Overload

Nickel poisoning

Category: Illness or disabilities

Type

Involuntary

Introduction and description

 

Nickel is a chemical element with symbol Ni and atomic number 28. It is a silvery-white lustrous, hard ductile metal with a slight golden tinge. The element's name comes from a mischievous sprite of German miner mythology, Nickel, although it might be better termed a goblin, given its action.

Native nickel is rarely found on Earth's surface, being mostly confined to the interiors of larger nickel–iron meteorites, in other words early man was never exposed to nickel.  But it is found in the earth’s crust.   In order of abundance in the earth's crust, nickel ranks as the 24th element and it has been extracted and used in numerous manufactured products.  Nickel is a useful metal, particularly in various alloys, in batteries and in nickel-plating. Nickel compounds are used especially as catalysts and pigments. Thus, we are being constantly exposed to this ubiquitous element, which makes it even more alarming when one realises how toxic nickel is.  Like lead, the body has no use for nickel and it appears that nickel is extremely toxic to the body. 

Many people are now aware of the dermatological problems caused by nickel.  But this is not the main problem.  The main problem with this metal is that it seems that once ingested or inhaled, the body finds it extremely difficult to get rid of it and thus it accumulates in body tissues and the bones until at some point we notice it because it is doing very real harm.  Occupational exposures can lead to the retention of 100 micrograms of nickel per day. But this metal gets everywhere, as we will see when we look at the sources.

Symptoms

 

Non-essential elements such as uranium, thallium, nickel, and aluminium, are strongly competitive with essential elements (Ca, Mg, Zn, Se, Mn, Co, Cr, and Mo)  in biochemical processes. [PMID: 25837556]  In other words all these heavy metals completely disrupt bodily systems.  We could call this mineral imbalance, but it would be to rather miss the point, the entire metabolism of the body is disrupted.  But if this was not enough, Nickel in particular causes the following:

Skin diseases

Dermatitis, eczema and a number of other skin diseases can be caused by nickel contact.  Jewellery, particularly ear rings are by now a known risk:

Numerous studies demonstrated that pierced ears were a significant risk factor for nickel allergy. PMID: 17937743

Nickel is also in some monetary coins, alarmingly it is also present in some cosmetics, including lipstick, running the risk of ingestion as well:

Hand eczema is one of the commonest eczemas encountered in dermatology practice. Contact allergens responsible for causing hand eczema vary from one geographical area of the world to another. This study tries to identify the commonest allergens causing hand eczema in ethnic Kashmiri population. A total of 800 patients were patch tested … over a 7-year period out of which 278 were diagnosed with hand eczema. …A positive patch-test result was obtained in 135 patients (48.5%) … Nickel and potassium dichromate were found to be the two commonest allergens causing hand eczema in our population PMID: 26955125

The EU has actually issued a directive whose aim is to reduce nickel exposure, but the problem is often in identifying which products have nickel in them:

One hundred and forty-one items belonging to one of three categories - accessories, utensils for needlework, painting and writing (called utensils), and electronic devices - were tested in the study. Forty-four percent of all items were DMG test-positive (releasing nickel), and 9% gave a doubtful DMG test result….The large proportion of nickel-releasing items in the present study shows clearly that broader parts of industry need to take action to prevent nickel allergy. The high proportion of DMG test-positive items indicates that there is still much work to be done to reduce the nickel exposure of the population. PMID: 27125984

 

Stomach and intestinal problems

Nickel exposure can come via contaminated food, in other words via ingestion, the symptoms in this case can induce diarrhoea, abdominal pain, and swelling. [PMID: 20204548]

Diabetes

A total of 2115 non-institutionalized men and women aged 55 to 76 years from Beijing and Shanghai were included, and urinary nickel concentration was assessed … The prevalence of type 2 diabetes was compared across urinary nickel quartiles. ………[Conclusion] Increased urinary nickel concentration is associated with elevated prevalence of type 2 diabetes in humans. PMID: 25324152

Heart disease and atherosclerosis

Particulate matter (PM), specifically nickel (Ni) found on or in PM, has been associated with an increased risk of mortality in human population studies and significant increases in vascular inflammation, generation of reactive oxygen species, altered vasomotor tone, and potentiated atherosclerosis in murine exposures. Recently, murine inhalation of Ni nanoparticles have been shown to cause pulmonary inflammation that affects cardiovascular tissue and potentiates atherosclerosis. ………….this study shows that inhalation of Ni nanoparticles results in functionally impaired endothelial progenitor cells [EPCs ]and reduced number in the bone marrow, which may lead to enhanced progression of atherosclerosis.  PMID: 20936915

Reproductive system failure

Nickel adversely affects the male reproductive system.

