Mercury poisoning may occur by ingestion of inorganic mercuric salts, organic mercury compounds, or inhalation of metallic mercury vapor. Ingestion of the mercuric salts causes a burning sensation in the throat, discoloration and edema of oral mucous membranes, abdominal pain, vomiting, bloody diarrhea, and shock. Direct nephrotoxicity causes AKI. Inhalation of high concentrations of metallic mercury vapor may cause acute fulminant chemical pneumonia. Chronic mercury poisoning causes weakness, ataxia, intention tremors, irritability, and depression. Exposure to alkyl (organic) mercury derivatives from highly contaminated fish or fungicides used on seeds has caused ataxia, tremors, convulsions, and catastrophic birth defects. Nearly all fish have some traces of mercury contamination; the US Environmental Protection Agency advises consumers to avoid swordfish, shark, king mackerel, and tilefish because they contain higher levels. Fish and shellfish that are generally low in mercury content include shrimp, canned light tuna (not albacore “white” tuna), salmon, pollock, and catfish. Dental fillings composed of mercury amalgam pose a small risk of chronic mercury poisoning and their removal is rarely justified. Some imported skin lightening creams contain toxic quantities of mercury.
There is no effective specific treatment for mercury vapor pneumonitis. Remove ingested mercuric salts by lavage and administer activated charcoal. For acute ingestion of mercuric salts, give dimercaprol (BAL) at once, as for arsenic poisoning. Unless the patient has severe gastroenteritis, consider succimer (DMSA), 10 mg/kg orally every 8 hours for 5 days and then every 12 hours for 2 weeks. Unithiol (DMPS) is a chelator that can be given orally or parenterally but is not commonly available in the United States; it can be obtained from some compounding pharmacies. Maintain urinary output. Treat oliguria and anuria if they occur.
Remove from exposure. Neurologic toxicity is not considered reversible with chelation, although some authors recommend a trial of succimer or unithiol (contact a regional poison center or medical toxicologist for advice).
et al. Notes from the field: methylmercury toxicity from a skin lightening cream obtained from Mexico—California 2019. MMWR Morb Mortal Wkly Rep. 2019;68:1166.