Toxicokinetics and toxicodynamics of elemental mercury following self-administration

Abstract

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.

Is Chelation Therapy Efficient for the Treatment of Intravenous Metallic Mercury Intoxication?

“…There is also a lack of correlation between symptomatology and Hg levels in both blood and urine. In our patient, mercury blood concentrations remained fairly constant during the treatment period and follow-up, which has also been described in other patients [20,28]. The efficacy of treatment in patients with metallic deposits is usually low.…”

Metals, oxidative stress and neurodegeneration: A focus on iron, manganese and mercury

“…A rapid antidotal intervention is required in high-dose acute exposures, which are commonly observed after occupational or intentional exposures to Hg 0 (Bluhm et al, 1992; De Palma et al, 2008; Eyer et al, 2006). Different chelating agents, including penicillamine, dimercaprol, 2,3-dimercaptopropane-1-sulphonate (DMPS), and meso-2,3-dimercaptosuccinic acid (DMSA), have been administered in these cases (Eyer et al, 2006; Houeto et al, 1994); however, the desired beneficial results are generally not achieved.…”

“…There is a consensus that chelating therapy can significantly increase Hg excretion, at least in some specific cases (Bluhm et al, 1992; Clarkson et al, 1981; De Palma et al, 2008; Eyer et al, 2006). Of note, chelating therapy is greatly based on -SH-containing molecules, such as D-penicillamine, N-acetyl-DL-penicillamine, dimercaprol, DMPS, and DMSA.…”

Tentative de suicide par injection intraveineuse de mercure. À propos d’un cas

“…Malgré la présence de dépôts de métal au niveau rénal et de sels mercuriques (Hg ++ ) dans la circulation sanguine, il n'est pas retrouvé de néphro-toxicité à court ou moyen terme dans les publications décrivant des cas d'injections intraveineuses de mercure métal [15] ; l'ionisation du mercure est suffisamment lente pour permettre une excrétion efficace des sels mercuriques formés, sans pour autant atteindre des concentrations toxiques circulantes, comme en témoigne l'absence d'anomalies rénales cliniques ou biologiques [6,16] et les concentrations urinaires particulièrement faibles mesurées à J + 3 chez notre patient. Les traitements chélateurs sont uniquement indiqués en présence d'un tableau d'intoxication systémique [7,[16][17][18]. La seule élévation des concentrations de Hg sanguins ou urinaires n'est pas en soi une indication à la chélation chez le patient asymptomatique, d'autant que l'impact sur la santé de la chélation à long terme Hg cheveux (3) (ng/mg cheveux) 0,37 (1) Norme en population générale < 5 µg/L (2) Norme en population générale < 50 µg/g de créatinine (3) Norme en population générale entre 0,31 et 1,66 ng/mg de cheveux n'est pas connu [19,20].…”