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Mercury Toxicity Treatment & Management

  • Author: David A Olson, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
 
Updated: Oct 23, 2015
 

Approach Considerations

Notify state and local health officials to clarify the mechanism of exposure and to institute appropriate decontamination measures, should these be necessary.

Treatment of mercury toxicity consists of removal of the patient from the source of exposure, supportive care, and chelation therapy. Patients with cognitive and emotional sequelae may require psychotropic medications.

Although laboratory studies are important, acute treatment in critical situations should be based on the patient’s history and clinical presentation, without waiting for laboratory confirmation.

Little information is available about the treatment of mercury-induced tremulousness, but initiation of empiric treatment for patients who are functionally impaired with this complication would be reasonable.

Once the neurologic consequences of Minamata disease appear, they are, unfortunately, irreversible. The goal of medical management in Minamata disease is to reduce the total body burden of mercury and minimize further damage.

Prehospital care

Prehospital management includes gathering information on the time, type, and mode of mercury exposure, as well as the following:

  • Initial assessment - Airway, breathing, and circulation (ABCs)
  • Oxygen
  • Intravenous (IV) access
  • Removal from the contaminated area

Surgical care

Surgery does not have a role in the treatment of Minamata disease; however, in other forms of mercury exposure, surgical intervention is sometimes warranted. Surgery occasionally has been employed to remove ingested mercury that has become lodged in the intestine or colon.[88]

Surgical removal of subcutaneous deposits of self-injected elemental mercury has also been described.[89] Early, definitive surgical excisions of the mercury deposits resulted in good outcomes with minimal toxicity.

Inpatient care

All patients in unstable condition should be admitted to an intensive care unit (ICU). After the patient is admitted, supportive measures, decontamination, and careful monitoring should be continued. In cases of inorganic mercuric salt ingestion, carefully monitor the patient's renal function.

Transfer

Serious clinical manifestations due to mercury exposure should be managed in a tertiary care facility by physicians experienced with toxicologic emergencies.

Activity

Employment and driving should be restricted if patients have significant emotional or cognitive problems.

Consultations

Consult with the regional poison control center or a medical toxicologist (certified through the American Board of Medical Toxicology and/or the American Board of Emergency Medicine) for additional information and patient care recommendations.

Follow-up

Determine follow-up care on a case-by-case basis. Obtain laboratory measurements of toxicity in patients with possible continued sources of exposure.

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Emergency Department Care

Supportive care begins with the ABCs, especially when managing the inhalation of elemental mercury and the ingestion of caustic inorganic mercury, both of which may cause the onset of airway obstruction and respiratory failure. The next step in supportive care is the removal of contaminated clothing and copious irrigation of exposed skin. Aggressive hydration may be required for acute inorganic mercury poisoning because of its caustic properties. Do not induce emesis if the compound ingested is of the caustic inorganic form.

Gastric lavage is recommended for organic ingestion, especially if the compound is observed on an abdominal radiograph series.

Activated charcoal is indicated for GI decontamination because it binds inorganic and organic mercury compounds to some extent.

Whole bowel irrigation may be used until rectal effluent is clear and void of any radiopaque material. However, its effectiveness in decreasing the GI transit time of elemental mercury is doubtful because of the high density of elemental mercury and the low density of the whole bowel irrigant solutions. Likewise, whole bowel irrigation has no adsorptive effect on any type of mercury within the GI tract.

Use chelating agents if the patient is symptomatic, if systemic absorption is anticipated, or if increased blood or urinary mercury levels are present. Chelating agents contain thiol groups, which compete with endogenous sulfhydryl groups.

Hemodialysis is used in severe cases of toxicity when renal function has declined. The ability of regular hemodialysis to filter out mercury is limited because of mercury's mode of distribution among erythrocytes and plasma. However, hemodialysis with L-cysteine compound as a chelator has been successful.

Older literature indicates that neostigmine may help motor function in methylmercury toxicity as this toxicity may lead to acetylcholine deficiency.[90]

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Chelation

Because mercury binds to the body's ubiquitous cellular sulfhydryl groups, chelating agents should be administered early in treatment.