In the present study, the effects of nickel exposure on Spodoptera litura Fabricius were investigated by feeding larvae artificial diets containing different doses of nickel for three generations. Damage to testes and effects on male reproduction were examined. The amount of nickel that accumulated in the testes of newly emerged males increased as the nickel dose in the diet increased during a single generation. …. Nickel doses also disrupted the development of the testes by decreasing the weight and volume of testes and the number of eupyrene and apyrene sperm bundles in treatment groups compared with the control.   PMID: 26807937

And the female reproductive system

Nickel is associated with reproductive toxicity. However, the reproductive toxicity of nickel nanoparticles (Ni NPs) is unclear. Our goal was to determine the association between nickel nanoparticle exposure and reproductive toxicity. ….Experimental results showed nickel nanoparticles increased follicle stimulating hormone (FSH) and luteinizing hormone (LH), and lowered etradiol (E2) serum levels at a dose of 15 and 45 mg/kg in female rats. Ovarian lymphocytosis, vascular dilatation and congestion, inflammatory cell infiltration, and increase in apoptotic cells were found in ovary tissues in exposure groups. PMID: 25407529

Bone diseases

Nickel can also migrate to bone and may be a contributor to such bone related diseases as rheumatoid arthritis.  In this study the researchers used autopsy tissue from people who had died from heavy metal poisoning

 

This study is a part of a monitoring program for the determination of metals in various human tissues of the population living in the vicinity of a new hazardous waste incinerator (HWI) in Constantí (Tarragona County, Spain). Concentrations of arsenic (As), beryllium (Be), cadmium (Cd), chromium (Cr), mercury (Hg), manganese (Mn), nickel (Ni), lead (Pb), tin (Sn), thallium (Tl), and vanadium (V) were determined in brain, bone, kidney, liver, and lung autopsy samples collected in 2003 from 22 individuals who had been living for at least 10 yr in the area under evaluation….The highest levels of Cd and Hg were found in kidney ….. and those of Ni, Pb, and Sn in bone PMID: 16037609

Epilepsy

Nickel poisoning can produce epileptic seizures

We report here the case of a patient admitted in our hospital after a single generalized tonic-clonic seizure. The remarkable coincidence that a colleague of his, with whom he was working to clean the same workshop, had been admitted 1 week earlier for respiratory distress, coma, and de novo nonconvulsive focal status epilepticus, led us to consider a possible toxicologic etiology. Urine analysis revealed a high nickel concentration, suggestive of acute nickel poisoning. PMID: 15946340

Birth defects and gene mutation

Exposure to nickel has produced congenital birth defects.  For example, Nickel(II) chloride (or just nickel chloride), is the chemical compound NiCl2. Nickel chloride solutions are also used for electroplating nickel onto other metal items.  Nickel salts are carcinogenic and cause congenital birth defects.  The following describes the effects on chickens

The following malformations were observed: exencephaly, everted viscera, short and twisted neck, short and twisted limbs, microphthalmia, hemorrhage, and reduced body size. The dose-response relationship was observed in all of the groups tested. The toxicity and teratogenicity of nickel chloride was the highest in the embryos treated at day 2. The results of the present study indicate that nickel chloride is teratogenic.  PMID: 7369783

In one systematic review of Nickel exposure during pregnancy and the impact on child outcomes. [PMID: 26571332], the authors found papers that showed an association between Nickel and

  • small for gestational age
  • low birth weight
  • neural tube defects
  • structural birth defects
  • and autism spectrum disorder

Nickel has also produced DNA damage to babies:

This study aimed to evaluate the effects of toxic heavy metal co-exposure on DNA oxidative damage in neonates from a primitive e-waste recycling region, Guiyu town, China.  Our participants included 201 pregnant women: …. umbilical cord blood (UCB) samples were collected after delivery. The UCB concentrations of lead, cadmium, chromium, and nickel were analyzed CONCLUSIONS: The primitive e-waste recycling and dismantling activities may contribute to the elevated umbilical cord blood toxic heavy metal levels in neonates born in Guiyu. Exposures to cadmium, chromium and nickel were associated with increased oxidative DNA damage in neonates.  PMID:  24295751

Cancers, tumours and fibromas

Nickel does not appear to be very discriminatory as to which organs it attacks.  This example is about bladder cancer, but as you will see in the other papers, lung cancer, and kidney cancer can be caused by nickel

The role of heavy metals and trace elements (HMTE) in the development of some cancers has been previously reported. Bladder carcinoma is a frequent malignancy of the urinary tract. … …..This prospective study included 102 paired samples of full-thickness cancer and adjacent non-cancerous bladder tissues ……. The high concentrations of cadmium, lead, chromium, nickel, and zinc, in the cancerous together with arsenic in the adjacent non-cancerous tissues of RC specimens suggest a pathogenic role of these elements in BC. PMID: 27147435

And

To evaluate the risk of lung cancer and nasal cancer among workers employed at the Clydach nickel refinery, South Wales since 1930 …..A persisting excess of respiratory cancer was found for workers employed in the period 1930-92, with a lung cancer SMR of 133 (95% CI 103 to 172) and a SMR for nasal cancer of 870 (95% CI 105 to 3141). The lung cancer excess was most clearly seen 20 years or more after first employment and seemed to be confined to process workers. PMID:  16621856

