A cluster of pediatric metallic mercury exposure cases treated with meso-2,3-dimercaptosuccinic acid (DMSA)

Abstract

Nine children and their mother were exposed to vapors of metallic mercury. The source of the exposure appears to have been a 6-oz vial of mercury taken from a neighbor's home. The neighbor reportedly operated a business preparing mercury-filled amulets for practitioners of the Afro-Caribbean religion Santeria. At diagnosis, urinary mercury levels in the children ranged from 61 to 1,213 microg/g creatinine, with a geometric mean of 214.3 microg/m creatinine. All of the children were asymptomatic. To prevent development of neurotoxicity, we treated the children with oral meso-2,3-dimercaptosuccinic acid (DMSA). During chelation, the geometric mean urine level rose initially by 268% to 573.2 microg mercury/g creatinine (p<0.0005). At the 6-week follow-up examination after treatment, the geometric mean urine mercury level had fallen to 102.1 microg/g creatinine, which was 17.8% of the geometric mean level observed during treatment (p<0.0005) and 47.6% of the original baseline level (p<0.001). Thus, oral chelation with DMSA produced a significant mercury diuresis in these children. We observed no adverse side effects of treatment. DMSA appears to be an effective and safe chelating agent for treatment of pediatric overexposure to metallic mercury. Images Figure 1

Comparison of Indoor Mercury Vapor in Common Areas of Residential Buildings with Outdoor Levels in a Community Where Mercury Is Used for Cultural Purposes

“…EPA 1993). At least one case of significant human exposure to elemental mercury requiring medical intervention as a result of cultural practices has been reported (Forman et al 2000). …”

Dimercaptosuccinic acid loading test for assessing mercury burden in healthy individuals

“…In two children, the concentration of serum alkaline phosphatase increased but treatment was not discontinued for this reason; in one child the blood eosinophil count increased during the ¢rst course, the drug was stopped and the eosinophil count returned to normal and did not increase when the child was re-challenged with a second full, 28-day course of DMSA. Forman et al 14 treated nine children of the same family, following exposure to metallic mercury vapour, with 30 mg/kg/day DMSA for ¢ve days followed by 20 mg/ kg/day for 14 days, and, at a later stage, all nine children received a further 14-day course of DMSA at 20 mg/kg/day. No side e¡ects of treatment were observed.…”

The pitfalls of hair analysis for toxicants in clinical practice: three case reports.

“…Patient 2 was taking three Captomer pills per day initially, and later three pills per week. By contrast, the recommended dose of Succimer for mercury intoxication is 30 mg/kg/day or 1,500 mg/day for a 50 kg woman for 5 days (14). Patient 3 received intravenous EDTA for 2.5 years.…”