Chelating agents contain thiol groups, which bind to mercury. For acute, inorganic toxicity, dimercaprol (British antilewisite [BAL]) has traditionally been recommended, but oral agents are gaining prominence. Chelation with 2,3-dimercaptosuccinic acid (DMSA or succimer) has been shown to result in increased mercury excretion, compared with N -acetyl-D,L-penicillamine, in adults with acute mercury vapor exposure. DMSA is generally well tolerated and has also demonstrated efficacy in children exposed to mercury. Chelation treatment may be administered in the outpatient setting with an oral chelator, such as DMSA.[91]

Polythiol is a nonabsorbable resin that can theoretically help in facilitating the removal of methylmercury (short chain alkyl organic mercury), which is then excreted in the bile after enterohepatic circulation.

Exchange transfusion has been used as a treatment of last resort. Because mercury-chelating agent complexes are large molecules, they may fail to be filtered out by standard hemodialysis membranes, rendering conventional hemodialysis ineffective.[92]

Despite the increased excretion of mercury with chelating agents, chelation removes only a small portion of the body's mercury stores. Furthermore, the efficacy of chelating agents in treating neurologic complications has not been established; however, among patients with amalgam fillings, placebo responses to chelation treatment have been reported.[93]

Finally, caution is warranted, however, as some physicians have documented initial clinical deterioration during chelation therapy.[84]

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Diet

Seafood rich in organic mercury should of course be avoided. Predators such as sharks and tuna typically have increased mercury concentrations compared with herbivorous fishes.

In some studies, the levels of mercury in shark, swordfish, and large tuna steaks exceeded the Food and Drug Administration (FDA) safety limit of 1 part per million. However, most other fish sold in the United States have clearly lower levels of approximately 0.3 part per million.

Because of the high morbidity and mortality rates associated with methyl mercury poisoning, especially in utero, pregnant women and nursing mothers should avoid consuming larger fish, because their mercury concentrations tend to be higher than those in smaller fish.

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Deterrence and Prevention

Workplace hygiene and careful monitoring and disposal of industrial waste are equally important in the prevention of mercury poisoning.

Because of the high morbidity and mortality rates associated with methyl mercury poisoning, especially in utero, pregnant women and nursing mothers should avoid consuming larger fish because their mercury concentrations tend to be higher than those in smaller fish.

Minamata disease can be prevented by reducing or eliminating one's consumption of fish caught from bodies of water that are contaminated with high concentrations of mercury.

Other forms of mercury exposure, such as elemental mercury vapor inhalation, occur when people vacuum or sweep mercury spills in an enclosed space. The proper authorities must handle any spill with the appropriate mercury decontamination kits and procedures.

Significant oral ingestion of elemental mercury may lead to significant environmental contamination as the mercury is passed, essentially unabsorbed, through the GI tract and expelled in the feces.

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Contributor Information and Disclosures
Author

David A Olson, MD Clinical Neurologist, Dekalb Neurology Group, Decatur, Georgia

David A Olson, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American College of International Physicians, American Heart Association, American Stroke Association, American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, National Association of Managed Care Physicians, American College of Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York AcademyofSciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

Barry M Diner, MD, MPH, FACEP Assistant Clinical Professor, Department of Emergency Medicine, Emory University School of Medicine; Attending Physician, St Luke's Episcopal Hospital, Houston, Texas

Barry M Diner, MD, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP Chair, Department of Emergency Medicine, Director of Medical Toxicology, Allegheny General Hospital; Associate Professor, Department of Emergency Medicine, Drexel University College of Medicine

Disclosure: Nothing to disclose.

Michael E Mullins, MD Assistant Professor, Department of Emergency Medicine, Washington University School of Medicine

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians

Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David K Tan, MD, EMT-T, FAAEM Assistant Professor and Chief, EMS Section, Division of Emergency Medicine, Medical Director, Washington University EMS, Washington University in St Louis School of Medicine

David K Tan, MD, EMT-T, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and National Association of EMS Physicians

Disclosure: Nothing to disclose.

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. Charcot JM. Clinical lectures of diseases of the nervous system. The Landmark Library of Neurology and Neurosurgery. 1994. 186.

  2. Wilson SAK. Neurology. The Landmark Library of Neurology and Neurosurgery. 1994. 739-740.

  3. Harada M. Minamata disease: methylmercury poisoning in Japan caused by environmental pollution. Crit Rev Toxicol. 1995. 25(1):1-24. [Medline].

  4. United Nations Environment Programme. Minamata Convention on Mercury. Minamata Convention on Mercury. Available at http://www.mercuryconvention.org/Convention. Accessed: October 18, 2014.

