Mercury Poisoning: Treatment

Sign & Symptoms of Mercury Poisoning: Chronic exposure to metallic mercury vapor produces characteristic intension tremor. It can also produce Mercurial erethism (excitability, insomnia, timidity, memory loss, and delirium known as “mad as a hatter”).  Decreased motor speed, visual scanning, and decreased verbal and visual memory, visuomotor (visual & motor) coordination are seen on neurobehavioral tests. Toxicity from elemental or inorganic mercury exposure begins when blood level is more than 3.6 µg/100 ml and urine levels more than 15µg/100 ml.

Organic mercury exposure is measured by mercury levels in blood in acute poisoning and mercury levels in hair in chronic poisoning. 

If children are exposed to mercury in any form (organic, inorganic, vaporized or ingested) may develop acrodynia known as “pink disease” that include flushing, itching, swelling, irritability, hypertension, high pulse rate, excessive salivation, perspiration, weakness, morbilliform rashes, desquamation of palms and soles.

Treatment: Acute ingestion of mercury is treated by gastric lavage or by inducing vomiting (with gag reflex which is by touching the pharynx or by hypertonic saline or drugs that cause vomiting). Polythiol resin is given which binds to mercury in the gastrointestinal tract (GIT) and reduce absorption from GIT. Chelating agent (bind metals into stable cyclic compounds with relatively low toxicity and enhances their excretion) like dimercaprol (British Anti Lewisite or BAL), 24 mg/kg per day IM in divided doses, penicillamine or DMSA (succimer or dimercaptosuccinic acid) should be given. Chelating agents are given as several 5 day courses which are separated by few days of rest days. If renal failure develops, treat with hemodialysis or peritoneal dialysis.

Chronic inorganic mercury poisoning is treated with N-acetyl penicillamine.

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