Lung failure, kidney failure and other organ failure

Nanoparticles are being used in ever increasing numbers in a range of industrial and medical products. Questions surrounding their potential to cause toxic effects in humans have been raised. Although animal experiments predict that nanoparticles are more toxic than their larger counterparts there are few descriptions in the literature of human exposure. A case described in 1994 has been re-examined from a pathology perspective. The subject, a 38-year-old previously healthy male, inhaled nanoparticles of nickel while spraying nickel onto bushes for turbine bearings using a metal arc process. He died 13 days after being exposed and the cause of death at autopsy was adult respiratory distress syndrome (ARDS). Nickel particles <25 nm in diameter were identified in lung macrophages using transmission electron microscopy. High levels of nickel were measured in his urine and his kidneys showed evidence of acute tubular necrosis.  PMID:  20623660

Death

 

A man was taken ill suddenly while spraying nickel using a thermal arc process. He was relieved of his duties and sent home. His condition deteriorated and he was admitted to hospital with a diagnosis of pneumonia. Thirteen days after exposure he died. At post mortem examination the cause of death was determined to be shock lung or Adult Respiratory Distress Syndrome (ARDS). Reproduction of the conditions under which the man had operated the metal arc process produced nickel concentrations of 382.1 mg m-3 in the air next to the operator. Of this nickel, 64.6% was in the form of particles less than 1.4 microns in diameter; the majority being 50 nm in diameter. The total amount of nickel inhaled by the man, who operated the process for 90 min, was estimated to be nearly 1 g. The toxicity of the nickel is thought to be associated with the very fine particulate nature of the metal fume and the large amount inhaled. The importance of wearing adequate protective equipment while operating this metal arc process is stressed. PMID: 7825932

 

Causes/Sources of nickel

Nanoparticles

As you will see from the examples above and those below, nanoparticles of nickel are not just toxic they kill people regularly and remarkably quickly.  Nickel nanoparticles are not eliminated from the body, in fact the body appears to have no way of dealing with nanoparticles of this metal.  And often it is so devastatingly quick acting that the damage done is rapid and fatal.

The nanoparticles can affect every organ in the body and also affect the fetus.  If the fetus survives, then it is likely to have congenital abnormalities.  Furthermore nanoparticles can be inhaled ingested and are easily absorbed through the skin.

Nickel nanoparticles (NiNPs) represent a new type of exposure because, due to the small size/high surface, they can release more Ni ions compared to bulk material. …. This study demonstrated that NiNPs applied on the skin surface cause an increase of nickel content into the skin and a significant permeation flux through the skin, higher when a damaged skin protocol was used. PMID: 26692505

The production of nickel nanoparticles for whatever reason is tantamount to manslaughter.

Food contamination

In the observations you will find Dr Duke’s list of Plants that he has found contain Nickel.  How should we interpret this?

All these plants are able to take up nickel from the soil.  This means they could be used as chelating agents – plants that clean polluted soils – as long of course as we ditched the plants in a very deep hole and buried them afterwards, but the other implication is that they are, as a consequence, a risk in areas where pollution has taken place.

If you know you are in a polluted area or receiving fruit and vegetables from a polluted area, then from this list you are able to see which fruit and vegetables to AVOID. 

The concentrations of arsenic (As), beryllium (Be), cadmium (Cd), chromium (Cr), mercury (Hg), manganese (Mn), nickel (Ni), lead (Pb), tin (Sn), thallium (Tl), and vanadium (V) were determined in a number of food items purchased in zones of Tarragona County (Catalonia, Spain) near a hazardous waste incinerator (HWI), which has been operating since 1999. Food samples corresponded to the following groups: meat, fish and seafood, pulses, cereals, vegetables, fruits, tubers, whole milk, yogurt, eggs, and sugar….. For the analyzed trace elements, the dietary intake by the general population of Tarragona was 458.5 microg/d for As, 14.3 microg/d for Cd, 88.3 microg/d for Cr, 5.3 microg/d for Hg, 2421.4 microg/d for Mn, 138.3 microg/d for Ni, 44.8 microg/d for Pb, 34.6 microg/d for Sn, and 28.9 microg/d for V. PMID:  15930589

Vegetables usually contain more nickel than do other food items; high levels have been found in legumes, spinach, lettuce and nuts. Certain products, such as baking powder and cocoa powder, have been found to contain excessive amounts of nickel as a consequence of nickel leaching during some flawed manufacturing processes.

But additional concern arises from the pollution of rivers, the sea and grazing land and whether bioaccumulation has occurred, for example, the freshwater fish being tested here is eaten:

We aimed to assess the bioaccumulation of selected four trace metals (Cd, Ni, Zn and Co) in four tissues (muscles, skin, gills and liver) of a freshwater fish Wallago attu (lanchi) from three different sites (upstream, middle stream and downstream) of the Indus River in Mianwali district of Pakistan. … In W. attu the level of cadmium ranged from 0.004 to 0.24; nickel 0.003-0.708; cobalt 0.002-0.768 and zinc 47.4-1147.5 μg/g wet weight. …. The order of bioaccumulation of these metals was Ni < Zn < Co < Cd. PMID: 26858541

 

