Mercury Poisoning

Occupational Sources Manufacture of electric equipment,

ammunitions, amalgams, felt making, disinfectants

coal plants - emit approximately half

of atmospheric mercury gold production, non-ferrous

metal production, cement production, waste disposal, crematoria, caustic soda production, pig iron and steel production, mercury production (mostly for batteries)

Mercury and its compounds are commonly Mercury and its compounds are commonly used in chemical laboratories, hospitals, used in chemical laboratories, hospitals, dental clinics, and facilities involved in the dental clinics, and facilities involved in the production of items such as fluorescent production of items such as fluorescent light bulbs, batteries, and explosives.light bulbs, batteries, and explosives.

Common items that may contain mercuryCommon items that may contain mercury Flourescent bulbsFlourescent bulbs Mercury thermometersMercury thermometers Watch batteriesWatch batteries thermostatsthermostats

Exposure Inhalation of Mercury Vapors - 80%

Most dangerous (lungs-blood- kidneys&brain) Oral ingestion of liquid metallic mercury,

subcutaneous routes Urinary and fecal routes - excretory pathways

Toxic Dose World Health Organization reports that the

amount of mercury-absorbed daily by the average human body is 0.3 - 0.05 ug

Uptake of >100ug can be extremely lethal

Mechanism of Toxicity Severe imbalance in the ratio of active to

inactive glutathione, the body's most important tool for detoxifying and excreting metals

Causes Neurological impairments particularly CNS affectation

Common Acute and Chronic Effects and

Confirmatory Diagnostic Test

Fulminant Symptoms

Acute /sudden/ may be intense Rarely causes systemic poisoning

Dermatitis Sensitization Stomatitis Conjunctivitis

Initial Exposure to High Concentrations

Metal Fume Fever Fatigue Fever Chills Respiratory: cough,

SOB, tightness, burning of chest and lung inflammation

Mercury splashes

Occupational Exposure

levels: 1-44 mg/m3 (4 to 8 hours) Chest pain Cough Hemoptysis impaired lung function Lung inflammation Pulmonary edema

Chronic Symptoms

Insidious/Gradual onset Classic triad of elementary mercury poisoning

Oral manifestations: gingivitis, salivation, stomatitis

Intentional tremors Erethism (neurobehavioral changes characterized

by anxiety, depression, irritability, emotional instability and regressive behavior; abnormal irritability or sensitivity of an organ upon stimulation)

Other Signs

Blue line in gums Metallic fetid breath Metallic or sweet taste Tremors of facial and hand muscles Loss of memory Depression Insomnia Hyperactive knee jerks Anxiety and irritability

Confirmatory Diagnostic Test

1. Urine Mercury level is above 50 mcg/dL – tentative maximum permissible concentration

2. Whole blood levels: 10 mcg/dL (methylmercury) 2 mcg/dL (inorganic Hg)

Specific Management/Antidote

Specific Management Decontamination requires removal of

clothes, washing skin with soap and water, and flushing the eyes with saline solution as needed.

Inorganic ingestion such as mercuric chloride should be approached as the ingestion of any other serious substance that causes corosion.

Immediate chelation therapy is the standard of care

Treatment/Antidotes DMSA

Forms an inactive complex with mercury Chelation for acute inorganic mercury poisoning to

be excreted Penicillamine

Increases the excretion of mercury after acute exposure to mercury vapor

Preventive Measures (Primary and Secondary)

Primary prevention

Personal Protective Equipment Use masks, respirators, and gloves

Engineering controls Proper ventilation via exhaust systems Good housekeeping Handle under fume hood to eliminate vapors Proper container Avoid spillage, proper waste disposal

Proper hygiene

Primary Prevention

Engineering Controls Proper ventilation via exhaust systems Handle under fume hood to eliminate vapors Proper container (airtight)

Administrative Controls Good housekeeping proper waste disposal Health education and Proper hygiene

Personal Protective Equipment Mask, respirators, gloves

Secondary Prevention

Recognize early clinical manifestations to avoid serious developments

Application of physiological methods of measurement

Pre-employment and periodic examination and records

Regular monthly medical evaluations with emphasis to blood level monitoring

Secondary Prevention

Urine mercury over 50mcg/dL Blood levels 10mcg/dL