Emergency Medicine Book

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Mercury Poisoning

Aka: Mercury Poisoning, Mercury Toxicity, Mercury Content in Fish, Mercury
  1. Background
    1. Mercury is the only metal liquid at room temperature
    2. Mined in Spain as Cinnabar
    3. Contaminates water and air via disposal of items
      1. Batteries
      2. Polyvinyl chloride
      3. Latex paint
  2. Pathophysiology
    1. Sources of exposure
      1. Mercury-containing device spill
      2. Disk battery ingestion
      3. Laxative abuse
      4. Repeated thimerosal exposure
      5. Contaminated seafood exposure (see below)
      6. Exposure to paint containing Mercury
    2. Effects vary by form of Mercury
      1. Elemental Mercury
        1. Exposure via inhalation, aspiration, or injection
        2. Causes lung toxicity and ARDS
        3. Can also cause neruologic and renal sequelae
      2. Inorganic Mercury salts
        1. Exposure via ingestion
        2. Results in gastrointestinal and nephrotoxicity
      3. Organic Mercury compounds
        1. Exposure via ingestion or transdermal
        2. Results in delayed neurotoxicity
    3. Mechanisms of injury
      1. Mercury binds sulfhydryl groups
      2. Nephrotoxicity
        1. Local immune reaction and direct damage
      3. Skin injury
        1. Local immune reaction
      4. Cardiovascular changes (Hypertension and Tachycardia)
        1. Catechol-O-methyltransferase
      5. Neurotoxicity
        1. Injury to Cerebellum, postcentral gyri, calcarine
  3. Symptoms and signs
    1. Inhalation injury (Mercury vapor)
      1. Acute exposure
        1. Shortness of Breath
        2. Fever and chills
        3. Acute Respiratory Distress Syndrome (ARDS)
        4. Bloody Diarrhea
        5. Renal tubular necrosis
      2. Subacute or chronic exposure
        1. Metal fume fever
        2. Neuropsychiatric changes
        3. Nephrotoxicity
        4. Skin changes
    2. Aspiration Injury (liquid Mercury)
      1. Tracheobronchial hemorrhage
      2. Aspiration pneumonitis
    3. Ingestion Injury (inorganic Mercury salts)
      1. Acute ingestion
        1. Corrosive Gastroenteritis
        2. Gastrointestinal Bleeding
        3. Mucous membrane grayish discoloration
        4. Hypovolemic shock (secondary to fluid shifts)
        5. Acute Tubular Necrosis
        6. Other gastrointestinal symptoms as below
      2. Chronic or subacute exposure
        1. Neurotoxicity
          1. Neurasthenia, erethism
        2. Nephrotoxicity
          1. Proteinuria (Nephrotic Syndrome may result)
        3. Gastrointestinal injury
          1. Metallic Taste
          2. Gingivostomatitis
          3. Loose teeth
          4. Burning mouth sensation
          5. Hypersalivation
    4. Chronic ingestion of Methylmercury (organic Mercury)
      1. Delayed neurotoxicity
      2. Visual field constricted
      3. Ataxia
      4. Sensory deficit
      5. Tremor or spasticity
      6. Dysarthria
      7. Hearing Loss
      8. Hyperreflexia
  4. Labs
    1. Urine Mercury level
      1. Best correlates with Mercury Toxicity
      2. Acceptable urine levels <20 mcg/L
      3. Treatment required if urine Mercury >150 mcg/L
    2. Blood Mercury level
      1. Required to detect organic Mercury exposure
      2. Acceptable blood levels <10 mcg/L
      3. Treatment required if blood Mercury >35 mcg/L
  5. Radiology
    1. Injected metallic Mercury is radiopaque
  6. Management: Acute Exposure
    1. Mercury ingestion
      1. See Gastric Decontamination
      2. Gastric Lavage
        1. Use protein solutions (e.g. milk)
        2. Charcoal not useful (does not bind Mercury)
    2. Mercury Inhalation
      1. Supportive care
      2. Antibiotics not indicated
      3. Corticosteroids not indicated
    3. Mercury aspiration
      1. Airway Suctioning
      2. Postural drainage
    4. Mercury injection
      1. Surgical debridement
  7. Management: Chelating agents for acute-chronic exposure
    1. Indications
      1. See Labs above for urine and blood Mercury levels
    2. Agents
      1. Dimercaprol
        1. Indicated in inorganic Mercury Poisoning
        2. Contraindicated in organic, methylmercury Poisoning
      2. DMSA
        1. Preferred agent for acute and chronic Poisoning
        2. Not FDA indicated
      3. D-Penicillamine
        1. Needs complete Gastric Decontamination before use
  8. Management: Environmental clean-up
    1. Precautions
      1. Do not use a vacuum (volatilizes Mercury)
      2. Dispose of contaminated absorbable surfaces
    2. Small spills (e.g. broken thermometer)
      1. Scoop onto stiff card
      2. Move Mercury into bag and seal bag
      3. Dispose of Mercury as hazardous waste
    3. Larger spills
      1. Sand or Mercury Decontamination kit
      2. Consider contacting HazMat
  9. Prevention: Precautions regarding dietary fish intake
    1. Avoid fish high in Mercury content
      1. Shark
      2. Swordfish
      3. King Mackerel
      4. Tilefish
    2. Limit fish with moderate Mercury content (6 oz/week)
      1. Albacore tuna
      2. Locally caught fish with unknown concentration
    3. Choose fish with lowest Mercury content
      1. Salmon
      2. Pollock
      3. Canned light tuna

