Some of the hip replacement parts can cause cobalt to leak into the bloodstream, causing symptoms similar to toxic levels of cobalt ingestion. Common symptoms include: Abdominal pain Abnormal heartbeat Anemia Brain damage Changes in mood Constipation Diarrhea Difficulty walking (mercury poisoning) Fever (cadmium) High blood pressure (lead) Impaired kidney function Impaired liver function Kidney damage and/or renal failure Lack of coordination (mercury) Depression, lack of orientation and concentration, as well as aphasia, are also results of PHACT-related cobalt poisoning [19]. While elevated levels of chromium do not appear to result in heart problems, they can wreak havoc with the reproductive system. Cobalt (Co) and its compounds are widely distributed in nature and are part of numerous anthropogenic activities. That's Froedert. All local poison control centers in the United States use this national number. Sinus tachycardia, left ventricular failure, and cardiogenic shock are some of the main manifestations, which may be preceded by nausea, diarrhea, and vomiting [13]. Slow breathing (less than eight breaths a minute) Irregular breathing (a gap of more than 10 seconds between breaths) Blue-tinged skin or pale skin. Treatments can reduce the symptoms of nickel allergy. Impairment of neurological basal ganglia and caudate nucleus was never described before. Symptoms of Alcohol Poisoning. What is Arthroplasty Cobalt Encephalopathy (ACE)? Swennen B, Buchet J-P, Stanescu D, et al. He discovered that 57 were cobalt positive, meaning the cobalt urine test revealed 1 part per billion (ppb) or higher. Dr. Tower has concluded that this approach is wrong, or at least incomplete, and he has seen that often the first signs of trouble with hip replacement patients are neurological symptoms. The neurological symptoms that occur with cobalt metal poisoning include: Dr. Tower did a post-surgical study of his patients with artificial hips containing at least one component made from chromium/cobalt. She had regained a normal appetite and gained weight, the metallic taste in her mouth was gone, and she had less. Some doctors may recommend chelation therapy to remove the metal, but that is a stop-gap if the implant is shedding ions it will keep wearing & adding more metal. He did my aftercare, 2 more surgeries & referred me to the best rehab PT group I ever had, who also coordinated with my primary. Affected patients should be monitored carefully for evidence of. Burns initially resemble first and second degree burns, but extend to subcutaneous tissue within a couple of days [Schiffl, Weidmann et al. Fired the surgeon & switched to a new, recommended one (outside my network) who also coordinated with my primary. Br J Ind Med.1993;50:835-842. If cobalt came in contact with the skin, wash the area thoroughly. Individuals must pay for the treatment themselves. [gpwlaw.com], You should call if you have any questions about poisoning or poison prevention. [en.wikipedia.org], Pseudotumors Pseudotumor from a metal on metal hip implant A pseudotumor (SUE-dough-two-mur) is a large soft tissue mass that forms around the hip. In July 2010, the woman suffered a severe cerebrovascular episode whose symptoms were similar to that of a stroke: dizziness, disorientation. The effects of poisoning depend on the substance, amount, and type of contact. We are absolutely pleased with how Clay Hodges handled my husbands hip replacement claim. I wonder how to find a toxicology expert and an endocrinologist? . State of Alaska Epidemiology Bulletin. DO NOT use it to treat or manage an actual poison exposure. Even injecting a whole vial of 15,000g of B12 at once can't do you any harm. [nursinghomelawcenter.org], Epidemiology A. Cobalt Toxicity in Two Hip Replacement Patients. Eventually the deficiency would lead to plant death. Cobalt poisoning (skin rashes, cardiomyopathy, problems with hearing, sight or cognition, tremors, and hypothyroidism). Br Heart J. Cobalt is a heavy metal that can be found in many different products, including batteries, pigments, and alloys. https://www.drugwatch.com/hip-replacement/metallosis/ Not scary at all actually, more like getting the right experts to weigh in so the best decisions get made. Categories: ImportedNumber of views: 1558, Tags: cobalt and chromium metals DePuy Pinnacle metal hip implant metal-on-metal hip implant symptoms of metal toxicity, ON YELP'S LIST OF THE Goldman-Cecil Medicine. Poisoning from metallosis is rare, but cobaltism is an established health concern. 