Pharmaceuticals

Thirty nine brands of pharmaceutical dosage forms (28 tablets, 4 syrups, 6 suspensions and one chewing gum) that are available in United Arab Emirates pharmaceutical markets were investigated for the presence of three heavy metals; lead, cadmium and nickel. Amongst the samples, 13 products were manufactured locally in United Arab Emirates and 26 products were imported from around the world. …. Amongst the 39 samples … all exhibited a positive response for lead, cadmium and nickel except three products whose Ni levels were below quantification level. PMID: 27168689

Mining

Mining operations are inevitable a source of nickel poisoning, as the miners breathe the dust from ores.  Major production sites include the Sudbury region in Canada (which is thought to be of meteoric origin), New Caledonia in the Pacific, the Merensky Reef, South Africa and Norilsk in Russia.  Australia and New Caledonia have the biggest estimate reserves (45% all together).  The largest deposits of nickel in non-Russian Europe are located in Finland and Greece. In addition, extensive deep-sea resources of nickel are in manganese crusts and nodules covering large areas of the ocean floor, particularly in the Pacific Ocean.  The one locality in the United States where nickel was commercially mined is Riddle, Oregon. The mine closed in 1987. The Eagle mine project is a new nickel mine in Michigan's upper peninsula.

Coins

Nickel has been a component of coins since the mid-19th century. Coins still made with nickel alloys include one- and two- Euro coins, 5¢, 10¢, 25¢ and 50¢ U.S. coins and 20p, 50p, £1 and £2 UK coins. The replacement of nickel-alloy 5p and 10p UK coins with nickel-plated steel models, begun in 2012, “has caused dermatological controversy”.

Steel making

Native nickel is rarely found on Earth's surface, being mostly confined to the interiors of larger nickel–iron meteorites that were protected from oxidation during their time in space. On Earth, such native nickel is found in combination with iron.  An iron–nickel mixture is thought to compose Earth's inner core.  Thus much iron processing will involve exposure to nickel.  An economically important source of nickel is the iron ore limonite, which often contains 1-2% nickel. Nickel, however, is also valuable in the modern world for the alloys it forms; about 60% of world production is used in nickel-steels (particularly stainless steel).

The aim of this retrospective cohort study was to determine if the workers of an Electric Arc Furnace (EAF), which recycles scrap, had higher mortality and morbidity due to possible exposure to pollutants at work. EAFs do not run on coke ovens. In EAFs 40 % of the particulate matter (PM) is made up of PM 2.5. The foundry dust contained iron, aluminum, zinc, manganese, lead, chromium, nickel, cadmium, mercury, arsenic, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls and dioxins.
Mortality study: an excess mortality was found in the exposed workers as compared to the general population ..  The mortality rate was increased for all tumours, for lung cancer, for ischemic heart disease, for chronic liver disease and for injury and poisoning. Morbidity study: there was a statistically significant increase of diabetes, rheumatoid arthritis, hypertension and cardiovascular diseases in exposed workers.  PMID:  26900394

 

Water contamination

In areas of high pollution, particulates can simply fall on reservoirs and sources of drinking water, polluting the source, but drinking-water and acid beverages can dissolve nickel from pipes and containers. Leaching or corrosion processes can contribute significantly to the oral nickel intake, occasionally up to 1 mg/day. Scattered studies indicate a highly variable dietary intake of nickel, but in any polluted area the average can be around 200-300 micrograms/day.

Nickel refining and purification; petroleum, plastic, and rubber production

Nickel carbonyl [Ni(CO)4], is formed when metallic nickel combines with carbon monoxide.  It is thus both a toxin and a heavy metal accidental by-product of, for example, car or lorry exhaust fumes.   It is used in the refining process of nickel and as a catalyst in petroleum, plastic, and rubber production. Purification of nickel oxides to obtain the purest metal is performed via the Mond process, which increases the nickel concentrate to greater than 99.99% purity. In the process, nickel is reacted with carbon monoxide at around 40–80 °C to form nickel carbonyl in the presence of a sulfur catalyst.

Nickel carbonyl is considered to be one of the most toxic chemicals used industrially and the magnitude of its morbidity and mortality has been compared to that of hydrogen cyanide.

A 46-year-old man presented to the emergency department 24 hours after accidental occupational exposure to nickel carbonyl. He admitted to dermal contamination and inhaling the vapor from his clothing after his respiratory protection was removed. ….. Nickel carbonyl exposure produces mild transient initial symptoms which are followed within 24 hours by more severe life-threatening events.  PMID:  8383493

and

Follow-up of patients with nickel carbonyl acute poisoning varying in severity revealed a pathologic trend--functional and organic disorders of nervous system with asthenic vegetative, asthenic organic dysfunctions, toxic encephalopathy, bronchopulmonary diseases (toxic bronchitis with subsequent pneumosclerosis), toxic myocardium dystrophy, hepatobiliary system affection--toxic hepatopathy.  PMID: 20095408

Waste processing

Inhaled nickel carbonyl is rapidly absorbed and distributed mainly to the lungs, brain, adrenal glands, and kidneys. In severe cases, acute nickel carbonyl exposure causes death.  There has also been exposure in waste processing workers:

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. …… 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.  PMID: 16002966

Electroplating

Because of nickel's slow rate of oxidation at room temperature, it is considered corrosion-resistant. Historically, this has led to its use for plating metals such as iron and brass, coating chemistry equipment, and manufacturing certain alloys that retain a high silvery polish, such as German silver. About 6% of world nickel production is still used for corrosion-resistant pure-nickel plating. Nickel-plated items are noted for provoking nickel allergy.

