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Outline
• Brief introduction on mercury and its poisoning
• Physico-chemical Properties
• Mercury sources, uses and poisoning contact
• Toxicology
• Clinical Manifestation
• Diagnosis
• Treatment
• Prevention

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What is mercury?

Mercury is a chemical element with the

symbol Hg and its element number is 80 in the
class of heavy metals .

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What is mercury poisoning?
Mercury poisoning (also known
as hydrargyria or mercurialism) is a disease caused by
exposure to mercury or its compounds.It is called
poisoning when the exposed to mercury is
symptomatic.

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 1.Physico-chemical Properties
of mercury
• A silver-white, poisonous metal
• liquid at normal temperature and pressure
• no taste or smell
• 13.6 times heavier than water.
•Relative Atomic Mass: 200.59
• Density: 13.534g·cm−3
• Boiling Point: 356.72°C
• Melting Point: -38.87°C
(at 25°C,WHO2003)
Many metals can be mixed with mercury to form
amalgams.
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There are 3 environmental forms of mercury:

Metallic elemental mercury (quicksilver, Hg0);

Inorganic mercurial salts (e.g., Hg2Cl2, Hg+, HgCl2,

Hg2+); they can also be found as Mercuric sulfide
(HgS), *Mercuric acetate((HgC4H6O4)
Organic mercurial e.g., methylmercury(MeHg),
ethylmercury(EtHg),phenylmercury(PheHg).

 Adverse effects from exposure to mercury differ

depending on the form and the route of exposure

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 zero oxidation state Hg0
exists as vapor or as liquid metal,

mercuric state Hg2+

may form either inorganic salts
or organomercury compounds

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The higher the temperature,the more vapours
are released from liquid elemental mercury.

Vapours are much more dangerous.

Elemental mercury is nonflammable and has low so

lubility in both water and organic solvents, but it i
s soluble in hot sulfuric acid,nitric acid and lipoids.

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 2.Mercury sources

Mercury mining and smelting

Anthropogenic sources ,include emissions from coal-
burning power stations and municipal incinerators, chlor-
alkali plants, cement kilns.
 Volcanoes emission

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Earth’s surface (both soil and water): mercury
vapor (Hg0), a stable monatomic gas,
evaporates from both soil and water.

Different materials that are made by or use

mercury in their functions

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 Uses:
Elemental mercury:
Sphygmomanometers, thermometers, barometers
Liquid at room temp – volatilises easily
Dental amalgam
Inorganic mercury:
Traditional remedies (ayurvedic, Chinese)
Used in gold extraction,
Rodenticides
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Organic mercury:
Vaccines,Fungicides, seed dressings

Large quantities of metallic mercury are employed as

electrodes in the electrolytic production of chlorine
and sodium hydroxide from saline.

These uses still give rise to accidental and occupational

exposures

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 Mercury mining and smelting

Mercury occurs in deposits thr

oughout the world mostly as cinna
bar (mercuric sulfide). The red pigm
ent vermilion, a pure form of mercu
ric sulfide, is mostly obtained by rea
ction of mercury ( produced by red
uction from cinnabar ) with sulfur. C
innabar is highly toxic by ingestion
or inhalation of the dust.

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  Medicine

Amalgam (dentistry) ： Its ability to

amalgamate with gold and silver are use
d in mining these precious metals and
as a dental restorative.

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Dental amalgams :
 comprised of 50 percent elemental mercury. This
form of mercury evaporates from the surface of
the amalgam and is inhaled, absorbed into the
blood, and then converted to inorganic mercury,
the most toxic form of mercury to cells. Inorganic
mercury builds up far more in your organs of
elimination — it’s 100 times as high in your
kidneys and liver than in your brain. But when it
does make its way into your brain, it’s far more
damaging than any other form. ※
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Vaccines:
Thiomersal: is an organic mercury compound us
ed as a preservative in childhood vaccines.
First introduced by Eli Lilly and Company in the
late 1920s and early 1930s,
The company began selling it as a preservative
in vaccines in the 1940s.
Thimerosal contains 49.6 percent mercury by
weight and is metabolized or degraded into
ethylmercury and thiosalicylate.
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In 1977, a Russian study found that adults exposed
to ethylmercury, suffered brain damage years later.
Studies on thimerosal poisoning also describe
tubular necrosis and nervous system injury,
including obtundation, coma and death.
As a result of these findings, Russia banned
thimerosal from children's vaccines in 1980.
Denmark, Austria, Japan, Great Britain and all the
Scandinavian countries have also banned the
preservative.

