| | Route of exposure | Health effects | Diagnosis/medical monitoring |
| | Arsenic (inorganic and organic) | Inhalation, oral, dermal | (1) Acute exposure: nausea, diarrhea, GI bleeding, cardiovascular effects, shock, and death. Liver, kidney damage and seizures have been reported.
(2) Chronic exposure: hyperpigmentation of skin, warts, corns, heart disease, neuropathy, liver damage, anemia and peripheral vascular disease (gangrene of lower limbs), and increased risk of skin, liver, lung and bladder cancer. Arsenic in drinking water can also cause diabetes and hypertension. | Urinary arsenic level is the most reliable indicator of recent exposure to arsenic. Arsenic in hair and fingernails can indicate exposure to high levels in the past 6–12 months. |
| | Lead | Inhalation oral dermal | (1) Hematologic: decreased heme synthesis enzymes, anemia.
(2) Cardiovascular: elevated blood pressure.
(3) Cognitive, neurobehavioral, and psychological effects.
(4) Gastrointestinal: colic or abdominal cramps.
(5) Peripheral neuropathy; encephalopathy (at high levels).
(6) Reduced fertility.
(7) Immune system: alterations in T cell, reduced IgG serum levels.
(8) Children: lethargy, loss of appetite, anemia, colic, neurological impairment, and impaired metabolism of Vit D. Exposure in uterus and during childhood can result in impaired neurological development, IQ deficits, and growth retardation. Lead-based paint is a common source of lead exposure. | Lead in whole blood is a reliable test. Erythrocyte protoporphyrin (EP) test can also be used but it is not sensitive to detect high levels of lead in children. |
| | Mercury (elemental or metallic, organic-methyl mercury and inorganic) | Inhalation oral food (fish), dental work. | (1) All forms of mercury are toxic to the CNS.
(2) Exposure to high levels can damage brain, kidneys, and developing fetus. (methyl mercury is the most toxic form).
(3) Toxicity to brain results in irritability, tremors, visual changes, and memory problems.
(4) Mercury salts can cause abdominal cramps, diarrhea, and kidney damage. | Acute exposure is best measured by mercury in blood and chronic exposure by mercury in urine. |
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