  5. Hamann CR, Boonchai W, Wen L, Sakanashi EN, Chu CY, Hamann K, et al. Spectrometric analysis of mercury content in 549 skin-lightening products: is mercury toxicity a hidden global health hazard?. J Am Acad Dermatol. 2014 Feb. 70(2):281-7.e3. [Medline].

  6. Takeuchi T, Eto K, Kinjo Y, Tokunaga H. Human brain disturbance by methylmercury poisoning, focusing on the long-term effect on brain weight. Neurotoxicology. 1996 Spring. 17(1):187-90. [Medline].

  7. Vahter ME, Mottet NK, Friberg LT, Lind SB, Charleston JS, Burbacher TM. Demethylation of methyl mercury in different brain sites of Macaca fascicularis monkeys during long-term subclinical methyl mercury exposure. Toxicol Appl Pharmacol. 1995 Oct. 134(2):273-84. [Medline].

  8. Carvalho CM, Chew EH, Hashemy SI, Lu J, Holmgren A. Inhibition of the human thioredoxin system. A molecular mechanism of mercury toxicity. J Biol Chem. 2008 May 2. 283(18):11913-23. [Medline].

  9. Basu N, Scheuhammer AM, Rouvinen-Watt K, Evans RD, Grochowina N, Chan LH. The effects of mercury on muscarinic cholinergic receptor subtypes (M1 and M2) in captive mink. Neurotoxicology. 2008 Mar. 29(2):328-34. [Medline].

  10. Huang CF, Hsu CJ, Liu SH, Lin-Shiau SY. Neurotoxicological mechanism of methylmercury induced by low-dose and long-term exposure in mice: oxidative stress and down-regulated Na+/K(+)-ATPase involved. Toxicol Lett. 2008 Feb 15. 176(3):188-97. [Medline].

  11. Ceccatelli S, Daré E, Moors M. Methylmercury-induced neurotoxicity and apoptosis. Chem Biol Interact. 2010 Nov 5. 188(2):301-8. [Medline].

  12. Yamashita T, Ando Y, Sakashita N, et al. Role of nitric oxide in the cerebellar degeneration during methylmercury intoxication. Biochim Biophys Acta. 1997 Mar 15. 1334(2-3):303-11. [Medline].

  13. Ralston NV, Raymond LJ. Dietary selenium's protective effects against methylmercury toxicity. Toxicology. 2010 Nov 28. 278(1):112-23. [Medline].

  14. Echeverria D, Woods JS, Heyer NJ, Rohlman D, Farin FM, Li T, et al. The association between a genetic polymorphism of coproporphyrinogen oxidase, dental mercury exposure and neurobehavioral response in humans. Neurotoxicol Teratol. 2006 Jan-Feb. 28(1):39-48. [Medline].

  15. Echeverria D, Woods JS, Heyer NJ, Martin MD, Rohlman DS, Farin FM, et al. The association between serotonin transporter gene promotor polymorphism (5-HTTLPR) and elemental mercury exposure on mood and behavior in humans. J Toxicol Environ Health A. 2010. 73(15):1003-20. [Medline]. [Full Text].

  16. Chernyak YI, Itskovich VB, Baduev BK, Borovskii GB. Dependence of blood levels of HSP70 and HSP90 on genotypes of HSP70, GSTT1, and GSTM1 gene polymorphism in individuals chronically exposed to mercury. Bull Exp Biol Med. 2012 Nov. 154(1):68-72. [Medline].

  17. Wang Y, Goodrich JM, Gillespie B, Werner R, Basu N, Franzblau A. An investigation of modifying effects of metallothionein single-nucleotide polymorphisms on the association between mercury exposure and biomarker levels. Environ Health Perspect. 2012 Apr. 120(4):530-4. [Medline]. [Full Text].

  18. Bose-O'Reilly S, McCarty KM, Steckling N, Lettmeier B. Mercury exposure and children's health. Curr Probl Pediatr Adolesc Health Care. 2010 Sep. 40(8):186-215. [Medline]. [Full Text].

  19. Dufault R, LeBlanc B, Schnoll R, et al. Mercury from chlor-alkali plants: measured concentrations in food product sugar. Environ Health. 2009 Jan 26. 8:2. [Medline]. [Full Text].

  20. Washam C. Beastly beauty products: exposure to inorganic mercury in skin-lightening creams. Environ Health Perspect. 2011 Feb. 119(2):A80. [Medline]. [Full Text].