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 Laboratory
• Thermometers ；

• Liquid mercury is a part of popular

secondary reference electrode in
electrochemistry as an alternative to the
standard hydrogen electrode ；

• Mercury sphygmomanometers ( blood

pressure meter), barometers, diffusion
pumps, coulometers, and many other
laboratory instruments.
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 Production of chlorine and caustic soda
• Chlorine is produced from sodium chloride ( NaCl)
using electrolysis to separate the metallic sodium from
the chlorine gas. Usually the salt is dissolved in water to
produce a brine. By-products of any such chloralkali
process are hydrogen (H2) and sodium hydroxide
(NaOH), which is commonly called caustic soda or lye.
By far the largest use of mercury in the late 20th century
was in the mercury cell process (also called the Castner-
Kellner process) where metallic sodium is formed as an
amalgam at a cathode made from mercury; this sodium is
then reacted with water to produce sodium hydroxide.

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Lamp and Reactors making
 Gaseous mercury is used in mercury-vapor lamps ， s
ome "neon sign" type advertising signs and fluorescent l
amp.

 Liquid mercury is used as a coolant for some nuclear re

actors
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Cosmetics
 Some skin whitening products contain the toxic chemic
al mercury(II) chloride as the active ingredient.

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•Mascara :Thiomersal(U.S. spelling "thimerosal ),
is widely used in the manufacture of mascara and
other eye makeup

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"The purpose of the products [preservatives] is to
inhibit the growth of bacteria and fungi that could
spoil the products and that could infect and damage
the eye." –Joanna Tempowski, World Health
Organization

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e

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Food
Some food can acquire mercury during their
processing
Other food (plants,fish and shellfish)that grew up in
coastal area where there is a high concentration of
mercury, accumulate methylmercury in their
tissues.

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Today, however, exposure of the general population
comes from three major sources: fish consumption,
dental amalgams, and vaccines.

 Each has its own characteristic form of mercury and

distinctive toxicologic profile and clinical symptoms.

 Dental amalgams emit mercury vapor that is inhaled

and absorbed into the bloodstream.

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Dentists and anyone with an amalgam filling are
exposed to this form of mercury

Liquid metallic mercury (quicksilver) still finds its

way into homes, causing a risk of poisoning from the
vapor and creating major cleanup costs.

Humans are also exposed to two distinct but related

organic forms, methyl mercury (CH3Hg+) and ethyl
mercury (CH3CH2Hg)

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The consumption of fish is by far the most
significant source of ingestion-related mercury
exposure in humans and animals, plants and
livestock also contain mercury due to
bioconcentration of mercury from seawater,
freshwater, marine and lacustrine sediments,
soils, and atmosphere.

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Exposure to mercury from dental amalgams and fish
consumption has been a concern for decades, but the
possible risk associated with thimerosal(preservative
in childhood vaccines) is a much newer concern.

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Fears of risks associated with thimerosal have been
heightened by a recent recommendation by the
Environmental Protection Agency (EPA) that the
allowable or safe daily intake of methyl mercury be
reduced to 0.05 μg of mercury per kilogram of body
weight per day.
Dental amalgam , thiomersal in vaccines and MeHg in
fishes are three modern faces of Hg.

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The threshold established by the World Health
Organization in 1978, to 0.1 μg of mercury per
kilogram per day.

Harrison's Principles of Internal Medicine," mercury

levels greater than 3.6 mcg/dL in the blood and 15
mcg/dL in urine indicate toxicity.