Mercury (C0025424)

Definition (MEDLINEPLUS)

Mercury is an element that is found in air, water and soil. It has several forms. Metallic mercury is a shiny, silver-white, odorless liquid. If heated, it is a colorless, odorless gas. It also combines with other elements to form powders or crystals. Mercury is in many products. Metallic mercury is used in thermometers, dental fillings and batteries. Mercury salts may be used in skin creams and ointments. It's also used in many industries.

Mercury in the air settles into water. It can pass through the food chain and build up in fish, shellfish and animals that eat fish. The nervous system is sensitive to all forms of mercury. Exposure to high levels can damage the brain and kidneys. Pregnant women can pass the mercury in their bodies to their babies. It is important to protect your family from mercury exposure.

Agency for Toxic Substances and Disease Registry
Definition (NCI) A silver-white, poisonous metal that is a liquid at ordinary temperatures. It is commonly used in thermometers and amalgams, and has been used as an ingredient in some homeopathic medicines and in very small amounts as a preservative in viral vaccines.
Definition (SPN) Dental mercury is a device composed of mercury intended for use as a component of amalgam alloy in the restoration of a dental cavity or a broken tooth.
Definition (MSH) A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to MERCURY POISONING. Because of its toxicity, the clinical use of mercury and mercurials is diminishing.
Definition (CSP) silver metallic element that exists as a liquid at room temperature, atomic symbol Hg, atomic number 80; used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents; can be absorbed through the skin and mucous membranes; because of its toxicity, the clinical use of mercury and mercurials is diminishing.
Definition (NCI) An element with atomic symbol Hg, atomic number 80, and atomic weight 200.59; a heavy, silvery-white metal, liquid at room temperature, a rather poor conductor of heat and a fair conductor of electricity.
Concepts Hazardous or Poisonous Substance (T131) , Element, Ion, or Isotope (T196)
MSH D008628
SnomedCT 45262002
English Mercury, Mercury, NOS, Mercury (Elemental), Hg, HG, Hydrargyrum, Liquid Silver, Quicksilver, Mercury [Chemical/Ingredient], metal mercury, hg, mercury (Hg), MERCURY, mercury, Hg element, Hg - Mercury, Mercury (substance), Mercury (Metal)
Swedish Kvicksilver
Czech rtuť
Finnish Elohopea
Russian RTUT', РТУТЬ
Croatian ŽIVA
Latvian Dzīvsudrabs
Polish Rtęć
Spanish mercurio (sustancia), mercurio, Mercurio
French Mercure
German Quecksilber
Italian Mercurio
Portuguese Mercúrio
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Mercury Poisoning (C0025427)