  21. Centers for Disease Control and Prevention. Mercury exposure among household users and nonusers of skin-lightening creams produced in Mexico - California and Virginia, 2010. MMWR Morb Mortal Wkly Rep. 2012 Jan 20. 61(2):33-6. [Medline].

  22. Tang HL, Chu KH, Mak YF, Lee W, Cheuk A, Yim KF. Minimal change disease following exposure to mercury-containing skin lightening cream. Hong Kong Med J. 2006 Aug. 12(4):316-8. [Medline].

  23. Espinoza EO, Mann MJ, Bleasdell B. Arsenic and mercury in traditional Chinese herbal balls. N Engl J Med. 1995 Sep 21. 333(12):803-4. [Medline].

  24. Sallon S, Namdul T, Dolma S, et al. Mercury in traditional Tibetan medicine - panacea or problem?. Hum Exp Toxicol. 2006 Jul. 25(7):405-12. [Medline].

  25. Garetano G, Stern AH, Robson M, Gochfeld M. Mercury vapor in residential building common areas in communities where mercury is used for cultural purposes versus a reference community. Sci Total Environ. 2008 Jul 1. 397(1-3):131-9. [Medline].

  26. Saper RB, Kales SN, Paquin J, et al. Heavy metal content of ayurvedic herbal medicine products. JAMA. 2004 Dec 15. 292(23):2868-73. [Medline].

  27. Kingman A, Albers JW, Arezzo JC, Garabrant DH, Michalek JE. Amalgam exposure and neurological function. Neurotoxicology. 2005 Mar. 26(2):241-55. [Medline].

  28. Public Health Service. Dental amalgam: a scientific review and recommended Public Health Service strategy for research, education, and regulation. Public Health Service. January 1993. [Full Text].

  29. Franzblau A, d'Arcy H, Ishak MB, et al. Low-level mercury exposure and peripheral nerve function. Neurotoxicology. 2012 Jun. 33(3):299-306. [Medline].

  30. Bellinger DC, Trachtenberg F, Barregard L, et al. Neuropsychological and renal effects of dental amalgam in children: a randomized clinical trial. JAMA. 2006 Apr 19. 295(15):1775-83. [Medline].

  31. DeRouen TA, Martin MD, Leroux BG, et al. Neurobehavioral effects of dental amalgam in children: a randomized clinical trial. JAMA. 2006 Apr 19. 295(15):1784-92. [Medline].

  32. FDA Issues Final Regulation on Dental Amalgam. July 28, 2009. FDA News Release. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm173992.htm.

  33. Triunfante P, Soares ME, Santos A, Tavares S, Carmo H, Bastos Mde L. Mercury fatal intoxication: two case reports. Forensic Sci Int. 2009 Jan 30. 184(1-3):e1-6. [Medline].

  34. Deschamps F, Strady C, Deslee G, Menciere-Faroy B, Deschamps S. Five years of follow-up after elemental mercury self-poisoning. Am J Forensic Med Pathol. 2002 Jun. 23(2):170-2. [Medline].

  35. Bigham M, Copes R. Thiomersal in vaccines: balancing the risk of adverse effects with the risk of vaccine-preventable disease. Drug Saf. 2005. 28(2):89-101. [Medline].

  36. Kirby D. Evidence of Harm. Mercury in Vaccine and the Autism Epidemic: A Medical Controversy. New York: Saint Martin's Press; 2005.

  37. Heron J, Golding J. Thimerosal exposure in infants and developmental disorders: a prospective cohort study in the United kingdom does not support a causal association. Pediatrics. 2004 Sep. 114(3):577-83. [Medline].

  38. Mowry JB, Spyker DA, Cantilena LR Jr, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol (Phila). 2014 Dec. 52 (10):1032-283. [Medline].

  39. Amin-zaki L, Majeed MA, Clarkson TW, Greenwood MR. Methylmercury poisoning in Iraqi children: clinical observations over two years. Br Med J. 1978 Mar 11. 1(6113):613-6. [Medline]. [Full Text].

  40. Feng X, Li P, Qiu G, et al. Human exposure to methylmercury through rice intake in mercury mining areas, Guizhou province, China. Environ Sci Technol. 2008 Jan 1. 42(1):326-32. [Medline].