1998-2022 Mayo Foundation for Medical Education and Resreach. Mayo Clinic Connect brings together 2 women with leukemia, 46 years apart. [orthopaedicprinciples.com], She had regained a normal appetite and gained weight, the metallic taste in her mouth had gone, and she had less fatigue and greater energy. Learn about UF clinical research studies that are seeking volunteers. I was lucky to have a good team, who got me back to normal. A patient believed to have been exposed to a dangerous amount of cobalt should undergo laboratory evaluation of cobalt concentration in the urine and blood as soon as possible upon presentation, as the excretion rate is maximized within 24 hours after an occasion of exposure. I would not return to the original surgeon. The most worrisome form of cobalt poisoning occurs when you breathe it into your lungs. How long have you been having issues? Cobalt poisoning can also occur from the wear and tear of some cobalt/chromium metal-on-metal hip implants. Common symptoms relate to the specific damage . A patient may first experience a mild burning sensation or hip pain before the more debilitating symptoms begin. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. My situation was also evaluated by a toxicology expert and an endocrinologist. Cobalt poisoning can lead to very serious health issues over time, and can also cause the implant to fail, leaving enough damage to bone, muscle & tendons to make revision difficult. I am a product liability lawyer with many clients who were injured by artificial hips containing cobalt and chromium. 16th ed. https://testdirectory.questdiagnostics.com/test/test-guides/TS_Cobalt_Blood/cobalt-blood Source: Nritya Creations (Right) Cobalt and nickel are neighbors on the periodic table . If possible, determine the following information: However, DO NOT delay calling for help if this information is not immediately available. This assay does not identify specific cobalt compounds or cobalt sources. This finding, if true, could be a game changer. Too often the pursuit of a blockbuster medical device or new prescription drug clouds a corporate boards better judgment. An individual is exposed to this chemical element via inhalation, ingestion, or dermal exposure and, in general, chronic exposure is required for most of the adverse effects to develop. Breathing treatments and medications to treat swelling and inflammation in your lungs may be prescribed. 1 Thus, clinical context is important to diagnose cobalt toxicity. [symptoma.com], In some rare cases, Cobalt-57 may also generate the Acute Radiation Syndrome, with symptoms like bleeding, diarrhea, nausea, vomiting, coma and even sudden death. Arch Toxicol.1994;68:528-531. This can lead to strokes, cardiac arrest, and death. Blood and urine tests, x-rays and ECG (electrocardiogram, or heart tracing) may be performed. The popularity of Metal-on-Metal (MoM) hip implants, which are typically made out of cobalt and chromium, has made cobalt poisoning of the eye more common. One issue Dr. Tower discovered was that ACE could occur with lower readings of cobalt in the body. However, I wonder if I should be finding a revision specialist with expertise in metal issues? The DePuy Pinnacle gained FDA approval in 2000, and although it has yet to be recalled like the DePuy ASR, there have been a significant number of adverse reports of failure and metal toxicity. Poisoning in cats is a serious problem. The Data on Cobalt Poisoning and Neuropsychiatric Complications. What is Arthroplasty Cobalt Encephalopathy (ACE)? New mucosal vaccine prototype provides unprecedented protection against Genetic cause of ALS and dementia repaired by RNA-targeting strategy developed at Nondiscrimination and Accessibility Notice, Drill bits, saw blades, and other machine tools, Cardiomyopathy (a problem where your heart becomes big and floppy and has problems pumping blood), Person's age, weight, and condition (for example, is the person awake or alert? Cobalt is a naturally occurring element in the earth's crust. I wonder how to find a toxicology expert and an endocrinologist? The symptoms all result from muscle paralysis caused by the toxin. Just my opinion. Cobalt poisoning can occur when you are exposed to large amounts of it. Lead is very common in the environment. Cobalt Poisoning can be manifested by a wide array of systemic effects. Immuno-biochemical findings in groups of individuals occupationally and non-occupationally exposed to emissions containing nickel and cobalt. Cobalt. Have had pain and dysfunction since the original surgery which makes it hard to know when the metal issue started. UF Health Neuromedicine Neuromedicine Hospital, College of Public Health & Health Professions, Clinical and Translational Science Institute, Center for Health Equity & Quality Research, Find Information on Medical Conditions & Services, College of Public Health & Health Professions (PHHP), Clinical & Translational Science Institute, UF Health leads way in robotic joint replacement system. The larger particles stay in your hip joint. However, thresholds at which symptoms of cobalt toxicity occur have not been defined. You should call if you have any questions about poisoning or poison prevention. Like. Founded in 1956, the University of Florida College of Nursing is the premier educational institution for nursing in the state of Florida and is ranked in the top 10 percent of all nursing graduate programs nationwide. Overexposure may cause fatigue, headaches, Typical Presentation of the Most Commonly Encountered Metals and Their Treatment (Open Table in a new window) Metal Acute Chronic Toxic Concentration Treatment Arsenic. The level of harm depends upon the dose, duration, and . What Are the Typical Symptoms of Cobalt Poisoning? Unfortunately, the bodys natural defenses are no match for cobalt and chromium metals. Symptoma empowers users to uncover even ultra-rare diseases. In his discussion Dr. Tower noted that after nine of his patients had revision surgeries, seven patients no longer showed signs of being cobalt-positive, and five of those seven improved neurologically. For years the focus following hip replacement surgeries has been on the physical condition of the hip itself. Cobalt is a component of vitamin B12, an essential vitamin. Additional symptoms may include fever, headaches, fatigue, sluggishness (letheragy), vomiting, loss of appetite (anorexia), The signs and symptoms may include: Nausea and vomiting from ingesting large amounts of cobalt compounds. Cobalt poisoning is a common problem in patients with artificial hips. Cobalt chloride; Cobalt oxide; Cobalt sulfate. Sue. We offer a a four-year Doctor of Veterinary Medicine programs as well as M.S. In particular, cobalt poisoning can lead to: Cardiomyopathy Deafness Nerve problems Ringing in the ears (tinnitus) Thickening of the blood Thyroid problems The silver lining to cobalt poisoning is that the symptoms and damage, if caught in time, may be completely reversible. When the tiny chromium and cobalt ions reach the bloodstream, symptoms of metal toxicity or metal poisoning can occur. Although cobalt has a biologically necessary role as metal constituent of vitamin B 12, excessive exposure has been shown to induce various adverse health effects.This review provides an extended overview of the possible Co sources and related intake routes, the detection and . Acute poisoning is often fatal regardless of therapy. [symptoma.com], Little JA,Sunico R (1958) Cobalt-induced goiter with cardiomegaly and congestive failure. They will give you further instructions. To use Symptoma.com you have to enable JavaScript in your web browser's settings! Itching, which may be severe. This is scary", "Not scary at all actually, more like getting the right experts to weigh in so the", "Please tell me about your team and how they worked together. If untreated, the disease may progress and symptoms may worsen to cause full paralysis of some muscles, including those used in breathing and those in the arms, legs, and trunk (part of the body from the . Sullivan JF,Egan JD,George RP (1969) A distinctive myocardiopathy occurring in Omaha,Nebraska:Clinical aspects. It has generally been accepted that cobalt readings below 4 ppb was not cause for concern, and some surgeons would not order further testing until the cobalt readings exceeded 7 ppb or even 10 ppb. It is a very small part of our environment. Confusion, stupor. [sullolaw.com], Elevated cobalt levels could prevent the body from repairing DNA while elevated chromium levels can result in DNA mutation. 1982; Meditext 2005]. Unlike the ASR, the Pinnacle is attached to the bone via screws. Experiencing the effects of toxic metal toxicity does not require "nuclear meltdown" levels of exposure either. Symptoms can include numbness, severe tiredness (fatigue), and tingling in your hands and feet. Neurologic dysfunction: There are various neurotoxic symptoms described in patients with presumed cobalt toxicity, including hearing loss, tinnitus, optic nerve atrophy, visual impairment, convulsions, vertigo, headaches, tremors, polyneuropathy, incoordination, cognitive decline, and depression. Good for you. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. One doc says it is a rare complication. The signs and symptoms of acute Cobalt Poisoning can vary from one individual to another. But Dr. Tower has observed neurological problems in several patients with metal-on-plastic hips, or hips utilizing a ceramic ball with a metal cup. This article is for information only. Cobalt poisoning is intoxication caused by excessive levels of cobalt in the body. Blood and urine tests, x-rays and ECG (electrocardiogram, or heart tracing) may be done. Gastrointestinal PO 0.04 mgCo/kg/day [27,28] Nausea Vomiting Diarrhea Hepatic effects [26,27] PO 0.04 mgCo/kg/day Central hepatic necrosis Increased Serum Bilirubin Increase AST,ALT,LDH Increase Creatine Phosphokinase Increase Ornithine CarbamylTransferase [toxicology.imedpub.com], In the first month, patients receive between five and 30 treatments (with 30 being most common), and are often advised to continue preventive treatment once a month. The neurological symptoms that occur with cobalt metal poisoning include: tremors Passing out or losing consciousness. Another rare form of cobalt poisoning is from a hip replacement. ACE is meant to identify a brain disease or associated neurological symptoms caused by elevated levels of cobalt from a metal artificial hip. Symptoms. Total failure of the implant can be the result of these adverse reactions to a DePuy Pinnacle metal hip implant. The hospitalist, a member of our network, recognized an impending "thyroid storm" started treatment (don't know the meds) and referred me to the others. So you may have been reacting to smaller amounts for a very long time. Lung function and respiratory symptoms in hard metal workers . In fact, if any part of an artificial hip contains chrome or cobalt materials, the patient is at risk for higher metal levels in the blood and neurological symptoms as a result. . Purported symptoms of metallosis generally include pain around the site of the implant, pseudotumors . We are finding cobalt poisoning in too many patients with metal-on-plastic and metal-on-ceramic hips. This can lead to serious tissue damage, or even death. Go to the Joint Replacements Support Group. The two surgeons I am consulting are very good doctors. This case's interest lies in the severity of . Students rotate through the various clinical settings on the campus, and primary care centers and specialty care centers located throughout Jacksonville. The phenomenon is known as prosthetic hip-associated cobalt toxicity (PHACT) and leads to some of the manifestations that inhaled and ingested cobalt does, including cardiac, neurologic, and thyroid impairment [18]. [mja.com.au]. chills (shivering) loss of appetite. PRINCIPAL OFFICE LOCATED IN HOUSTON, TEXAS, 2020 SW FREEWAY (US 69), SUITE 300, HOUSTON, TX 77098, Iranian Ballistic Missile Injury Lawsuits, Cardiovascular and neurological disorders, Emotional problems such as depression, anxiety and irritability. Treatment in cases of acute high-level chromium exposure is usually supportive and symptomatic. [mja.com.au], Cobalt-60 emits radiation, causing long-lasting symptoms like fatigue and hairloss, and even loss of consciousness. Meecham HM, Humphrey P. Industrial exposure to cobalt causing optic atrophy and, Bonenfant JL, Auger C, Miller G, et al. He always kept us informed of the progress. Muscle weakness and paralysis. Vomiting. I had no idea MoM implants were ever done. * Cobalt may affect the heart, thyroid, liver and kidneys. I can't say enough about how much he has helped me. And clouded judgment hurts people. In addition to the aforementioned symptomatology, persisting occupational exposure to cobalt may also lead to conjunctival congestion, weight loss in patients with the cobalt-associated pulmonary disease, and neurological sequelae which include nerve deafness, as well as memory and visual acuity impairment [9] [10] [11]. As hip replacements fail and metal flakes enter the body, patients can suffer from cobalt toxicity (elevated cobalt levels). Ranked among the top schools of pharmacy nationally, the college supports research, service and educational programs enhanced with online technologies. [thelawfirm.com], The prognosis of Cobalt Poisoning is dependent on the amount of substance consumed, time between consumption and treatment, severity of the symptoms, as well as general health status of the patient. Waltham, MA: Elsevier; 2016:490-491. The remarkable nature of these case studies is that "hip pain was not a prominent feature," Dr. Bunning says. Cobalt poisoning can be seen as a result of super alloys in orthopaedic implants, ionizing radiation, occupational exposure and rarely as . The area may be washed and a skin cream may be prescribed. In: Aronson JK, ed. 2013-2022, ANDREW SULLO IS A TOP 100 NATIONAL TRIAL LAWYER 2013 2014 2015 2016 2017 2018 2019, Andrew Sullo 100 Mejores Abogados Nacional | 2013 2014 2015 2016 2017. diarrhoea. [rarediseases.org], Typical Presentation of the Most Commonly Encountered Metals and Their Treatment (Open Table in a new