Over time, the condition also leads to decreased nerve function. Cobalt is toxic to the heart muscle. It can cause heart muscle disease toxic cardiomyopathy after too much exposure. An increase in red blood cells polycythemia may be a symptom of too much cobalt. Not treating this issue can cause congestive heart failure. Too much intake of cobalt may cause enlargement of the thyroid gland goiter.
It can also reduce the activity of the thyroid. Cobalt may also increase blood sugar levels. Since cobalt is a key part of vitamin B, people with Leber syndrome, a rare eye condition, should not take it without talking to their healthcare providers. Some forms of vitamin B may lead to vision loss in people with this issue. Women who are pregnant or breastfeeding should talk with their healthcare providers before taking any supplements.
There have been reports of high levels of cobalt in people who had hip replacements that used metal-on-metal devices. Symptoms of a higher level of cobalt in the blood are:. If you or someone you are with has an exposure, call the local emergency number such as , or the local poison center can be reached directly by calling the national toll-free Poison Help hotline from anywhere in the United States. Cobalt was once used as a stabilizer in beer foam.
It caused a condition called "beer-drinker's heart," which resulted in heart muscle weakness. Usually you have to be exposed to high levels of cobalt for weeks to months to have symptoms. However, it is possible to have some symptoms if you swallow a large amount of cobalt at one time. The most worrisome form of cobalt poisoning occurs when you breathe it into your lungs. This usually will only happen in industrial settings where large amounts of drilling, polishing, or other processes release fine particles containing cobalt into the air.
Breathing in this cobalt dust can lead to chronic lung problems. If you breathe in this substance for long periods, you will likely develop breathing problems that are similar to asthma or pulmonary fibrosis, such as shortness of breath and decreased exercise tolerance.
Cobalt poisoning that occurs from constant contact with your skin will likely cause irritation and rashes that go away slowly. Swallowing a large amount of absorbable cobalt at one time is very rare and is likely not very dangerous. It may cause nausea and vomiting. However, absorbing a large amount of cobalt over longer periods of time can lead to serious health problems, such as:.
If you or someone you know has been exposed to cobalt, the first step is to leave the area and get fresh air. If cobalt came in contact with the skin, wash the area thoroughly. Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline from anywhere in the United States.
This hotline will let you talk to experts in poisoning. They will give you further instructions. This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.
Cobalt and other metals, like chromium, molybdenum, and nickel, create alloys that are used as a material to construct total hip arthroplasty [ 25 , 26 ]. Prostheses can be made only from metals, and they are called MoM metal on metal , or they can contain metals and polyethylene — MoP metal on polyethylene , or only ceramics.
Biomaterials are characterised as substances different from a medicament or combination of synthetic or natural substances, and they aim to replace natural body tissues.
They are also used in the construction of artificial organs and in the production of medical equipment [ 27 ]. The model of systemic biokinetics of cobalt was developed for the International Commission on Radiological Protection ICRP because of concern for workers who intake radionuclides occurring in the nuclear industry and as diagnostic tools in nuclear medicine. The primary kinetics model was created by Leggett in and was bound with alkaline earth elements.
The structure of the primary model was based on the framework for biokinetics of inorganic cobalt [ 21 ]. This model helps us to understand the biological behaviour of inorganic cobalt in the human body. It was based on many studies carried out earlier on humans and laboratory animals that were exposed to radioactive and also stable cobalt under controlled conditions.
The differences between inorganic and organic cobalt were established. Both forms were accumulated in a high concentration in the liver and retained in the body for a long time. This model describes the circulation of cobalt ions between blood and four systemic tissues: liver, kidneys, skeleton, and other organs. The proposed model of behaviour of inorganic cobalt is based on the earlier data by Smith et al.
Measurements were presented as a fractional transfer per day from places where inorganic cobalt was bound and transferred to receptor compartments. This systemic model provides all recycling data as well as for phases of loss as urinary and faecal excretion; some of these results were based on the data from Smith et al. Thus, this model is mainly based on the data by Smith et al.
The biokinetics model of inorganic cobalt was created by R. Leggett and was based on the research of initial systemic cobalt circulation and its dislocation in compartments of the body. Among these compartments were: liver, kidneys, skeleton, other tissues, and blood.
The aim of this biokinetics model was to establish the level of cobalt ions circulating in blood after intravenous injection of 60 Co and 58 Co. The distribution of cobalt was examine by autoradiography in the body and was expressed in percentages. The blood was divided into blood bound to cobalt ions, which is transferred to organs, and blood remaining in plasma, as shown in Fig. Such organs as liver, kidneys, skeleton, and others also represented circulation of cobalt ions in blood. Kidneys receive 4.
The use of biomaterials in medical practice should meet several conditions, e. The time of safe use of biomaterials depends on several factors. The most important of them is biocompatibility. It is a property of biological material, which, besides its basic function in the body, does not cause worsening of the patient's condition, or any other complications.
Implants with of good compatibility should not be toxic or immunologically active, so they should not induce chronic reactions or an inflammatory condition. In material engineering we can enhance several groups of materials, such as ceramics, polymers, carbon, and metals. All of the groups are different, and they are characterised by different properties [ 28 ]. The metal group contains steel Cr-Ni-Mo, titanium and its alloys, cobalt alloys, niobium, and precious metals.
These materials are characterised by various properties such as susceptibility to stretching, brittleness, and mechanical resistance. Due to these properties they are commonly used in the production of various implants, but they are not without defects [ 15 , 29 , 30 ]. Biomaterials always trigger a reaction in tissues. The biomaterial used in the prosthesis plays a very important role in the success of the implant.
