Lessons learned from a fatal case of mercury intoxication

Alhamad, Tarek; Rooney, James; Nwosu, Azikiwe; MacCombs, Jay; Kim, Young‐Sik; Shukla, Vertika

doi:10.1007/s11255-010-9896-3

Cited by 19 publications

(15 citation statements)

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“…It reduces the blood level of mercury and relieves clinical symptoms. [ 10 , 20 ] DMPS and DMSA are the major chelating agents used in clinical settings. However, mercury was secreted from the body so slowly, at a speed of 1 mg per day through kidney, that chelation therapy may take years, even whole life, to clear the toxicant completely.…”

Section: Discussionmentioning

confidence: 99%

Mercury poisoning through intravenous administration

Liu

Chen

2017

Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

Mercury poisoning through intravenous administration

Liu

Chen

2017

Medicine

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“…Este cuadro clínico se denomina eretismo mercurial. La intoxicación crónica puede cursar con alteraciones renales que van desde la proteinuria aislada al síndrome nefrótico, en el contexto de nefropatía membranosa secundaria a nefritis por inmunocomplejos (depósitos de Ig G1 y de C 3 ) [8][9][10] .…”

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Intoxicación familiar por mercurio elemental: Caso clínico

P²,

et al. 2013

Rev. chil. pediatr.

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Family poisoned by elemental mercury: a case reportIntroduction: Mercury is a heavy metal widely dispersed in nature, occurring in three chemical forms. Exposure to mercury at work sites and even at home may be clinically significant. Objective: To update the knowledge about the risks of this toxic element. Case report: the case of a teenager and his family poisoned by elemental mercury is reported. The diagnostic process was difficult, mainly due to an initial presumption of probable infectious etiology, unavailability of key anamnestic data and unusual clinical behavior, with signs and symptoms of multisystem compromise (neurological, hepatic, renal and dermatological compromise). Discussion: The study was based on literature review of various clinical presentations regarding this poisoning and its management, emphasizing the need for dimercaptosuccinic acid chelator. As a major public health problem, the importance of education and implementation of public policies to have a mercury-free environment is discussed. (Key words: Mercury, elemental mercury, mercury poisoning, exposure to elemental mercury, dimercaptosuccinic acid). Rev Chil Pediatr 2013; 84 (1): 72-79 RESUMEN Introducción: El mercurio es un metal pesado ampliamente distribuido en el medio ambiente, en sus tres formas químicas. La exposición a dicho metal en recintos laborales e incluso en el hogar, puede llegar a ser clínicamente significativa. Objetivo: Actualizar el conocimiento acerca de los riesgos de este tóxico. Caso clínico: Se presenta el caso clínico de un adolescente y su familia intoxicados por mercurio elemental, cuyo proceso diagnóstico fue difícil, principalmente por la presunción inicial de una probable etiología infecciosa, falta de disponibilidad de datos anamnésticos claves y el inusual comportamiento clínico, con signos y síntomas de compromiso multisistémico (neurológico, hepático, renal y dermatológico). Discusión: Se revisa la literatura en relación a las diversas formas de presentación clínica de esta intoxicación y su manejo, destacando Recibido el 12 de abril de 2012, devuelto para corregir el 04 de julio de 2012, segunda versión el 17 de agosto de 2012, aceptado para publicación el 28 de septiembre de 2012.Este trabajo cumple con los requisitos sobre consentimiento/asentimiento informado, comité de ética, financiamiento, estudios animales y sobre la ausencia de conflictos de intereses según corresponda.Correspondencia a:

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“…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%

“…Furthermore, haemodialysis and plasma exchange are only indicated if renal failure occurs combined with anuria [5,13]. Nevertheless, Yoshida et al [13] suggested that renal damages due to acute mercury poisoning may not be permanent.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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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.

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Lessons learned from a fatal case of mercury intoxication

Abstract: Despite the tragic outcome, on review of case literature, we believe this case provides valuable lessons concerning the use of DMSA and DMPS to treat mercury toxicity, particularly with regard to the combined use of chelation agents and hemodialysis.

Cited by 19 publications

References 16 publications

Mercury poisoning through intravenous administration

Mercury poisoning through intravenous administration

Intoxicación familiar por mercurio elemental: Caso clínico

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

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