window) Metal Acute Chronic Toxic Concentration Treatment Arsenic Nausea, vomiting, "rice-water" diarrhea, encephalopathy, MODS, LoQTS, painful neuropathy [emedicine.medscape.com], In July 2010, the woman suffered a severe cerebrovascular episode whose symptoms were similar to that of a stroke: dizziness, disorientation, nausea, vomiting, and being off balance on the left side. [schmidtandclark.com], Additional symptoms may include fever, headaches, fatigue, sluggishness (letheragy), vomiting, loss of appetite (anorexia), abdominal pain, constipation, joint pain, loss of recently acquired skills, incoordination, listlessness, difficulty sleeping [rarediseases.org], The signs and symptoms may include: Nausea and vomiting from ingesting large amounts of cobalt compounds Abdominal pain Exposure of the compound to the eye may result in pain, irritation, redness, and watery eyes Contact dermatitis from direct contact [dovemed.com], [] neuropathy, coma, autonomic instability, MODS Late: Alopecia, Mees lines, residual neurologic symptoms Alopecia, neuropathy Toxic: >3 g/L (blood) MDAC Prussian blue Zinc MFF (oxide fumes); vomiting, diarrhea, abdominal pain (ingestion) Copper deficiency [emedicine.medscape.com], Lead poisoning can present with abdominal pain, headache, anemia, peripheral neuropathy and irritability. The other says hell find out whats wrong when he goes in. [mctlawyers.com], Sinus tachycardia, left ventricular failure, and cardiogenic shock are some of the main manifestations, which may be preceded by nausea, diarrhea, and vomiting. In the rare case that you have large levels of cobalt in your blood, you may need hemodialysis (kidney machine) and get medicines (antidotes) to reverse the effects of the poison. Dry mouth. cobalt and cobalt-chrome alloys. Aronson JK. Cobalt poisoning can occur when you are exposed to large amounts of it. Devlin JJ, Pomerleau AC, Brent J, et al. Our state-of-the-art medical center serves an urban population of 1 million from north Florida to south Georgia. The soft tissue damage in my outer thighs is less noticeable, but the dents never completely went away. Ringing in the ears (tinnitus) Thickening of the blood. I have been happy with my replacements for over 11 years now. Common food sources: Improperly canned or fermented foods, usually homemade. https://testdirectory.questdiagnostics.com/test/test-guides/TS_Cobalt_Blood/cobalt-blood, https://www.drugwatch.com/hip-replacement/metallosis/. It can harm the eyes, skin, heart, and lungs. Complete your request online or contact us by phone. Cobalt poisoning is a common problem in patients with artificial hips. Redness or changes in skin color. Are Neurological Problems From Metallosis Limited to Metal-on-Metal Artificial Hips? You can call 24 hours a day, 7 days a week. Symptoms of chromium toxicity Heavy exposure to chromium (IV) has been reported to cause the following debilitating symptoms in individuals working in such hazardous conditions: Acute dermatitis and skin ulcers (also known as chrome ulcers). The UF College of Pharmacy-Jacksonville offers a four-year Doctor of Pharmacy (Pharm.D.) When I was diagnosed with metallosis, the Ortho told me it was OK to wait 5 more months for surgery, and I foolishly believed him. The friction releases tiny metal particles into your hip joint. Epidemiological survey of workers exposed to cobalt oxides, cobalt salts, and cobalt metal. Disruption of DNA. The signs and symptoms may include: Nausea and vomiting from ingesting large amounts of cobalt compounds Abdominal pain Exposure of the compound to the eye may result in pain, irritation, redness, and watery eyes University of Florida Health knows how important ongoing medical learning is to health care providers and the community. One doc may order a CT scan. 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. Does this settle the questions regarding artificial hip implants and metallosis? Workers may be harmed from exposure to cobalt and cobalt-containing products. J Hyg Epidemiol Microbiol Immunol.1983;27(4):387-394. If your original surgeon is not experienced in doing revisions of metal-on-metal hips, you might want to seek out one who is. [sullolaw.com], Treatment for skin contact : Since these rashes are rarely serious, very little will be done. Many metal hip replacements were constructed using a hard metal called cobalt in order to extend the life of the hip replacement. weakness. The metal ions thereby released may cause both local and wider (systemic) symptoms. Thank you. Cobalt Toxicity. It is used in steel 1988;43(4):299-303. Cardiovascular and neurological disorders. Usually the metal won't erode at all but it certainly would if metal were rubbing against metal, at least a little. [toxicology.imedpub.com], The patient reported difficulty in remembering names and registering information, headaches and cerebellar signs (ataxia and dysdiadochokinesis). Feeling faint. The UF College of Veterinary Medicine is Florida's only veterinary college and provides many unique educational programs for students and services aimed at helping pets, wildlife and endangered species. 