Diseases Caused by Nickel or Its Compounds

1. Introduction and Definitions

Nickel is a silvery-white metal commonly used in various industrial applications, including the production of stainless steel, batteries, and coins. Nickel compounds are also used in electroplating, chemical manufacturing, and as catalysts. While nickel has many valuable uses, exposure to nickel and its compounds can lead to significant health issues, particularly affecting the skin, respiratory system, and immune system. This article provides comprehensive information on diseases caused by nickel and its compounds, targeting occupational health nurses and doctors.

2. Agent Causes the Disease

Exposure to nickel can occur through inhalation of dust or fumes, ingestion, or dermal contact. Nickel compounds such as nickel sulfate, nickel chloride, and nickel carbonate are commonly encountered in industrial settings. Prolonged exposure to these compounds can lead to various health problems, including allergic reactions, respiratory issues, and cancer.

3. Workers at Risk of This Disease

Several occupations and tasks put workers at higher risk of exposure to nickel and its compounds, including:

  • Metal Workers: Involved in the production and processing of nickel and nickel alloys.
  • Electroplating Workers: Handling nickel compounds in electroplating processes.
  • Battery Manufacturing Workers: Using nickel compounds in the production of batteries.
  • Welders and Solderers: Exposed to nickel fumes during welding and soldering activities.
  • Mining and Smelting Workers: Extracting and processing nickel-containing ores.
  • Jewelry and Coin Production Workers: Handling nickel in the manufacturing of jewelry and coins.

4. Symptoms

Symptoms of diseases caused by nickel exposure can vary depending on the level and duration of exposure:

  • Acute Exposure: Symptoms include skin irritation and allergic dermatitis, characterized by redness, itching, and blisters. Inhalation can cause respiratory irritation, coughing, and shortness of breath.
  • Chronic Exposure: Long-term exposure can lead to chronic bronchitis, reduced lung function, and an increased risk of respiratory cancer. Chronic skin exposure can cause persistent dermatitis and eczema. Prolonged exposure to high levels of nickel compounds can lead to nickel-induced lung and nasal cancers.

5. Diagnosis

Diagnosing diseases caused by nickel involves a combination of clinical evaluation, occupational exposure assessment, and specific tests:

  • Medical History and Physical Examination: Detailed assessment of the patient's work history and symptoms.
  • Patch Testing: To diagnose allergic contact dermatitis caused by nickel.
  • Pulmonary Function Tests: To assess lung function and detect any obstructive or restrictive patterns.
  • Chest X-rays or CT Scans: Imaging to detect lung inflammation, fibrosis, or other damage.
  • Biopsy: For histopathological examination in cases of suspected cancer.
  • Blood and Urine Tests: Measuring nickel levels to assess exposure.

6. Treatment

Treatment for diseases caused by nickel focuses on managing symptoms and preventing further exposure:

  • Remove from Exposure: Immediate removal from the source of nickel exposure is crucial.
  • Symptomatic Treatment: Providing medications to manage respiratory symptoms, such as bronchodilators and corticosteroids, and treatments for skin irritation, such as topical corticosteroids and emollients.
  • Allergen Avoidance: Avoiding contact with nickel-containing items and using hypoallergenic alternatives.
  • Supportive Care: Including hydration, rest, and monitoring of respiratory and skin health.
  • Long-term Monitoring: Regular follow-up to monitor lung function, skin health, and overall health status.

7. Prevention

Preventing diseases caused by nickel involves implementing strict control measures in the workplace:

  • Engineering Controls: Using local exhaust ventilation, enclosed processes, and proper maintenance of equipment to reduce airborne exposure to nickel dust and fumes.
  • Work Practices: Implementing safe work practices such as proper handling and disposal of nickel-containing materials, and avoiding eating, drinking, or smoking in areas where nickel is used.
  • Personal Protective Equipment (PPE): Providing and ensuring the use of appropriate respirators, protective clothing, gloves, and eye protection.
  • Health Surveillance: Regular health screenings, including pulmonary function tests, skin examinations, and monitoring of nickel levels in blood and urine for workers exposed to nickel.
  • Education and Training: Informing workers about the hazards of nickel and safe work practices to minimize exposure.

Workplace Exposure Limits:

  • OSHA PEL (Permissible Exposure Limit):

    • Time-Weighted Average (TWA): 1 mg/m³ (averaged over an 8-hour workshift).
  • NIOSH REL (Recommended Exposure Limit):

    • TWA: 0.015 mg/m³ (averaged over a 10-hour workshift).
  • ACGIH TLV (Threshold Limit Value):

    • 1.5 mg/m³ (as the inhalable fraction) averaged over an 8-hour workshift.