any person having a reportable disease and by laboratories performing tests identifying reportable diseases. Reporting can be through the Iowa Disease Surveillance System (IDSS), phone, fax, or mail. The preferred reporting method is through IDSS. To report via fax or mail, please use the Arsenic Case Report Form available in the Epi Manual and online at www.idph.state.ia.us/eh/reportable_diseases.asp
How to report to the Division of Environmental Health (Non IDSS Users)
Phone (Mon-Fri 8 am-4:30 pm):
Iowa Department of Public Health
Division of Environmental Health
Lucas State Office Building
321 E. 12th Street
Des Moines, Iowa 50319-0075
24-hour Disease Reporting Hotline:
Agency for Toxic Substances and Disease Registry (ATSDR)
National Institute for Occupational Safety and Health (NIOSH)