1971;33:175-178. The reaction tends to occur only where your skin came into contact with nickel, but sometimes may appear in other places on your body. Remember I am not a doctor and this is not medical advice. The UFCOM-J offers accredited graduate medical education residency and fellowship programs, in addition to non-standard fellowship programs. This would include products such as the DePuy ASR hip and the Zimmer Durom hip (and several other metal-on-metal hip products, about which I have written often on this website). This study focuses on a 66-year-old-man whose vision was damaged because he got cobalt poisoning from a MoM hip implant. J Pediatr 52: 284-288 Sederholm T,Kouvalainen K,Lamberg BA (1968) Cobalt-induced hypothyroidism and polycythemia in lipoid nephrosis. Clinical Features, Testing, and Management of Patients with Suspected Prosthetic Hip-Associated Cobalt Toxicity: a Systematic Review of Cases. ACE is meant to identify a brain disease or associated neurological symptoms caused by elevated levels of cobalt from a metal artificial hip. But we need to start looking much more closely at the things we put into our bodies, whether its a Twinkie, a sleeping pill, or a metal artificial hip. So a high serum B12 of 1000 ng/L will give cobalt levels of 100 times less than is acceptable . drowsiness, dizziness or weakness. Additionally, her hip pain was gone and her cobalt levels had come back down to normal. CELEBRATING 20 YEARS IN BUSINESS A measure of 5.6 is considered "borderline" by some docs, but it becomes and issue if you are having symptoms. Cobalt is known to cause dermatitis, should it come into contact with an individual's skin [15] [16]. It's caused when the metal wears and introduces cobalt into the bloodstream. Periodic blood tests are strongly recommended for anyone with a metal-on-metal implant to catch blood poisoning at its earliest stages, especially if they . @chadessa This is an on-going issue, and the metal-on-metal implants that cause the problems are no longer as popular as they were a few years ago. Effect of occupational exposure to cobalt blue dyes on the. Together we care for our patients and our communities. Waltham, MA: Elsevier; 2016:490-491. Although cobalt has a biologically necessary role as metal constituent of vitamin B 12, excessive exposure has been shown to induce various adverse health effects.This review provides an extended overview of the possible Co sources and related intake routes, the detection and . Also, it is well past time for medical device companies toslow downand return to more extensive testing of new medical products. Nemery B, Casier P, Roosels D, et al.Survey of cobalt exposure and respiratory health in diamond polishers. The Pinnacle was the predecessor to the ASR which received FDA approval in 2005. General symptoms. vomiting. After 12+ years post THR have a diagnosis of cobalt poisoning. Sensitive skin and skin rash Neurological changes and cognitive impairment caused by limited blood flow The symptoms of cobalt poisoning are known to start mildly and gradually worsen over time. Lead poisoning symptoms in adults. Cobalt toxicity occurs due to exposure of large quantities of cobalt, a naturally occurring element found in the environment, via ingestion, inhalation, skin contact, or bloodstream contact resulting from metal wear of cobalt and chromium metal-on-metal hip implants. Joint and muscle pain. The risk to the patient occurs with any artificial hip containing a cobalt component. Conventional wisdom has been that eliminating the metal on metal contact should eliminate the risk of metallosis, but Dr. Tower at least does not accept this thinking. Cobalt is a component of vitamin B12, which supports the production of red blood cells. Clay was able to win multiple settlements on my behalf with most of them being the maximum amount able to be awarded. However, it is possible to have some symptoms if you swallow a large amount of cobalt at one time. Cobalt is a component of vitamin B12, which supports the production of red blood cells. [doi.org], They bind to heavy metals in the body and prevent them from binding to other agents, creating a compound that can then be excreted from the body. 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