Goals:
(1) Prevent further exposure to chromium(VI).
(2) Reduce chromium(VI) to chromium(III).
(3) Do both within 2 hours of the exposure if possible. After this the chromium has reached cells and is causing cellular damage.
(4) Maintain urine flow with forced diuresis (Meert et al) if possible or treat renal failure.
Removal of chromate:
(1) Wash any exposed skin or mucous membrane.
(2) Perform gastric lavage if ingested.
Reduction of chromium(VI):
(1) Wash or lavage with a topical solution of vitamin C 10% (100 grams per liter)..
(2) Intravenous infusion of vitamin C:
(2a) 0.5 to 5 grams per kg (Bradberry and Vale)
(2b) repeated administration of 1 g IV (Meert et al).
(3) Intravenous infusion of N-acetylcysteine at 140 mg per kg every 4 hours.
Complications of therapy:
(1) High dose vitamin C therapy may be associated with oxalate crystal deposition in the kidneys, especially if renal failure occurs.
(2) High dose vitamin C may be associated with a worse outcome if started 3 or more hours after exposure (Bradberry and Vale).
Hemodialysis can be helpful if the patient develops renal failure.
