A young man with a heavy heart

Davey, Patrick; Benson, Merrill D.

doi:10.1136/hrt.82.6.e11

Cited by 10 publications

(10 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After i.v. injection, Hg 0 coalesces into microemboli that, given the low solubility and chemical stability of the element, may last for years (43,48,49). They occur at the injection site and then distribute to the right ventricle and the lung vessels.…”

Section: Discussionmentioning

confidence: 99%

Toxicokinetics and toxicodynamics of elemental mercury following self-administration

Palma

Mariotti

Lonati

et al. 2008

Clinical Toxicology

View full text Add to dashboard Cite

Introduction. Intravenous injection of mercury has seldom been reported, especially in cases of attempted suicide, and is associated with variable clinical outcomes. Case report. A young woman came to our attention after self-injecting and ingesting mercury drawn from 37 thermometers. The patient suffered lung embolization complicated by adult respiratory distress syndrome (ARDS), toxic dermatitis, anemia, mild hepato-renal impairment, and died after 30 days. Mercury was monitored in biological fluids (blood, plasma, urine, and bronchoalveolar fluid) to study its toxicokinetics and to evaluate dose-effect relationships. Its urinary clearance significantly increased after a chelation challenge test with meso-2,3-dimercaptosuccinic acid (DMSA) (median values of 2.48 and 8.85 before and after the test, respectively, p < 0.05). Conclusions. Mercury poisoning by intravenous injection is a clinical emergency, potentially leading to death. When injected, the element has a very slow clearance, mainly renal. Our data do not allow any conclusion about the effectiveness of chelation therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Toxicokinetics and toxicodynamics of elemental mercury following self-administration

Palma

Mariotti

Lonati

et al. 2008

Clinical Toxicology

View full text Add to dashboard Cite

show abstract

“…Most metallic mercury poisoning cases have good prognosis (with or without a mild symptom or some sequelae), and only a few patients eventually died. [ 3 – 12 , 16 – 22 ] There are several effective methods of removing the mercury in the body. Surgically clear is useful for getting rid of the “mercury bank” in the injection site and has an effective effect in reducing circulating mercury levels and improving symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Residual mercury may cause various complications such as interstitial lung impairment, asthenozoospermia, peripheral axonopathy, aplastic anemia, and cardiac granulomas. [ 21 , 22 , 25 ] Therefore, early diagnosis and appropriate treatment are critical, it should be concerned about the combined use of chelation agents and other treatments, such as surgical excision, hemodialysis and plasma exchange in clinical settings, long-term follow-up to monitor complication and consequences from mercury intoxication with appropriate treatment approaches is warranted.…”

Section: Discussionmentioning

confidence: 99%

Mercury poisoning through intravenous administration

Liu

Chen

2017

Medicine

View full text Add to dashboard Cite

Rationale:Metallic mercury poisoning through intravenous injection is rare, especially for a homicide attempt. Diagnosis and treatment of the disease are challenging.Patient concerns:A 34-year-old male presented with pyrexia, chill, fatigue, body aches, and pain of the dorsal aspect of right foot. Another case is that of a 29-year-old male who committed suicide by injecting himself metallic mercury 15 g intravenously and presented with dizzy, dyspnea, fatigue, sweatiness, and waist soreness.Diagnosis:The patient's condition in case 1 was deteriorated after initial treatment. Imaging studies revealed multiple high-density spots throughout the body especially in the lungs. On further questioning, the patient's girlfriend acknowledged that she injected him about 40 g mercury intravenously 11 days ago. The diagnosis was then confirmed with a urinary mercury concentration of 4828 mg/L.Interventions:Surgical excision, continuous blood purification, plasma exchange, alveolar lavage, and chelation were performed successively in case 1. Blood irrigation and chelation therapy were performed in case 2.Outcomes:The laboratory test results and organ function of the patient in case 1 gradually returned to normal. However, in case 2, the patient's dyspnea was getting worse and he finally died due to toxic encephalopathy and respiratory failure.Lessons:Early diagnosis and appropriate treatment are critical for intravenous mercury poisoning. It should be concerned about the combined use of chelation agents and other treatments, such as surgical excision, hemodialysis and plasma exchange in clinical settings.

show abstract

“…Davey and Benson [15] and Alhamad et al [5] reported metal dense deposits in the heart following intravenous injection of metallic mercury or inhalation of vaporized mercury. Intra-arterial injection can cause ischemia and/or gangrene secondary to embolisation [10].…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonic embolism, development of pulmonary empyema, and embolisation to the heart has been reported following intravenous injection [ 4 , 15 - 17 ]. Davey and Benson [ 15 ] and Alhamad et al [ 5 ] reported metal dense deposits in the heart following intravenous injection of metallic mercury or inhalation of vaporized mercury. Intra-arterial injection can cause ischemia and/or gangrene secondary to embolisation [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Auto-aggressive metallic mercury injection around the knee joint: a case report

et al. 2011

View full text Add to dashboard Cite

BackgroundAccidental or intentional subcutaneous and/or intramuscular injection of metallic mercury is an uncommon form of poisoning. Although it does not carry the same risk as mercury vapour inhalation, it may cause destructive early and late reactions.Case PresentationHerein we present the case of a 29-year-old male patient who developed an obsessive-compulsive disorder causing auto-aggressive behaviour with injection of elemental mercury and several other foreign bodies into the soft tissues around the left knee about 15 years before initial presentation. For clinical examination X-rays and a CT-scan of the affected area were performed. Furthermore, blood was taken to determine the mercury concentration in the blood, which showed a concentration 17-fold higher than recommended. As a consequence, the mercury depots and several foreign bodies were resected marginally.ConclusionBlood levels of mercury will decrease rapidly following surgery, especially in combination with chelating therapy. In case of subcutaneous and intramuscular injection of metallic mercury we recommend marginal or wide excision of all contaminated tissue to prevent migration of mercury and chronic inflammation. Nevertheless, prolonged clinical and biochemical monitoring should be performed for several years to screen for chronic intoxication.

show abstract

A young man with a heavy heart

Cited by 10 publications

References 14 publications

Toxicokinetics and toxicodynamics of elemental mercury following self-administration

Toxicokinetics and toxicodynamics of elemental mercury following self-administration

Mercury poisoning through intravenous administration

Auto-aggressive metallic mercury injection around the knee joint: a case report

Contact Info

Product

Resources

About