  41. Barregard L. Exposure to inorganic mercury: from dental amalgam to artisanal gold mining. Environ Res. 2008 May. 107(1):4-5. [Medline].

  42. Myers GJ, Davidson PW. Prenatal methylmercury exposure and children: neurologic, developmental, and behavioral research. Environ Health Perspect. 1998 Jun. 106 Suppl 3:841-7. [Medline].

  43. Stern AH, Jacobson JL, Ryan L, Burke TA. Do recent data from the Seychelles Islands alter the conclusions of the NRC Report on the toxicological effects of methylmercury?. Environ Health. 2004 Jan 30. 3(1):2. [Medline]. [Full Text].

  44. Davis LE, Kornfeld M, Mooney HS, et al. Methylmercury poisoning: long-term clinical, radiological, toxicological, and pathological studies of an affected family. Ann Neurol. 1994 Jun. 35(6):680-8. [Medline].

  45. Nierenberg DW, Nordgren RE, Chang MB, et al. Delayed cerebellar disease and death after accidental exposure to dimethylmercury. N Engl J Med. 1998 Jun 4. 338(23):1672-6. [Medline].

  46. Albers JW, Kallenbach LR, Fine LJ, et al. Neurological abnormalities associated with remote occupational elemental mercury exposure. Ann Neurol. 1988 Nov. 24(5):651-9. [Medline].

  47. Letz R, Gerr F, Cragle D, Green RC, Watkins J, Fidler AT. Residual neurologic deficits 30 years after occupational exposure to elemental mercury. Neurotoxicology. 2000 Aug. 21(4):459-74. [Medline].

  48. ATSDR. Agency for Toxic Substances and Disease Registry. Toxicological Profile for Mercury. ATSDR. August 1997.

  49. EPA. Water quality criterion for the protection of human health: methylmercury. Environmental Protection Agency. Jan 2001. EPA-823-R-01-001.

  50. CDC. From the Centers for Disease Control and Prevention. Blood and hair mercury levels in young children and women of childbearing age--United States, 1999. JAMA. 2001 Mar 21. 285(11):1436-7. [Medline].

  51. Myers GJ, Davidson PW, Cox C, et al. Prenatal methylmercury exposure from ocean fish consumption in the Seychelles child development study. Lancet. 2003 May 17. 361(9370):1686-92. [Medline].

  52. Gerstenberger SL, Martinson A, Kramer JL. An evaluation of mercury concentrations in three brands of canned tuna. Environ Toxicol Chem. 2010 Feb. 29(2):237-42. [Medline].

  53. Canadian Food Inspection Agency. Food safety facts on mercury and fish consumption. Canadian Food Inspection Agency.

  54. Health Canada. Advisory: Information on mercury levels in fish. May 29, 2002. Health Canada Online.

  55. Ontario Ministry of the Environment. Guide to eating Ontario sport fish, 2001-2002. 21st ed rev. Ontario Ministry of the Environment. 2001.

  56. Centers for Disease Control and Prevention. Mercury and Vaccines (Thimerosal). Updated June 2007. Available at http://www.cdc.gov/od/science/iso/concerns/thimerosal.htm.

  57. Madsen KM, Lauritsen MB, Pedersen CB, et al. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data. Pediatrics. 2003 Sep. 112(3 Pt 1):604-6. [Medline]. [Full Text].

  58. World Health Organization. World Health Organization: Global Advisory Committee on Vaccine Safety. Rec 32. WHO. 2003 Jun 11-12. 282-284.

  59. Environmental Protection Agency (EPA). Spills, Disposal and Site Cleanup. US Environmental Protection Agency. Available at http://www.epa.gov/mercury/spills/index.htm. Accessed: March 30, 2009.

  60. Jao-Tan C, Pope E. Cutaneous poisoning syndromes in children: a review. Curr Opin Pediatr. 2006 Aug. 18(4):410-6. [Medline].

  61. Tezer H, Kaya A, Kalkan G, Erkocoglu M, Ozturk K, Buyuktasli M. Mercury poisoning: a diagnostic challenge. Pediatr Emerg Care. 2012 Nov. 28(11):1236-7. [Medline].

  62. Takaoka S, Kawakami Y, Fujino T, Oh-ishi F, Motokura F, Kumagai Y. Somatosensory disturbance by methylmercury exposure. Environ Res. 2008 May. 107(1):6-19. [Medline].

