Clinical Information

Nickel is a highly abundant element with a silvery-white appearance. Nickel is frequently combined with other metals to form alloys and is essential for the catalytic activity of some plant and bacterial enzymes but has no known role in humans. Most nickel is used to make stainless steel.

Nickel and its compounds have no characteristic odor or taste. Nickel compounds are used for nickel plating, to color ceramics, to make some batteries, and as catalysts that increase the rate of chemical reactions. One of the most toxic nickel compounds is nickel carbonyl, Ni(CO)4, which is used as a catalyst in petroleum refining and in the plastics industry, is frequently employed in the production of metal alloys (which are popular for their anticorrosive and hardness properties), in nickel-cadmium rechargeable batteries, and is used as a catalyst in hydrogenation of oils. Ni(CO)4 is very toxic and is lipid soluble, allowing it to cross cell membranes.

Occupational exposure to nickel occurs primarily via inhalation of nickel compounds. Inhalation of dust high in nickel content has been associated with development of lung and nasal cancer.

Food is the major source of exposure to nickel. Foods naturally high in nickel include chocolate, soybeans, nuts, and oatmeal. Individuals may also be exposed to nickel by breathing air, drinking water, or smoking tobacco containing nickel. Stainless steel and coins contain nickel. Some jewelry is plated with nickel or made from nickel alloys. Patients may be exposed to nickel in implanted devices including joint prostheses, sutures, clips, and screws made from nickel -containing alloys.

The most common harmful health effect of Ni in humans is an allergic reaction. Approximately 10% to 20% of the population is sensitive to it. The most serious harmful health effects from exposure to nickel, such as chronic bronchitis, reduced lung function, and cancer of the lung and nasal sinus, have occurred in people who have breathed dust containing certain nickel compounds while working in nickel refineries or nickel -processing plants. Urine is the specimen of choice for the determination of nickel exposure, but serum concentrations can be used to verify an elevated urine concentration.

Patients undergoing dialysis are exposed to nickel and accumulate nickel in blood and other organs; there appear to be no adverse health effects from this exposure. Hypernickelemia has been observed in patients undergoing kidney dialysis. At the present time, this is considered to be an incidental finding as no correlation with toxic events has been identified. Routine monitoring of patients undergoing dialysis is currently not recommended.