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ACUTE EXPOSURE INFORMATION

1. USES: Nickel is used as a catalyst in the petroleum, plastic and rubber industries. Nickel is also combined with other metals to form products that may be commonly worn or found in the home. Nickel is used in various corrosion-resistant alloys; alloys (most commonly with iron, copper, zinc, or chromium). It occurs naturally in soil and fresh and saltwater. Nickel carbonyl is a highly toxic nickel compound commonly used as a chemical reagent and is covered in another management (See NICKEL CARBONYL).

2. TOXICOLOGY: Water-soluble nickel compounds do not readily enter cells; whereas, water-insoluble nickel compounds enter cells through phagocytosis and are carcinogenic. Carcinogenicity may be related to DNA protein binding, oxidation, and DNA-protein cross-linking by nickel.

3. EPIDEMIOLOGY: Exposure to nickel is common. Severe toxicity to forms other than nickel carbonyl is uncommon. Contact dermatitis or hypersensitivity, possibly severe, occurs in sensitized individuals (2% to 5% of the general population). Nickel is the most common cause of allergic contact sensitization.

4. WITH POISONING/EXPOSURE
   1. TOXIC EXPOSURE: Adverse effects can result from ingestion, skin contact, inhalation or parenteral routes of exposure; nickel may be absorbed from the gastrointestinal and respiratory tracts as well as percutaneously.
   2. INHALATION: Inhalation of nickel alloys or dust has been linked to pulmonary irritation, asthma, pneumoconiosis, pulmonary fibrosis and pulmonary edema. Early symptoms after inhalation are dizziness, sore throat, hoarseness, and weakness. Gingivitis, stomatitis, metallic taste, nasal irritation, nasal mucosal damage, nasal septum perforation, hyposmia/anosmia, cough and shortness of breath are sometimes reported. Exposure to nickel fumes may result in "metal fume fever."
   3. INGESTION: Oral toxicity of elemental nickel is low. Large doses taken orally may cause nausea, vomiting and diarrhea. Elemental nickel is present in some foods and water, but dietary exposures are generally not significant.
   4. DERMAL: "Nickel itch" may begin with a burning and itching sensation, followed by erythema and nodular eruptions. Once acquired, nickel sensitivity usually persists. Nickel and its inorganic compounds can be absorbed through the skin but not in amounts sufficient to cause intoxication.
   5. PARENTERAL: Parenteral exposures may occur from implanted metal prostheses, stainless steel needles or contaminated dialysate solutions. Inflammatory reactions have occurred around nickel-containing prostheses and medical implants. Nickel intoxication from dialysis exposure includes nausea, vomiting, headache, weakness and palpitations.
   6. CARCINOGENICITY: Some work environments (ie, nickel refinery work) and forms of nickel are associated with human malignancies, mainly nasal and respiratory cancers.

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