Portland Metal Exposures: Interim Clinical Updates
 
 

This interim update was developed by the Multnomah County Health Department and the Oregon Health Authority (OHA) in consultation with The Northwest Pediatric Environmental Health Specialty Unit (NW PEHSU) and the Oregon Poison Center (OPC).

Background: DEQ detected elevated levels of airborne metals near Bullseye Glass Company (arsenic and cadmium) located near SE 22nd and SE Powell and is concerned about metal levels near Uroboros Glass (cadmium) located at N Kirby and N Thompson, both in Portland. Both factories also use chromium, some forms of which can be dangerous. At this time, both factories have stopped using all three chemicals. Read more information and view maps from the Department of Environmental Quality and the OHA.

Concern for Human Health Risk: A complete assessment of this situation has not been completed and the risk to human health is not yet known. Updated information will be shared as it becomes available from air, soil, and human testing. The degree of exposure among people living, working, attending school or recreating in the areas around these factories is unknown, but exposure levels are likely to be impacted by the type and duration of activities.

Toxicity of Arsenic, Cadmium, and Chromium: All three of these metals can cause symptoms related to acute exposure but the benchmark levels that were exceeded are based on the probability of lifetime cancer risk from chronic exposure. One source of past exposure was airborne emissions from the factories; on-going exposure can still occur through diet, soil or dust. The following table lists the major chronic toxicities from these metals and provides information on pregnancy and lactation. More information on these and many other substances is available at

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Table 1. Chronic Toxicity and Maternal Considerations Related to Arsenic, Cadmium, and Chromium

Metal

Risks from Chronic Exposure

Pregnancy and Lactation

Arsenic

Skin lesions and skin cancer

Bladder, liver, lung cancer*

Peripheral neuropathy

Possible impaired cognitive/behavioral development

Crosses placenta and found in breast milk. Limited evidence of adverse consequences on birth outcomes.

Cadmium

Renal tubular dysfunction which can lead to osteoporosis or osteomalacia

Lung and prostate cancer

Possible impaired cognitive/behavioral development

Crosses placenta and found in breast milk. Limited evidence of adverse consequences on birth outcomes.

Chromium

Lung and upper respiratory cancer Asthma, allergic contact dermatitis

Crosses placenta and found in breast milk. No known human consequences

lung cancer is the specific risk associated with inhalation

Who needs to be tested? Until the environmental assessment is completed, we cannot make definitive recommendations about who should be screened for exposure to these metals. Community concern is high enough that many patients will request testing for themselves or family members. Based on the preliminary data from DEQ and our understanding of emissions from these sources, those who spent the most time within about one-half mile of either glass factory have the greatest potential for exposure.


What test should be ordered? If you deem testing to be appropriate, then follow the recommendations in Table 2 on specific urine tests; testing of hair or nails is not clinically useful; results requiring additional testing or consultation are listed. Under no circumstances should chelation or provocation be used before testing. Arsenic and chromium are quickly excreted, therefore results from testing now will not reflect chronic exposure. In contrast, cadmium persists for decades so past exposure will be reliably documented. Note: False positives may occur in children under age 6 years.

Table 2. Screening test recommendations for patients exposed to glass factory emissions

Metal

Screening Test

Timing of testing

Levels requiring additional testing'

Arsenic

Spot urine for arsenic. Results will not reflect past exposure.

Arsenic is rapidly excreted, testing will not assess chronic exposure. No seafood consumption in 72 hours prior to testing

All ages: > 50 mcg/L inorganic As, obtain additional tests3 All ages: > 200 mcg/L obtain expert consultation4

Cadmium

Spot urine for cadmium'

When convenient. Cadmium has very long half-life.

Age <= 20 yrs: Urine >=1.0 mcg Cd/g Cr6

>21 years: >=3 mcg Cd/g Cr6

Chromium

Spot urine for chromium. Results will not reflect past exposure.

Chromium is very rapidly excreted, testing will not assess chronic exposure. Note: no supplements before testing

All ages: >5mcg/L , obtain expert consultation4

 

1 Consensus recommendation of OHA, OPC, and NWPESHU toxicologists using national data and clinical correlation

2 Total urinary arsenic of > 35 mcg/L should be fractionated to identify inorganic arsenic. Only the fractionated specimen will provide the inorganic concentration needed for decision making. Specimens not reaching the fractionation threshold indicate no additional testing required. Laboratory Reference levels reported for total arsenic per mcg/g creatinine should not be used.

3 For > 50 mcg/L inorganic arsenic also obtain CBC, electrolytes, BUN, creatinine, urinalysis, AST, ALT, bilirubin, repeat fractionated urinary arsenic.

Oregon Poison Center (1-800-222-1222)

5 Blood cadmium levels only reflect acute exposure; urine is preferred for chronic exposure

6 CBC, electrolyte panel with BUN/Cr, urinalysis, urine for B2 microglobulln, repeat urine cadmium

Obtaining expert consultation: For patients with lab results exceeding levels listed in table 2, obtain additional screening tests and repeat metal testing. Medical toxicology consultation is available through the Oregon Poison Center (1-800-222-1222). If necessary, the Poison Center will refer calls regarding children or pregnancy to the NW PEHSU (1-877-KID-CHEM).

Sharing results with public health agencies: A system for sharing lab results with public health agencies is under development; we will update you when more information is available. For now, please maintain a list of all patients who have been tested.

Recommendations for patients and families: Any risk from emissions from the glass factories in Portland adds to other exposures in an urban setting. Patients and families are urged not to smoke or be exposed to second hand smoke because burning cigarettes release both arsenic and cadmium. A healthy diet including selenium (nuts, whole grains), iron (enriched cereals, meat, beans), calcium (milk products, leafy greens) and folate (beans, spinach, avocado) may mitigate toxicity from metals. Promote hand-washing after working or playing outdoors because soil can be contaminated with a variety of metals. Families living within one-half mile of factories should await further guidance before consuming backyard produce.

Interim                                Clinical Update February 15, 2016                        Interim