Differential Diagnosis for Heavy Metal Toxicity Causing Tremor and Agitation

• Single Most Likely Diagnosis
  • Mercury toxicity: Mercury is known to cause neurological symptoms including tremors, agitation, and personality changes. Its effects on the nervous system can lead to a condition known as "mad hatter's disease," which historically affected hatters who treated fur with mercuric nitrate.
• Other Likely Diagnoses
  • Lead toxicity: While lead poisoning is more commonly associated with developmental delays in children and abdominal pain in adults, high levels of exposure can lead to neurological symptoms including tremors and agitation.
  • Arsenic toxicity: Arsenic poisoning can cause a wide range of symptoms, including neurological effects such as tremors and agitation, especially in acute or high-dose exposures.
• Do Not Miss Diagnoses
  • Thallium toxicity: Thallium is highly toxic and can cause severe neurological symptoms, including tremors and agitation, along with hair loss and skin changes. It's crucial to consider thallium poisoning due to its potential for severe and irreversible damage if not promptly treated.
  • Manganese toxicity: Manganese exposure, particularly in occupational settings like mining or welding, can lead to manganism, a condition that resembles Parkinson's disease and includes symptoms like tremors and agitation.
• Rare Diagnoses
  • Tin toxicity: Certain forms of tin, like trimethyltin, can cause severe neurological symptoms, but this is relatively rare and usually associated with specific occupational exposures.
  • Bismuth toxicity: While bismuth is generally considered safe in therapeutic doses (e.g., in Pepto-Bismol), high doses or prolonged exposure could potentially lead to neurological symptoms, though this is less common compared to other heavy metals.