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 3.Toxicology
Metabolism
Absorption
• Elemental mercury(Hg0) is a dense liquid at
room temperature. It volatilizes readily , emitt
ing mercury vapor, which is readily absorbed i
n the lungs (approximately 80%);

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Elemental mercury is very poorly absorbed
through the skin or gastrointestinal(GI)
tract.The problem with that is the inhalation of
fumes from that mercury.
Elemental mercury causes significant amounts
of neurological damage. As the exposure gets
longer, there may be additional changes in the
bone marrow that affect the ability to produce
blood cells, infertility and problems with heart
rhythm.
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• Inorganic mercurial salts (Hg+ and Hg2+) va
ry in solubility and absorptive properties.

• Mercury salts, are basically industrial, if

inhaled or ingested they gravitate more
toward the kidney and not so much the
nervous system.

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Organic mercurial compounds mostly are readily
absorbed through lungs and GI tract, and some are re
adily absorbed through the skin.

The organic mercury acts very similarly to the

elemental form. It affects a lot the nervous
system. In pregnancy case it can cause birth
defects and loss of the foetus if the level gets high
enough.

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Distribution and Transformation

 In Kidney,liver, heart and brain the vapor is a m

onatomic gas, highly diffusible and lipid soluble, t
hat passes virtually without hindrance across cell
membranes and more complex barriers such as the
blood brain barrier and the placenta. It undergoes
rapid oxidation to the divalent mercuric species in
most tissues.
Hg 、 Hg1+ Oxidation Hg2+

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A diagrammatic picture of the disposition and metabolism of inhaled mercury vapor
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 Excretion
Urine and feces are the main pathways of excretion.

The urinary excretion of mercury is from direct release

from renal tissue as opposed to originating from mercury
in plasma via glomerular filtration . Urine levels therefore
reflect kidney levels. Since the kidneys ultimately
accumulate the major fraction of the total body burden of
inorganic mercury, they serve as a rough biomarker for
exposure to mercury vapor.

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Fecal excretion is also an important route of
elimination of inorganic mercury. The process
starts with secretion from liver to bile and
thereby into the intestinal tract. Some limited
reabsorption may take place but the bulk of
the biliary mercury is excreted in the feces.
There is experimental evidence that secretion
of inorganic mercury across the intestinal track
also contributes to fecal excretion.

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• Mechanism
The mechanisms of mercury poisoning have n
ot yet been identified .It is highly likely that the c
omplexes of mercury with small-molecule thiols
such as GSH(glutathione) and cysteine are involv
ed.

Hg2+ SH

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protein-SH Hg—SH

Hg2+

inactivation of enzymes

Hg

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What is glutathione: It is a protein (amino acid)
molecule which is important as our body
antioxidant, immune system booster and
detoxifier
 - It presents in every cell to promote normal
function as maintaining the immune system
 - One of the master antioxidant that mostly
found in liver

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4.Clinical manifestation

Acute effects

Chronic Effects

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Acute effects:
Acute poisoning usually results from the accidental or de
liberate ingestion of mercury compounds and seldom f
rom occupational exposure.

Symptoms of acute toxicity following high-level exposur

e to mercury vapor occur within hours of the exposure.

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Irritant respiratory effects:
--cough, dyspnea
--pulmonary oedema,
-- ARDS(acute respiratory distress syndrome)
Metal fume fever:
--pyrexia, cough, malaise, flu-like symptoms
CNS features:
--confusion, emotional lability, psychoses
--convulsions, CNS depression & coma
Renal damage

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Oral mercury salt (HgCl2, lethal dose

of 1g, common in suicide) can cause

gastrointestinal symptoms , nausea ,
vomiting, diarrhea, and abdominal pain,
and lead to kidney and nerve damage.

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 Oral mercury salt:

Oral disorders: burning mouth and tongue,

foul breath, burning and tingling of lips and
face, mouth and tongue sores or ulcerations.
gingivitis

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Chronic Effects
 In a long-term low-dose intake of mercur
y or mercury compounds occuring after
contact with mercury during 8 -10
years,clinical symptoms develop graduall
y and are characterized by affection of
the nervous system.

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The classic symptoms of chronic mercury poisoning
are tremor, gingivitis and erethism.

The earliest findings are usually gingivitis, hypersaliva

tion (mercurial ptyalism) and an unpleasant,bitter, me
tallic taste in the mouth.