Nickel(II) sulfate, or just nickel sulfate, is an inorganic compound with the formula NiSO4(H2O)6. This highly soluble blue-coloured salt is a common source of the Ni2+ ion for electroplating.  Approximately 40,000 tonnes were produced in 2005. It is mainly used for electroplating of nickel.  In 2005–06, nickel sulfate was the top allergen in patch tests (19.0%).  It would also appear that it damages hearts:

The effects of simultaneous alcohol and nickel sulphate poisoning on the cardiovascular system of rats. Morvai V, Szakmáry E, Ungváry G, Szénási G. Acta Physiol Hung. 1993;81(3):239-51. PMID: 8197879

Welding

Many of the metals used in welding are excreted by the body in the urine, in effect, the body is able to handle metals such as chromium.  But it appears as though nickel is absorbed – it is not excreted:

The uptake and elimination of metals from welding fumes is currently not fully understood. In the Aachen Workplace Simulation Laboratory (AWSL) it is possible to investigate the impact of welding fumes on human subjects under controlled exposure conditions. In this study, the uptake and elimination of chromium or chromium (VI) respectively as well as nickel was studied in subjects after exposure to the emissions of a manual metal arc welding process using low or high alloyed steel…………..Urine analysis for chromium and nickel was performed before and after exposure … [Results]… …… exposure to  high alloyed manual metal arc welding fumes lead to elevated urinary chromium levels …. On the other hand mean urinary nickel concentrations slightly increased, but did not exceed background levels PMID: 25512666

From the symptoms explained above it appears that inhaled nickel is deposited in the liver and kidneys, lungs and other organs and there it stays, causing many cases of organ failure and cancer later on.

Prostheses

A prosthesis (plural: prostheses) is an artificial device that replaces a missing body part, which may be lost through trauma, disease, or congenital conditions.  Unfortunately and very sadly those made of nickel can cause tumours and cancers

It is suggested that for the treatment of tumors arising from the implantations of nickel-containing prostheses in humans, chelation therapy be considered.  PMID: 6260008

And

Metal implant sensitivity (intolerance) can cause pain, reduced mobility, loosening of the implant and skin rashes. …. Even "pure" titanium alloys may contain traces of nickel. The histology of implant-associated skin reactions goes from teleangiectatic postimplantation erythema to eczema and vasculitis. PMID: 27090521

 

Dental braces and equipment

Both dental equipment and a number of appliances used on patients have nickel in them [Dental metal-induced innate reactivity in keratinocytes. Rachmawati D, Buskermolen JK, Scheper RJ, Gibbs S, von Blomberg BM, van Hoogstraten IM. Toxicol In Vitro. 2015 Dec 25;30(1 Pt B):325-30. doi: 10.1016/j.tiv.2015.10.003. Epub 2015 Oct 9. PMID: 26456670].

A common presentation of intraoral contact dermatitis is the presence of lichenoid plaques on the buccal mucosa adjacent to the offending antigen. This paper describes a case of cutaneous and mucosal nickel allergy arising after placement of dental braces.

An 11-year-old boy was referred by his orthodontist to the University of Minnesota Occupational and Contact Dermatitis Clinic to be evaluated for a possible metal allergy. The patient developed an itchy rash on his abdomen and under his wristwatch 1 week after dental braces were placed. He was diagnosed with allergic contact dermatitis from nickel. The patient avoided cutaneous nickel exposure and had a minimal resolution of his symptoms. One year later, the patient developed swelling and burning of the lips. Secondary to extreme discomfort, the braces, which contained nickel, titanium, and zinc, were removed. The patient underwent standard patch testing; the final reading at 96 hours showed a +++ reaction to nickel, palladium, cobalt chloride, and neomycin. The patient experienced relief of his oral symptoms after removal of the braces.  PMID:  15724351

Cigarettes

Dr Duke’s analysis of plants that contain nickel, does not mention tobacco, but it is clear from the research papers that some cigarettes do contain nickel.  Where does it come from?

The tobacco plant contains nickel and several other toxic metals, most probably absorbed from the soil, fertilizing products or from pesticides. PMID: 12729253

I believe it might have been better to say some tobacco plants in the sentence above, because it is clear that tobacco grown on unpolluted soils and without heavy chemical use is nickel free – organic cigarettes!

