MERCURY POISONING

MERCURY
Elemental mercury is a heavy, silvery liquid which is
non-toxic, but vapourises at room temperature to give
off a toxic vapor, mercuric mercury
Compounds
Elemental mercury

Organic mercury: Methyl Hg, Ethyl Hg, Methoxy methyl

mercurial

Inorganic mercury:

 Soluble and more toxic: Mercuric oxide, Mercuric

sulphide, Mercuric nitrite etc
 Less soluble and less toxic: Mercurous chloride
(Calomel)
Uses of mercury compounds

Industry Medicine and Miscellaneous

• Barometer, dentistry • Electroplating
thermometer etc • Antiseptic and • Embalming
• Ceramics disinfectant • Fabric softener
• Dry cell batters • Dental amalgam • Fingerprint
• Electrical • Diuretic powder
appliances etc • purgative • Fungicide
• Gold and silver
extraction
• Paints
Fatal dose

Mercuric chloride : 0.5 to 1g

Mercurous chloride: 1.5 to 2 g
Mode of action
After inhalation, elemental mercury is readily absorbed
through the alveolar membrane and enters the blood stream

Mercury is rapidly converted to mercuric ions in the blood

which can lead to renal tubular damage during excretion

In the central nervous system, mercury acts mainly upon

cerebellum, temporal lobe, basal ganglia and corpus callosum

Both organic and inorganic mercurials can be absorbed

through intact skin
Acute poisoning
Inhalation
Ingestion
Injection
Inhalation
This usually occurs while heating metal in a closed
room or following , or following gold refining in an
enclosed area

Symptoms ( which may be delayed upto 4 hr) include

dyspnoea, cough, fever, headache, chills, GI
disturbances, metallic taste and blurring of vision

In severe cases, there may be non-cardiogenic

pulmonary edema, dyspnoea, convulsions etc
Sometimes, manifestations similar to Kawasaki
disease (mucocutaneous lymph node syndrome are
seen especially in children, which may be mistaken for
scarlet fever: conjunctival congestion, fever, reddened
palms and soles, deep red oral mucosa with “
strawberry tongue”, skin rash and cervical
lymphadenopathy
Ingestion
 Small quantities of elemental mercury usually cause no harm on
ingestion

 Ingestionof mercuric salts produces corrosion leading to

abdominal pain, vomiting, diarrhoea and shock.

 The mucosa of the GI tract usually appears greyish. There may be

hematemesis

 In severe cases, there is onset of renal failure, pulmonary edema

and coma

 Urine may appear pinkish

Injection
Subcutaneous or intramuscular injections of elemental
mercury may cause abscess formation with
ulceration, extruding tiny droplets of mercury

Intravenous injection can result in mercurialism

characterised by thrombophlebitis, granuloma
formation and pulmonary embolism

Repeated hemoptysis is a characteristic feature

Chronic poisoning
( Hydrargyrism)
Inhalation :

 Tremor: Danbury tremor ( classical and most consistent

manifestation) – begins in hands and is of a coarse, intentional type,
interspersed with jerky movements

 Later progresses to the lips, tongue, arms and legs

 Advanced condition : Hatter’s shake – severe tremor, daily

activities become grossly impaired eg: shaving, writing, holding a
tumbler or spoon etc

 Concussion mercurialis: most severe form, no activity is possible

Ataxia, reeling gait

Metallic taste, anorexia, nausea, increased salivation

Gingivitis, halitosis, blue line on gums

Erethism: cluster of psychiatric symptoms including

abnormal shyness, loss of self-confidence, depression,
irritability, amnesia, progressing in later stages to
delirium with hallucinations or manic depressive
psychosis (mad hatter)
Mercuria lentis: characterised by the brown reflex of
anterior lens capsule of the eye. Fine punctate opacities

Renal damage: membraneous glomerulonephritis

Hatter’s shake
Tremors that are static and intentional that affecting
arms, hands, tongue, and later legs.

OTHER NAMES OF HATTER'S SHAKE

1. Danbury Tremors
2. Glass-blower shake
3. Intention tremor
4. Shaking palsy
Ingestion
Acrodynia ( Pink disease): seen mainly in children

Onset is usually insidious with anorexia, insomnia,

profuse sweating, skin rash, and photophobia

Hands and feet becomes puffy, pinkish, painful,

paraesthetic, perspiring and peeling

Teeth may be shed with ulceration of gums

Minimata disease
Poisoning with organic mercurials

Features are related mainly to CNS- dysarthria, ataxia,

parasthesia, neuropathies, diminished auditory and
visual acquity, mental deterioration and chorea
Diagnosis
X-ray

Blood mercury level: normal is less than 3 mcg/100

mL

Urine mercury level: normal is less than 10-15

mcg/100mL
Treatment
Removal from source of exposure

Gastric lavage with 250 ml of sodium formaldehyde

sulfoxylate (chemical antidote)

Chelation : BAL – 100mg IM every 4 hour for 48 hr,

followed by 100mg every 8 hr for 7 days

Chelation is not very effective for organic mercurials

Albumins such as egg, skimmed milk, vegetable
glutens to precipitate mercury

Maintain electrolyte and water balance

Postmortem appearances
Acute mercury poisoning: mucosa of mouth, throat,
oesophagus and stomach appears greyish in color with
softening and superficial corrosion

Kidneys are often pale and swollen due to edema of

renal cortex
Medico legal aspects
Homicide or suicide cases are rare

Accidental: broken thermometers, ingestion of

antiseptic solutions containing mercuric chloride,
children might swallow mercury tablets or elemental
mercury because of its shiny gray appearance
Thank you