Intoxication sévère au chlorure de mercure

Ollier, E.; Carcel, C.; Bost, M.; Grenet, Guillaume; Billon, A.; Patat, Anne-Marie; Kassaï, Behrouz; Sapori, Jean-Marc

doi:10.1016/j.toxac.2017.03.054

Cited by 1 publication

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“…She was kept in the intensive care unit for another endoscopy 12 hours later. The maximum concentration of mercury on the second day upon admission was measured as high as 4940,6ug/L [7,8].…”

Section: Case Presentationmentioning

confidence: 95%

Mercuric chloride poisoning: Oesophagectomy as treatment?

Awad¹,

Guy²,

Monneuse³

2020

Case Rep Imag Surg

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Background: Mercury is one of the most dangerous heavy metals if repeatedly ingested. It existed for medicinal purposes such as thermometers, for disinfection in Arabic medicine and in the consumption of fish in Japan. It exists in several forms and the medical care required for these various forms depends on the mode of intake, the dose and more specifically the pharmacokinetics of each compound. Ingestion of Mercuric chloride is a very rare and medically challenging dilemma as it requires an early multi-departmental approach to the management of the patient.Clinical Presentation: A 32-year-old patient ingested 2g of mercuric chloride for suicidal reasons. Initially presenting to the emergency department with nausea and vomiting admitting she had ingested this compound arose our vigilance with immediate introduction of the chelating agent Dimercaprol and she underwent a series of endoscopies as well as computed tomography (CT) scans before her case deteriorated and she was taken to the operating theatre on day 23 for a total esophagogastrectomy, oesophagostomy and jejunostomy for enteral alimentation.Understanding the sequence of events and the dose of ingested mercuric chloride leads us to a certain degree of assurance that a surgical intervention was required earlier in the course of treatment. The early administration of the chelating agent which has great affinity for mercury compounds helps excrete the mercury safely, the oropharyngeal examination in the initial phase is of great importance as with its corrosive function it may cause an inflammatory stenosis response and/or an eventual intubation. Topographies and endoscopies are also critical in deciding the subsequent steps. Due to the fact that patients develop acute renal failure dialysis becomes a priority as well. Conclusion:What is of importance to us is the multidisciplinary approach to these specific and rare group of patients. The medical care should be meticulously organised in a systematic manner in order for the right decision to be carried out at the right time. In this case of mercuric chloride poisoning an earlier oesophagectomy would have definitely avoided the ongoing necrotic process and would have provided the patient with an earlier reconstructive surgery.

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Section: Case Presentationmentioning

confidence: 95%