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ACUTE EXPOSURE INFORMATION
- USES: Mercury exists in 3 forms: elemental, inorganic, and organic. Each causes distinct toxicity patterns. This document discusses ONLY ELEMENTAL mercury. Elemental mercury (quicksilver) is found in thermometers, barometers, sphygmomanometers, dental amalgams, fluorescent light bulbs, Mexican-American folk medicine, and in some medical equipment (eg, tip of Dobhoff tubes); it is also used in the gold mining industry. Severe toxicity is unusual, and most often develops from vaporization from heating mercury in a closed space. Moderate toxicity may develop from vaporization by vacuuming a mercury spill (ie, a broken thermometer), or prolonged inhalation exposure.
- TOXICOLOGY: Mercury covalently binds the sulfur moiety in sulfhydryl groups throughout the body disrupting enzymes, membranes, structural proteins, and transport mechanisms. Toxicity develops as elemental mercury is oxidized to the mercurous (Hg+) and mercuric (Hg2+) forms that interact with these entities causing multiorgan dysfunction.
- EPIDEMIOLOGY: Mercury thermometer exposures are not uncommon, but people rarely get sick. Other elemental mercury poisonings are uncommon, but deaths occur.
- WITH POISONING/EXPOSURE
- INGESTION: Ingestion is generally nontoxic in an intact gastrointestinal tract, but mucosal breaks and prolonged contact may increase absorption. Symptoms may resemble inorganic mercury poisoning.
- INHALATION: Adverse effects mainly result from vapor inhalation and primarily affect the lungs. Pulmonary pathology includes pneumonitis, necrotizing bronchiolitis, pulmonary edema, acute lung injury, and death. Central nervous system effects, renal damage, gingivitis, and stomatitis can also develop. Within a few hours of high concentration of mercury vapor exposure, weakness, chills, metallic taste, nausea, vomiting, diarrhea, abdominal pain, headache, tremor, visual disturbances, dyspnea, cough, and chest tightness may develop.
- INTRAVENOUS OR INTRAMUSCULAR: IV injection may rarely result in pulmonary embolism, and IM injection may lead to renal dysfunction and chronic absorption; signs and symptoms are usually mild, but may be similar to inorganic mercury toxicity.
- CHRONIC: Chronic mercury poisoning (mercurialism) usually results from inhalation of elemental mercury vapor or particles. Evidence of chronic poisoning may occur within weeks of an extreme acute exposure or may develop insidiously over many years. Chronic inhalation leads to the classic triad of neuropsychiatric disturbances (ie, personality changes, hallucinations, delirium, insomnia, irritability, fatigue, memory loss, erethism), tremor (fine intention tremor of fingers that progresses to choreiform movements of limbs), and gingivostomatitis. Children and some adults develop acrodynia associated with severe leg cramps, irritability, insomnia, diaphoresis, hypertension, miliarial rash, and peeling erythematous skin on the fingers, hands, and feet. Renal dysfunction has been reported.
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