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Three classic symptoms of chronic mercury poisoning:

‘Erethism’
It is a form of toxic organic psychosis characterized by excessive timidi
ty, morbid irritability, mental hyperactivity and outbursts
of temper.

Gingivitis:
Gingivitis is most marked in those with poor oral hygiene.
Mercury Line: A bluish line on the dental margin of the gums, similar
to that seen in lead workers.

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Mercurial Tremor
Cerebellar kinetic tremor /intentional tr
emor

Intention tremor is present during a purposef

ul movement toward a target, such as touching a f
inger to one's nose during a medical exam. Trem
or has increased amplitude at the end of a goal-dire
cted movement.

(Tremor began in action, aggravated in the course o

f action, stopped after the action completes. Noted
by others, nervous or even more to control,tremor
is more obvious.)
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Tremor, generally considered to be the first neurological indic
ation of poisoning by elemental mercury or its inorganic com
pounds, is usually present at rest especially in the hands.
It may be slight and accompanied by mild motor retardation (
mercurial micro-parkinsonism). There is often an intentional
component to the tremor, resembling that seen in cerebellar d
isease, which may seriously impair the ability to carry out fine
and complex movements, such as handwriting.
The tremor in mercury poisoning may fluctuate in severity an
d be accompanied by
ataxia resulting in difficulties in walking and in speaking.

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5.Diagnosis
Early typical symptoms:
--irritability,
--weakness,
--Gingivitis,
--stomatitis.

Confirmation of diagnosis is mercury

determination in hair, blood, urine and feces.
•U&E (Urea and Electrolytes)

• Radiology
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• Blood mercury:
--normal <10ug/l
--symptoms with blood mercury >150-200ug/l

• Urine mercury
--probably the most reliable indicator
--normal <10ug/l
--symptoms with urine mercury >100-150ug/l

• Mercury in hair:

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 Blood and hair Hg concentrations are used as
biomarkers for MeHg in both the adult and fetal
brain, although each provides a somewhat different
indication of exposure .
 In fact, the concentration in scalp hair is about 250
times the corresponding concentration in blood and
reflects the average exposure over the growth period
of the hair segment.

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Diagnosis of organic mercury poisoning depends on
its characteristic clinical picture and diagnostic radio
logy, especially magnetic resonance imaging (MRI).
In cases of methyl mercury or dimethylmercury into
xication, MRI may reveal atrophic changes in the oc
cipital lobe, cerebellum and post-Rolandic region in
the cerebrum.

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 According to the degree of expressiveness
of pathological process chronic poisoning is
divided into 3 stages:
INITIAL (FUNCTIONAL), MODERATE AND
SEVERE.

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6.Treatment
Identifying and removing the source of the
mercury is crucial.
--For example, removing contaminated clothing,
washing skin with soap and water, and flushing the
eyes with saline solution as needed.
 Supportive care
--Particularly important with inhalation

Drive mercury therapy:

1. Sodium Dimercaptosulphonate (DMPS)
2. Sodium Dimeraptosuccinate (Na-DMS)
3. D-penicillamine (DPCN)
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 Most effective is DMPS
5-10 ml (0,05 g or 5% 1 ml per 10 kg of patient’s weight). 1
day - 2-4 injections, next 6-7 days –1 injection/ day.
 Its sulfhydryl groups form untoxic complexes with
poison and are excreted with urine.
 Sodium thiosulphate 30% 5-10 ml i/v slowly.
 Drugs which improve metabolism and blood supply of
brain (Pyracetam, Stugeron).
 Glucose 40% 20 ml + Vit. C,
 Vit.B 1, B 12, B 6.
 Tranquilizers.
 Symptomatic therapy.
Patients with cognitive and emotional problems may
require psychotropic medications.