Waste incinerators

Batteries contain both nickel and cadmium and both pose a hazard, as such those involved in the manufacture of these batteries is at risk.  There is however another risk.  There has been a move in a number of cities to incinerate waste from households.  Many hospitals ironically also incinerate waste.  The smoke and fumes from these incinerations is theoretically ‘scrubbed’ however it is clear from papers that this scrubbing is not always effective.  The chimneys from these incineration plants are often high, meaning the toxic fumes can spread far and wide contaminating the soil and water supplies of areas many miles from the plant itself.  For example

The concentrations of arsenic (As), beryllium (Be), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), mercury (Hg), manganese (Mn), nickel (Ni), lead (Pb), antimony (Sb), tin (Sn), thallium (Tl), and vanadium (V) were determined in 30 soil samples collected in April 2011 near a hazardous waste incinerator (HWI; Constantí, Catalonia, Spain), which is under regular operations since 1999. PMID: 22569806

And

The most significant potentially carcinogenic substances arising from a state-of-the-art clinical waste incinerator (CWI) and vehicle emissions were identified as polychlorinated dibenzo-p-dioxins, polycyclic aromatic hydrocarbons (PAHs), benzene, 1-butadiene, arsenic, cadmium, chromium and nickel. Long-term exposures of the notional maximum exposed individual (MEI) in the local environment, together with aggregate emissions from transport of clinical waste, were estimated. …. Aggregate emissions from road transport of clinical waste were of a similar order to stack emissions from incineration. PMID: 20737342

Hospitals

Hospitals are major sources of nickel pollution.  Nickel is released by incinerators which are used for medical waste, but much medical equipment is made from alloys of nickel or electroplated nickel.

There is even evidence of contamination of intravenous fluids [Potential toxicity from nickel contamination of intravenous fluids. -Sunderman FW Jr.  Ann Clin Lab Sci. 1983 Jan-Feb;13(1):1-4. PMID: 6340593]

Children’s toys

Nickel released from children's toys is deposited on the skin.  Overgaard LE, Engebretsen KA, Jensen P, Johansen JD, Thyssen JP. Contact Dermatitis. 2016 Jun;74(6):380-1. doi: 10.1111/cod.12553. PMID: 27133630

Cosmetics, hair dyes and tattoo inks

Nickel has been found in lipsticks, eye make-up and face powder, along with other cosmetics and usually leads to skin problems, although lipstick if ingested may lead to other problems [Safety evaluation of traces of nickel and chrome in cosmetics: -Ma'or Z, Halicz L, Portugal-Cohen M, Russo MZ, Robino F, Vanhaecke T, Rogiers V. Regul Toxicol Pharmacol. 2015 Dec;73(3):797-801. doi: 10.1016/j.yrtph.2015.10.016. Epub 2015 Oct 22. PMID: 26496819 ]

And

In this study …, the concentrations of metals (cadmium, copper, chromium, aluminum, lead, nickel, zinc, cobalt, manganese, and iron) in samples of some commonly used hair dyes and tattoo inks were determined …. Results indicated that the tattoo ink samples contained allergenic metals such as nickel, chromium, and cobalt at concentrations above the suggested limit … and the toxic metals were …. impurities in ingredients for use for cosmetics, in the majority of the samples. PMID: 26867288

And

Skin whitening cream may contain mercury, and lipstick may contain chromium and nickel, Indian study shows. Travasso C. BMJ. 2014 Feb 5;348:g1330. doi: 10.1136/bmj.g1330. PMID: 24500361

Spectacles

Allergic contact dermatitis of the face from contact with nickel and ammoniated mercury in spectacle frames and skin-lightening creams. Sun CC. Contact Dermatitis. 1987 Nov;17(5):306-9. PMID: 3436136

Artisanal mining

‘Artisanal mining’ is the recycling of electronic waste through open incineration in order to recover reusable metals.  The sorts of electronic items that are put through this process include old cellphones, batteries, circuit boards, plastics and screens. The components are shredded, sieved and incinerated at 743-818 °C and the metals then recovered and reused.

The life cycle assessment model USEtox(®) was used to estimate impacts of the ash residue chemicals on human health and the ecosystem. Among metals, copper in printed circuit boards had the highest ecotoxicity impact … Beryllium in plastics had the highest impact on producing non-cancer diseases …. and Nickel had the largest impact on producing cancers …. Among organic chemicals, dioxins from incinerated batteries produced the largest ecotoxicological impact … Furans in incinerated batteries can generate the largest number of cancers and non-cancer diseases…. The results reveal the hazards of burning discarded electronic products to recover precious metals, and pinpoints opportunities for manufacturers to reduce toxic materials used in specific electronic components marketed globally.  PMID: 24937657

Biological sources

Although not recognized until the 1970s, nickel plays important roles in the biology of microorganisms and plants.  The increased and more virulent pathogenic activity of certain organisms may be due to the presence of heavy metals such as Nickel.

  • Ureases are found in numerous bacteria, fungi, algae, plants and some invertebrates, as well as in soils, as a soil enzyme. They are nickel-containing metalloenzymes of high molecular weight.
  • Hydrogenases generate energy from hydrogen and can thus operate in anaerobic environments.  Hydrogenases proficient in H2 uptake can help heavy metal contaminants to be recovered. These uptake hydrogenases have been recently discovered in pathogenic bacteria and parasites and are believed to be involved in their virulence.  The NiFe-hydrogenases contain nickel
  • Cofactor F430 - is a  nickel-tetrapyrrole coenzyme and is present in the methyl coenzyme M reductase, which powers methanogenic archaea.
  • Other nickel-containing enzymes include a rare class found in bacteria and several parasitic eukaryotic trypanosomal parasites

It appears that our continued release of heavy metals has helped the pathogens [particularly some bacteria] that cause disease to thrive:

Nickel can thus have an impact on human health through infectious diseases arising from nickel-dependent bacteria, parasites etc. Nickel released from Siberian Traps volcanic eruptions (site of the modern city of Norilsk) is suspected of having had a significant impact on the role played by Methanosarcina, a genus of euryarchaeote archaea that produced methane during the biggest extinction event on record.