Definition (CSP) acute or chronic disease produced by exposure to mercury or toxic mercury compounds.
Concepts Injury or Poisoning (T037)
MSH D008630
ICD9 985.0
ICD10 T56.1, T56.1X1, T56.1X
SnomedCT 212520008, 85180002, 212844002
English Mercury poisoning syndrome, Mercury Poisoning, Mercury Poisonings, Poisoning, Mercury, Poisonings, Mercury, Toxic effect of mercury and its compounds, MERCURIALISM, mercury poisoning, Toxic effect of mercury and its compounds, NOS, Hg or Hg comp causng tox effct, Mercury and its compounds, MERCURY POIS, POIS MERCURY, Mercury causing toxic effect, Mercury compound poisoning (disorder), Mercury compound poisoning, poisoning by mercury (diagnosis), poisoning by mercury, Toxic effect mercury, Toxic effects of mercury and its compounds, Mercury Poisoning [Disease/Finding], mercury poisons, mercury poison, poisoning mercury, Toxic effects of mercury and its compounds NOS, Mercurialism, Hydrargyria, Hydrargyrism, Hydrargyrosis, Mercury poisoning, Mercury or mercury compound causing toxic effect, Toxic effect of mercury AND/OR its compounds (disorder), Toxic effect of mercury AND/OR its compounds, hydrargyrism, mercurialism, Poisoning by compounds of mercury
Dutch toxisch gevolg van mercurium en zijn verbindingen, kwikvergiftiging, Kwik en kwikverbindingen, Kwikvergiftiging, Vergiftiging, kwik-
French Effet toxique du mercure et ses composés, Hydrargyrisme, Hydrargyrie, Intoxication au mercure, Intoxication mercurielle, Intoxication par le mercure
German toxischer Effekt von Quecksilber und seinen Verbindungen, Toxische Wirkung: Quecksilber und dessen Verbindungen, Quecksilbervergiftung
Italian Effetti tossici del mercurio e suoi composti, Avvelenamento da mercurio
Portuguese Efeito tóxico de mercúrio e seus compostos, Envenenamento por mercúrio, Intoxicação por Mercúrio
Spanish Efecto tóxico del mercurio y de sus compuestos, Envenenamiento por mercurio, intoxicación por compuesto de mercurio, Mercury causing toxic effect, intoxicación por compuesto de mercurio (trastorno), efecto tóxico del mercurio Y/O sus derivados (trastorno), efecto tóxico del mercurio Y/O sus derivados, hidrargiria, intoxicación mercúrica, intoxicación por mercurio, mercurialismo, Envenenamiento por Mercurio, Intoxicación por Mercurio, Intoxicacion por Mercurio
Swedish Kvicksilverförgiftning
Japanese ｽｲｷﾞﾝﾁｭｳﾄﾞｸ, 水銀症, 水銀中毒, メチル水銀中毒, 中毒-水銀
Czech rtuť - otrava, Toxický účinek rtuti a jejích sloučenin, Otrava rtutí
Finnish Elohopeamyrkytys
Russian RTUT'IU OTRAVLENIE, MINAMATY BOLEZN', МИНАМАТЫ БОЛЕЗНЬ, РТУТЬЮ ОТРАВЛЕНИЕ
Korean 수은 및 그 화합물의 중독작용
Croatian OTROVANJE ŽIVOM
Polish Zatrucie rtęcią
Hungarian Higany és vegyületeinek toxikus hatása, Higanymérgezés
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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