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wikitox:problems_for_discussion_3_mercury

Problems for Discussion - 3 - Mercury

OBJECTIVES

1. To be able to discuss the chemistry and phamacokinetics of elemental, inorganic and organic mercury compounds.
2. To be able to discuss the clinical manifestations of exposure to each chemical form of mercury.
3. To be able to discuss the clinical utility of whole blood, spot urinary and 24-hour urinary mercury levels following potential mercury exposure.
4. To be able to discuss the role of chelation in mercury intoxication.

READING

  1. Mercury Wikitox
  2. Brodkin E, Copes R, Mattman A, Kennedy J, Kling R, Yassi A.Lead and mercury exposures: interpretation and action. CMAJ. 2007 Jan 2;176(1):59-63. (fulltext)
  3. Baughman TA. Elemental mercury spills.Environ Health Perspect. 2006 Feb;114(2):147-52. (fulltext)
  4. Clarkson TW.Metal toxicity in the central nervous system.Environ Health Perspect. 1987 Nov;75:59-64 (fulltext)
  5. Clarkson TW, Magos L, Myers GJ. The toxicology of mercury - current exposures and clinical manifestations. N Eng J Med. 2003;349:1731-1737. (fulltext)
  6. Nierenberg DW, Nordgren RE, Chang MB, et al. Delayed cerebellar disease and death after accidental exposure to dimethylmercury. N Eng J Med. 1998;338:1672-6.(fulltext)
  7. Khordi-Mood M, Reza A, Sarraf-Shirazi AR, Balali-Mood M. Urinary Mercury Excretion Following Amalgam Filling in Children. Clin Toxicol. 2001;39:701-705.
  8. Brent J. Toxicologists and the Assessment of Risk: The Problem with Mercury. Clin Toxicol. 2001;39:707-10.
  9. McFee RB, Caraccio TR. Intravenous mercury injection and ingestion: clinical manifestations and management. Clin Toxicol. 2001;39:733-8.
  10. Ho BS, Lin JL, Huang CC, Tsai YH, Lin MC. Mercury vapor inhalation from Chinese red (Cinnabar). Clin Toxicol. 2003;41:75-8.
  11. Kales SN, Goldman RH. Mercury exposure: current concepts, controversies, and a clinic's experience. Journal of Occupational and Environmental Medicine 2002; 44: 143-154

PROBLEM 1

A 74-year-old male with a history of dementia has accidentally ingested some mercury from a bulb thermometer in a nursing home. Some mercury has been spilled on the carpet. Nursing staff estimate that up to one mL may be missing. The patient is asymptomatic.

  1. What investigation and management do you recommend for the patient?
  2. What is your risk assessment for the staff in the nursing home?
  3. What recommendations do you make with regard to clean-up and retrieval of the spilled mercury?

PROBLEM 2

A 54-year-old male presents to his general practitioner with chest pain, dsypnoea, cough, nausea, chills and headaches. He is an amateur prospector and heated some elemental mercury on a metal skillet in his shed 24-hours prior to presentation.

  1. What is your risk assessment for this patient?
  2. What other important aspects of the history need to be ascertained?
  3. Discuss biological testing for mercury in this setting?
  4. What treatment would be appropriate?

PROBLEM 3

A 14-year-old female presents to the emergency department after intentionally ingesting 20 mL of 0.5% mercurochrome. Her mouth is red and she complains of a sore throat. Physical examination is otherwise normal.

  1. Outline your approach to risk assessment and management.

PROBLEM 4

A General Practitioner calls you from a practice in Far North Queensland. He has a 30-year-old male who two weeks ago was exposed at work to a mercury-containing fungicide used in the sugar cane industry. It contains a high concentration of an alkyl organic mercury compound.

The patient was pouring the undiluted fungicide and accidentally spilled it onto the skin of his arms. The patient sustained a chemical burn to his left forearm. This was immediately decontaminated with water and the burn was subsequently treated as a thermal burn. It is healing well.

The patient has no neurological symptoms and is now asymptomatic. FBC, renal function and LFTs are normal. However, the patient has a whole blood mercury level of 8000 nmol/L (160 mcg/dL).

  1. What is your risk assessment?
  2. What other baseline investigations might be useful?
  3. What supportive, preventative and occupational measures might be indicated?
  4. Discuss chelation in this setting.
  5. Discuss follow-up in this setting.
/home/wikitoxo/public_html/data/pages/wikitox/problems_for_discussion_3_mercury.txt · Last modified: 2018/09/01 09:01 (external edit)