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For further information, see CMDT Part 38-42: Mercury Poisoning

Key Features

  • Acute mercury poisoning usually occurs by

    • Ingestion of inorganic mercuric salts

    • Inhalation of metallic mercury vapor

  • Some organic mercury compounds (eg, dimethyl mercury) are extremely toxic by any route

  • Other organic mercury compounds in fish (eg, ethyl mercury) can lead to elevated mercury levels with long-term intake

Clinical Findings

  • Mercury salts

    • Metallic taste

    • Burning sensation in the throat

    • Discoloration and edema of oral mucous membranes

    • Abdominal pain

    • Vomiting

    • Bloody diarrhea

    • Shock

  • Acute kidney injury from nephrotoxicity

  • Inhalation of high concentrations of metallic mercury vapor may cause acute fulminant chemical pneumonia

  • Chronic mercury poisoning causes

    • Weakness

    • Ataxia

    • Intention tremors

    • Irritability

    • Depression

  • Exposure to alkyl (organic) mercury derivatives from highly contaminated fish or fungicides used on seeds has caused

    • Ataxia

    • Tremors

    • Convulsions

    • Catastrophic birth defects

Treatment

ACUTE POISONING

  • No specific treatment exists for mercury vapor pneumonitis

  • Ingestion of liquid metallic mercury: small amounts usually pass unabsorbed through the GI tract

  • Treat oliguria and anuria if they occur to maintain urinary output

  • For acute ingestion of mercuric salts

    • Remove ingestion by gastric lavage

    • Administer activated charcoal 60–100 g in aqueous slurry orally or via gastric tube (unproved efficacy)

    • Give dimercaprol (British anti-Lewisite, BAL) at once, 10% solution in oil, 3–5 mg/kg intramuscularly every 4–6 hours for 2 days

    • Consider succimer (DMSA), 10 mg/kg orally every 8 hours for 5 days and then every 12 hours for 2 weeks, unless patient has severe gastroenteritis

    • Unithiol (DMPS) can be given orally or parenterally but is not commonly available in the United States; it can be obtained from some compounding pharmacies

    • Contact a poison control center or medical toxicologist for assistance

CHRONIC POISONING

  • Remove from exposure

  • Neurologic toxicity is not considered reversible with chelation, although some recommend a trial of succimer or unithiol

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