mercury poisoning

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` MERCURY POISONING

FORMS OF MERCURY:

FORMS OF MERCURY There are 3 different forms of mercury - elemental - inorganic - organic Each has a different toxicological profile

SOURCES OF MERCURY:

SOURCES OF MERCURY Elemental mercury: Sphygmomanometers, thermometers, barometers Liquid at room temp – volatilises easily Sphygmomanometer s , thermometers barometer

SOURCES OF MERCURY:

SOURCES OF MERCURY Inorganic mercury: Traditional remedies ( ayurvedic , chinese ) Used in gold extraction, caustic soda manufacturing Rodenticides

SOURCES OF MERCURY:

SOURCES OF MERCURY Organic mercury: Fungicides, seed dressings Methyl mercury in fish

ACCUMULATION OF MERCURY:

ACCUMULATION OF MERCURY

ABSORPTION OF MERCURY:

ABSORPTION OF MERCURY Inhalation : 60-80% Dermal : 3-15% GI Tract : Metallic <0.2% Inorganic 15% Organic 90 + %

Organic mercury poisoning:

Organic mercury poisoning Rare but severe Effects: CNS Toxicity: poor concentration, fatigue, ataxia, tremor, constricted visual fields, coma & convulsions BM suppression Renal toxicity - dealkylation to inorganic form Poorer response to treatment

Inorganic mercury poisoning:

Inorganic mercury poisoning Gastrointestinal phase : Hg 2+ is a potent GI irritant gingivitis, stomatitis oesophageal, gastric, small and large bowel erosions haematemesis, diarrhoea, CVS collapse Systemic toxicity : Hg 2+ inhibits sulphydryl enzymes hypotension, lactic acidosis Nephrotoxicity : Hg 2+ deposits in the tubules acute renal failure potentially leads to CRF in survivors Biopsy of kidney showing mercury in it

Elemental Mercury poisoning:

Elemental Mercury poisoning ACUTE: Irritant respiratory effects: cough, dyspnoea pulmonary oedema Metal fume fever: pyrexia, cough, malaise, flu-like symptoms CNS features: confusion, emotional lability, psychoses convulsions, CNS depression & coma Renal effects: rarely ARF

Elemental Mercury poisoning:

Elemental Mercury poisoning CHRONIC: ‘ Erethism ’ TREMOR, dysarthria peripheral neuropathy, sweating personality change Stomatitis, gingivitis Chronic renal impairment Acrodynia - related to elemental mercury exposure in children Acrodynia gingivitis stomachitis

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local complications Systemic toxicity i.v / i.m injection causes complication as depicted:

Pulmonary absorption on inhalation:

Pulmonary absorption on inhalation Healthy lungs Lungs with mercury(inhaled)

Diagnosis:

Diagnosis Blood mercury: only really useful acutely normal <10µg/l symptoms with blood mercury >150-200µg/l Urine mercury: probably the most reliable indicator normal <10µg/l symptoms with urine mercury >100-150µg/l U&E Radiology: for elemental ingestion/aspiration/injection

THERAPY:

THERAPY Dimercaprol widely used for inorganic mercury; effective for protection of kidney (Hg++) ineffective from protection of brain (CH3Hg+) cannot be given orally, side effects Pencillamine given orally effective for Hg, less so for CH3Hg+ some side effects Dimercaptosuccinic acid (DMSA) given orally probably effective for CH3Hg+, Hg, Hg++ low toxicity Polythiol resion CH3Hg+ only pencillamine DMSA dimercaprol