Diagnosis

Urine tests - are largely ineffective in testing for nickel, as the principle problem is that it is not excreted, which is why it does so much damage.  If it is so high it is detectable, the poisoning is extremely severe and could easily be fatal.

Patch tests - Where nickel is the cause of allergic contact dermatitis, it can be diagnosed by an epicutaneous patch test.

Mucosa patch tests - The following study employed another method to identify the problems caused by nickel ingestion

Eighty-six patients with intestinal symptoms related to ingestion of nickel-containing foods were submitted to epicutaneous and oral mucosa patch tests for nickel. All patients with positive oral mucosa patch test results were subject to a low-nickel diet and monitored over time. Skin lesions were observed in 33 out of 86 (38.4%) patients evaluated by the epicutaneous patch test. Mucosal lesions were seen in 53 out of 86 (61.6%) patients given the oral mucosa patch test. After 2 months of a low-nickel diet, 52 out of 53 (98.1%) patients showed an improvement of their symptoms. There is a significant correlation between response time of the oral mucosa patch test and the latency of symptoms after ingestion of nickel-containing foods. Consequently, the oral mucosa patch test can be used to recognize and study the adverse effects of dietary nickel exposure that could be defined as allergic contact mucositis. A low-nickel diet is also shown to be an effective treatment for this condition.  PMID: 20204548

Blood tests – can identify the presence of nickel in the blood stream, but of course once it has settled in an organ it will not be detectable, except via more intrusive methods.

Treatment

The standard treatment for nickel poisoning is chelation therapy, the following is an older paper [1991] but is still largely valid today – only trained medical personnel can administer this strength of agent. 

For the treatment of acute poisoning from the inhalation of nickel carbonyl, sodium diethyldithiocarbamate (Dithiocarb) has proved to be a specific antidote; tetraethylthiuram (Antabuse) is effective to a lesser degree; d-penicillamine and dimercaprol (BAL) have limited therapeutic value.
For the treatment of nickel eczema and dermatitis, favorable response has been obtained by placing patients on a diet of low nickel content together with the oral administration of Dithiocarb or Antabuse.
No specific therapy has been advanced for the treatment of nickel cancer in humans. In experimental animals, Dithiocarb has an inhibitory effect on the production of rat rhabdomyosarcomas induced by the intramuscular implantation of nickel subsulfide, and N-methyl formamide inhibits the growth of transplantable nickel fibromas in rats. It is suggested that for the treatment of tumors arising from the implantations of nickel-containing prostheses in humans, chelation therapy be considered.  PMID: 6260008

There is a treatment called the “Low nickel diet”, which is intended to help people with persistent dermatitis.  The aim is to reduce nickel intake in food.

Fifty-five patients who adhered to the diet for at least 4 weeks, and whose dermatitis had cleared or improved at the end of this time, responded to a questionnaire follow-up 1 to 2 years later. Forty of these patients had long-term improvement of their dermatitis. Patients with strongly positive patch tests to nickel had less benefit from the diet than patients with moderately positive patch tests. PMID: 8245235

 

