Acute Chromium Intoxication Caused by Chromic Acid Burns

A 20-year-old male plating worker was accidentally immersed up to his lower thorax in a vat of hot chromic acid solution. The patient sustained third degree burns over 60% of the lower body surface area. Blood and urine concentrations of chromium were 740μg/dl and 1, 550μg/l, respectively. The initial course was characterized by hypotension, hypoglycemia, acute renal failure, hepatic damage, and thrombocytopenia. Continuous hemodiafiltration between Day 3 and Day 28 after the exposure resulted in recovery from renal failure. Although he underwent debridement and epidermization twice, candidiasis of the burned surface led to candidemia. After a second skin grafting on Day 50, his condition deteriorated, with azotemia again and hyperbilirubinemia. General convulsions occurred after Day 55, and he died on Day 66. The autopsy revealed tubular necrosis of the kidneys, a markedly enlarged liver (5, 700g), with severe fatty infiltration and a slightly atrophic brain without microscopical abnormality. The 21 cases of acute chromium intoxication previously reported are reviewed and recommendations for the management of such patients are presented.