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There are other supplements which create a good
absorption of medication and support the removal of
toxin, these must be combined with medication
through diet or changing life style.
1 、 Colon cleansing
2 、 Eat more fiber
3 、 Drink a lot of water
4 、 Consume more fermented foods
5 、 Go green
6 、 Get more physical activity

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Natural detoxification
Mercury detoxification is all about simply helping the
own natural detox system to function better.In other
words they must be the upgrade 0f the system by:
 Boosting the Glutathione Production
 Mobilizing Mercury by Boosting Enzymes and
Transport Proteins
 Capturing and Eliminating Mercury with
Intestinal Binders

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Boosting the Glutathione
Production
The first requirement for effective mercury
detoxification is boosting your glutathione levels.
 Most forms of oral glutathione are not effective
because they are destroyed in the digestive process.
But the consumption of foods containing glutathione
precursors is suggested so that the body can make
more of it; specifically, cysteine-rich foods.
The absolute best source is high quality whey protein.
This whey must come from the “clean” milk of
organically raised cows, and not have been overly
processed, which denatures the fragile proteins.

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 As glutathione is a protein (amino acid)
molecule which is important as our body
antioxidant, immune system booster and
detoxifier
 - It presents in every cell to promote
normal function as maintaining the
immune system
 - One of the master antioxidant that
mostly found in liver
 - It eliminates toxic compound (such as
Paracetamol) in liver
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- It reconstitutes vitamin C and E which is
being oxidized
 - Combine taking with vitamin c
injection greatly enhance your immunity,
reduces tiredness, more youthful skin and
stay healthy
 - Fights against the cancer, heart disease,
premature aging, autoimmune disease and
chronic illness.

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 7.Prevention

Replace the mercury with non-toxic raw

materials, improve the production equipment,
reform process.
Reduce the concentration of mercury vapor in
the air of work job.

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NIOSH REL （ National Institute for Occupational Safety and Health, Recommended
Exposure Limit ） :

TWA(Total Weight Average) mercury vapor:

-- 0.05 mg/m3 (skin)
--Ceiling: 0.1 mg/m3 (skin)

OSHA PEL:(Occupation Safety and Health Agency,

Permissible Exposure Limit)
--TWA PEL of 0.05 mg/m3 （ 8-hour ）
--Ceiling: 0.1 mg/m3

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• Demand for mercury job-shop and cleaning measures.
• Strengthen the ventilation of the mercury job shop.
• The mercury job shop must take measures to cool down.
• Take measures to reduce the concentration of mercury
of the pollution workshop.
A. Iodine heating fumigation
B. Iodine sublimation method

Strengthening personal protection,

Establish necessary health inspection system,
Medical Surveillance :Biological and medical monitoring

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Medical monitoring
Baseline and periodic examinations: to check if there is
any change concerning mercury poisoning in a given
period to employees
Biologic monitoring : is the measurement of chemical
agents in the blood, urine, or other body tissue of
exposed individuals to determine how much of the
chemical has been absorbed into the body. It serves as a
back-up to environmental exposure measurements

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The monitoring of workers exposed to mercury is generally based upon the periodic measurement of mercury in the urine. Urine levels provide a measur
e of low level or cumulative exposure and are usually preferred over blood levels, which are more appropriate measures after acute exposures to inorganic
mercury vapour. This also applies to people in the general
population who may have become accidentally exposed to
vapour from liquid mercury. Mild and reversible proteinuria is the most sensitive clinical indicator of mercury
vapour toxicity, followed by non-specific symptoms and
changes in plasma lysomal enzyme, and in more advanced
cases, objective tremor and psychomotor disturbances.
The first clinical symptoms in workers (rarely seen anymore in
high economy countries) are proteinuria and slight hand
tremor. Testing the urine for reversible proteinuria by a
simple dipstick method was widely used in routine exposure monitoring and was s
urprisingly sensitive to increases in exposure.
Occupational contraindications:

 Suffering from nervous system, kidney,

gastrointestinal tract ， liver and oral disease.

 Pregnancy and breast-feeding women

workers should be temporarily out of mercur

y exposure.

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1.The sourses 、 uses and contact ways
2.Toxicology
Mechanism:Hg2++protein-SH→Hg-SH
3.Toxicity effect: acute poisoning
chronic poisoning
and Clinical manifestation
4.Diagnosis : Clinical manifestation+blood or urine or hair
5.Treatment: Drive mercury therapy
Basical therapy
Natural detoxification
6.Prevention:work place concentration
medical and biological monitoring
wear protective equipment
avoid taking it home

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