References and further reading

  • Am J Emerg Med. 1993 Jan;11(1):64-6. Acute nickel carbonyl poisoning. Kurta DL1, Dean BS, Krenzelok EP. 1Pittsburgh Poison Center Children's Hospital, Pittsburgh 15213.
  • Secondary poisoning risk assessment of terrestrial birds and mammals exposed to nickel. DeForest DK, Schlekat CE, Brix KV, Fairbrother A. Integr Environ Assess Manag. 2012 Jan;8(1):107-19. doi: 10.1002/ieam.248. Epub 2011 Aug 24. PMID: 21793198
  • Nickel poisoning. III. Procedures for detection, prevention, and treatment of nickel carbonyl exposure including a method for the determination of nickel in biologic materials. KINCAID JF, STANLEY EL, BECKWORTH CH, SUNDERMAN FW. Am J Clin Pathol. 1956 Feb;26(2):107-19. PMID: 13292397
  • [Cases of nickel carbonyl acute poisoning at major petrochemical enterprises]. Valeeva ET, Galimova RR, Karimova LK, Muldashova NA. Med Tr Prom Ekol. 2009;(11):17-9. Russian.  PMID: 20095408
  • Nickel carbonyl poisoning: report of a fatal case. Jones CC. Arch Environ Health. 1973 May;26(5):245-8. PMID: 4696381
  • Ab initio simulation of carbon clustering on an Ni(111) surface: a model of the poisoning of nickel-based catalysts.  Kalibaeva G, Vuilleumier R, Meloni S, Alavi A, Ciccotti G, Rosei R. J Phys Chem B. 2006 Mar 2;110(8):3638-46. PMID: 16494419
  • Acute nickel carbonyl poisoning: a report of 179 cases. Shi ZC. Br J Ind Med. 1986 Jun;43(6):422-4.  PMID: 3718888
  • Ann Occup Hyg. 2015 May;59(4):467-80. doi: 10.1093/annhyg/meu104. Epub 2014 Dec 15.  Human biomonitoring of chromium and nickel from an experimental exposure to manual metal arc welding fumes of low and high alloyed steel.  Bertram J1, Brand P2, Schettgen T2, Lenz K3, Purrio E3, Reisgen U3, Kraus T2.
  • Am J Ind Med. 2010 Aug;53(8):763-7. doi: 10.1002/ajim.20855.  Pulmonary and systemic toxicity following exposure to nickel nanoparticles. Phillips JI1, Green FY, Davies JC, Murray J.
  • Ann Clin Lab Sci. 1981 Jan-Feb;11(1):1-8.  Chelation therapy in nickel poisoning. Sunderman FW Sr.
  • Ann Occup Hyg. 1994 Dec;38(6):921-30. Death following exposure to fine particulate nickel from a metal arc process. Rendall RE1, Phillips JI, Renton KA.
  • Biol Trace Elem Res. 2016 May 5. Quantitative Evaluation of Heavy Metals and Trace Elements in the Urinary Bladder: Comparison Between Cancerous, Adjacent Non-cancerous and Normal Cadaveric Tissue.  Abdel-Gawad M1, Elsobky E2, Shalaby MM3, Abd-Elhameed M4, Abdel-Rahim M4, Ali-El-Dein B4.
  • Biol Trace Elem Res. 2011 Feb;139(2):151-9. doi: 10.1007/s12011-010-8652-y. Epub 2010 Mar 5.  Oral mucosa patch test: a new tool to recognize and study the adverse effects of dietary nickel exposure. Picarelli A1, Di Tola M, Vallecoccia A, Libanori V, Magrelli M, Carlesimo M, Rossi A.
  • Chemosphere. 2016 Apr;148:178-87. doi: 10.1016/j.chemosphere.2015.10.068. Epub 2016 Jan 22.  Effects of nickel exposure on testicular function, oxidative stress, and male reproductive dysfunction in Spodoptera litura Fabricius.  Sun H1, Wu W2, Guo J3, Xiao R3, Jiang F3, Zheng L3, Zhang G4.  4State Key Laboratory for Biocontrol & Institute of Entomology, Sun Yat-sen University, Guangzhou 510275, China. Electronic address: zhanggr@mail.sysu.edu.cn.
  • Inhalational nickel carbonyl poisoning in waste processing workers. Seet RC, Johan A, Teo CE, Gan SL, Lee KH. Chest. 2005 Jul;128(1):424-9. PMID: 16002966
  • Dermatitis. 2004 Sep;15(3):154-7.  Cutaneous and oral eruption from oral exposure to nickel in dental braces.  Schultz JC1, Connelly E, Glesne L, Warshaw EM.
  • [First epileptic seizure induced by occupational nickel poisoning.  Denays R, Kumba C, Lison D, De Bels D.  Epilepsia. 2005 Jun;46(6):961-2. PMID:  15946340]
  • Congenital abnormalities in nickel poisoning in chick embryos. Gilani SH, Marano M. Arch Environ Contam Toxicol. 1980;9(1):17-22. PMID: 7369783
  • Sci Total Environ. 2014 Feb 15;472:354-62. doi: 10.1016/j.scitotenv.2013.11.032. Epub 2013 Nov 30. Associations of neonatal lead, cadmium, chromium and nickel co-exposure with DNA oxidative damage in an electronic waste recycling town. Ni W1, Huang Y1, Wang X1, Zhang J1, Wu K2.
  • J Environ Monit. 2003 Apr;5(2):198-201.  Cigarette smoking and nickel exposure. Torjussen W1, Zachariasen H, Andersen I.
  • J Occup Med Toxicol. 2016 Feb 20;11:7. doi: 10.1186/s12995-016-0095-8. eCollection 2016. Health status of male steel workers at an electric arc furnace (EAF) in Trentino, Italy. Cappelletti R1, Ceppi M2, Claudatus J1, Gennaro V3.
  • Inhal Toxicol. 2010 Dec;22 Suppl 2:95-9. doi: 10.3109/08958378.2010.515269. Epub 2010 Oct 11.  Exposure to inhaled nickel nanoparticles causes a reduction in number and function of bone marrow endothelial progenitor cells.  Liberda EN1, Cuevas AK, Gillespie PA, Grunig G, Qu Q, Chen LC.
  • Int J Epidemiol. 2015 Feb;44(1):240-8. Nickel exposure is associated with the prevalence of type 2 diabetes in Chinese adults. Liu G, Sun L, Pan A, Zhu M, Li Z, ZhenzhenWang Z, Liu X, Ye X, Li H, Zheng H, Ong CN, Yin H, Lin X, Chen Y.

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