Therefore, the use of any biomaterials in the body is determined by the material's biofunctionality and biocompatibility. The latter of these is very important but difficult to determine because of a number of interactions between body substances and biomaterials [ 26 ]. One such interaction is insufficient corrosion resistance in body fluid. The corrosion of metal is the main problem in constructing implants. Several studies have demonstrated that corrosion mechanisms can cause the release of ions of Co, Cr, and Mo into the surrounding tissue and synovial fluid [ 25 , 31 ].
Moreover, these released metal ions may cause inflammatory and hypersensitivity reactions, and alternations in bone modelling that leads to aseptic loosening and implant failure [ 32 , 33 ]. The presence of an implant, an alien body in a living organism, detected by the immunological system, triggers certain defensive mechanisms, as shown in Fig. After the implantation of a prosthesis the first defensive reaction is the creation of biofilm. It means that the surface of the implant is covered with serum albumin and platelets and is defined as an organic or non-organic deposit on the surface of the material and contains cellular elements and bacteria and fungi [ 15 ].
The bacterial forms have the ability to bind extracellular matrix albumins like collagen and fibrinogen, and cause their adhesion such as: Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas species, Enteroccocus.
If the colonisation of bacteria is stopped by the host's cells, such as macrophages and fibroblasts, we cannot observe any changes in the body, but sometimes the defensive mechanism can be weaker than the pace of adhesion, and we can observe the growth of an increasing number of bacteria, as shown in Fig.
The final result of the tissue response is the creation of a collagen and elastin capsule around the prosthesis. This situation could lead to vasa's atrophy and necrosis, bone resorption, and ultimately failure of the implant [ 15 , 25 ]. Influence of cobalt ions released from surface of implant and immunological responses of body.
Moreover, this situation could be directly connected with work of implant. As mentioned earlier, the prosthesis contains various alloys of metals such as: cobalt, copper, chromium, molybdenum, and nickel, and they all release ions into the host tissues because of corrosion. The biological liquids in the body consist of many ions of chlorine, sodium, potassium, lime, phosphates, and organic components, and in addition a higher temperature of the body and changes of pH in tissues surrounding the implant cause the process of corrosion of metals [ 28 , 29 ].
These ions are released over time, and their level can be highly significant because they are the source of many pathophysiological effects. Studies have demonstrated a sevenfold increase in metal ions in the synovial fluid. Another investigation has shown that Cr and Co ions increase the release of proinflammatory cytokines from macrophages and inhibition of osteoblasts, osteoclasts, and T and B cell proliferation [ 32 ].
Moreover, wear debris could be accumulated at the highest doses in the adjacent tissues and bone marrow and could circulate in the bloodstream and penetrate other organs in the body [ 24 , 34 ]. The implant is an alien, foreign body, and the organism will activate some mechanisms which aim at its destruction.
Macrophages are the type of leukocytes that, after reaching maturity, leave the tissue and get into the bloodstream. These cells are very important components of the immunological system and they synthesise cytokines and other factors that initiate inflammation and bone resorption.
All of them cause osteolysis and aseptic loosening and failure of prostheses [ 26 , 36 ]. The released ions of metals from metal on the metal surface of periprosthetics could enter the bloodstream and circulate on the body and ultimately accumulate in the heart, liver, kidney, spleen, pancreas, and lymphatic tissue, and only a part of them will be eliminated through urine. This metallic debris may have direct toxicological effects over a long time [ 37 ]. The metallic corrosion products can penetrate the cell plasma membrane, bind cellular proteins or enzymes, and modulate cytokine expression.
Osteolysis, and aseptic and non-aseptic loosening are major causes of implant failure [ 26 , 38 , 39 ]. The reaction of the body to ions of cobalt and other metals is a type IV hypersensitivity reaction. The ions of cobalt and other metals released from the surface of the implant are absorbed by present macrophages, which are involved in many of the processes associated with phagocytose orthopaedic biomaterial particles.
Moreover, macrophages release matrix metalloproteinases MMPs and chemokines [ 39 — 42 ]. The delayed type IV hypersensitivity reaction is a type of immune response where Th helper and cytotoxic Tc cells are also engaged. Th cells are responsible for the damage of infected tissues by macrophages and the activation of cytokines. Another type of cytotoxic Tc provides cell-mediates, which are responsible for cytolysis [ 26 ].
Cobalt is an essential trace element for the human body. This metal is very widespread in the natural environment and can be formed as an effect of anthropogenic activity. This metal occurrs in two forms: organic and inorganic.
The organic form of cobalt is present in the green parts of plants, fish, cereals, and water, and it is a necessary component of vitamin B Cobalt gets into the body in a few ways: firstly, with food; secondly by the respiratory system; thirdly, by the skin; and finally, as a component of biomaterials.
Cobalt and its alloys are fundamental components in orthopaedic implants and have been in use for about 40 years. The condition of the individual patient should be considered when selecting the implant. Moreover, a patient with endoprosthesis MoM should be monitored, especially regarding the concentration of cobalt ions in the systemic liquid. Inorganic forms of cobalt are toxic and can accumulate in tissues and evoke a chain of changes in cells.
Cobalt ions released from the implant surface can cause toxic and immunological reactions. Moreover, cobalt ions are released for a long time and the concentration of cobalt can develop into metalosis, and cobalt ions circulating with blood could accumulate in other organs, such as: heart, liver, spleen, lymph nodes, and kidneys, where the ions are excreted with urine and excrement.
Also, these ions could induce cytotoxicity and genotoxicity effects in body cells. As illustrated, the influence of cobalt ions on the body should be studied deeply, as well as interactions between ions of cobalt and other metals occurring in body fluid.
Perhaps these interactions have some specific and significant effects on the immunological system. National Center for Biotechnology Information , U.
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