Ferrer A
Unidad de Toxicología Clínica, Hospital Clínico Universitario, San Juan Bosco 15, 50009 Zaragoza, Spain.
An Sist Sanit Navar. 2003;26 Suppl 1:141-53.
Metals are amongst the oldest toxic substances known to man. In today's industrialized world the sources of exposure to metals are ubiquitous both in the field of work and from polluted water, foodstuffs and the environment. Their toxicity is characterized by the metallic element in question, but this is modified by the type of compound, whether organic or inorganic, and its characteristics of hydrosolubility and liposolubility, which determines its toxicokinetics and thus the possibilities of it reaching its targets. The biomolecules most affected by metals are the proteins with enzymatic activity, which is why their pathology is multisystemic. The principal systems affected are the gastrointestinal, central and peripheral neurological, haematic and renal. Some metallic compounds are carcinogenic. Metals's treatment is conditioned by their chemical reactivity. They can be deactivated and eliminated by the administering of chelating agents that produce complex molecules, which are non-toxic and can be excreted. The principal chelating agents are: BAL (British Anti-Lewisite or dimercaprol) DMPS (2,3-Dimercapto-1-propanesulfonic Acid) and DMSA (meso-2,3-Dimercaptosuccinic or Succimer), EDTA, Penicilamine (b,b-dimethylcysteine) and Deferoxamine. Toxicokinetic characteristics, mechanism of action, clinical picture and treatment of some of the most relevant metals and metalloids: lead, mercury and arsenic, are considered.
金属是人类已知的最古老的有毒物质之一。在当今工业化世界中，无论是在工作领域还是从受污染的水、食品和环境中，金属的接触源无处不在。它们的毒性由相关金属元素决定，但会因化合物类型（有机或无机）及其水溶性和脂溶性特征而有所改变，这些特征决定了其毒代动力学，进而决定了其到达靶标的可能性。受金属影响最大的生物分子是具有酶活性的蛋白质，这就是为什么它们的病理表现是多系统的。主要受影响的系统是胃肠道、中枢和外周神经系统、血液和肾脏。一些金属化合物具有致癌性。金属的治疗取决于它们的化学反应性。可以通过给予螯合剂来使它们失活并消除，螯合剂会产生无毒且可排泄的复杂分子。主要的螯合剂有：二巯丙醇（英国抗路易氏剂）、二巯基丙磺酸钠、二巯基丁二酸、乙二胺四乙酸、青霉胺和去铁胺。本文考虑了一些最相关的金属和类金属（铅、汞和砷）的毒代动力学特征、作用机制、临床表现和治疗方法。