  63. Malkani R, Weinstein JM, Kumar N, Victor TA, Bernstein L. Ataxia and cranial neuropathies from subcutaneously injected elemental mercury. Clin Toxicol (Phila). 2011 Apr. 49(4):334-6. [Medline].

  64. Haut MW, Morrow LA, Pool D, Callahan TS, Haut JS, Franzen MD. Neurobehavioral effects of acute exposure to inorganic mercury vapor. Appl Neuropsychol. 1999. 6(4):193-200. [Medline].

  65. Yokoo EM, Valente JG, Grattan L, Schmidt SL, Platt I, Silbergeld EK. Low level methylmercury exposure affects neuropsychological function in adults. Environ Health. 2003 Jun 4. 2(1):8. [Medline].

  66. Weil M, Bressler J, Parsons P, Bolla K, Glass T, Schwartz B. Blood mercury levels and neurobehavioral function. JAMA. 2005 Apr 20. 293(15):1875-82. [Medline].

  67. Chang JW, Pai MC, Chen HL, Guo HR, Su HJ, Lee CC. Cognitive function and blood methylmercury in adults living near a deserted chloralkali factory. Environ Res. 2008 Nov. 108(3):334-9. [Medline].

  68. Boyd AS, Seger D, Vannucci S, Langley M, Abraham JL, King LE Jr. Mercury exposure and cutaneous disease. J Am Acad Dermatol. 2000 Jul. 43(1 Pt 1):81-90. [Medline].

  69. Dantzig PI. A new cutaneous sign of mercury poisoning?. J Am Acad Dermatol. 2003 Dec. 49(6):1109-11. [Medline].

  70. Chu CC, Huang CC, Ryu SJ, Wu TN. Chronic inorganic mercury induced peripheral neuropathy. Acta Neurol Scand. 1998 Dec. 98(6):461-5. [Medline].

  71. Miyakawa T, Murayama E, Sumiyoshi S, Deshimaru M, Fujimoto T. Late changes in human sural nerves in Minamata disease and in nerves of rats with experimental organic mercury poisoning. Acta Neuropathol. 1976 Jun 15. 35(2):131-8. [Medline].

  72. Risher JF, Amler SN. Mercury exposure: evaluation and intervention the inappropriate use of chelating agents in the diagnosis and treatment of putative mercury poisoning. Neurotoxicology. 2005 Aug. 26(4):691-9. [Medline].

  73. Li YF, Chen C, Li B, et al. Scalp hair as a biomarker in environmental and occupational mercury exposed populations: suitable or not?. Environ Res. 2008 May. 107(1):39-44. [Medline].

  74. Urban P, Lukas E, Benicky L, Moscovicova E. Neurological and electrophysiological examination on workers exposed to mercury vapors. Neurotoxicology. 1996 Spring. 17(1):191-6. [Medline].

  75. Ruedy J. Methylmercury poisoning. CMAJ. 2001 Oct 30. 165(9):1193-4. [Medline]. [Full Text].

  76. Halbach S, Welzl G. Levels of organic and inorganic mercury in human blood predicted from measurements of total mercury. J Appl Toxicol. 2010 Oct. 30(7):674-9. [Medline].

  77. Young-Jin S. Mercury. Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, et al, eds. Goldfrank's Toxicologic Emergencies. 8th ed. New York: The McGraw-Hill Companies; 2006. 96.

  78. [Guideline] Charlton N, Wallace KL. American College of Medical Toxicology - Position Statement: Post-Chelator Challenge Urinary Metal Testing. July 27, 2009. [Full Text].

  79. Guallar E, Sanz-Gallardo MI, van't Veer P, et al. Mercury, fish oils, and the risk of myocardial infarction. N Engl J Med. 2002 Nov 28. 347(22):1747-54. [Medline].

  80. Rees JR, Sturup S, Chen C, Folt C, Karagas MR. Toenail mercury and dietary fish consumption. J Expo Sci Environ Epidemiol. 2007 Jan. 17(1):25-30. [Medline].

  81. Sallsten G, Barregard L, Wikkelso C, Schutz A. Mercury and proteins in cerebrospinal fluid in subjects exposed to mercury vapor. Environ Res. 1994 May. 65(2):195-206. [Medline].

  82. Korogi Y, Takahashi M, Hirai T, et al. Representation of the visual field in the striate cortex: comparison of MR findings with visual field deficits in organic mercury poisoning (Minamata disease). AJNR Am J Neuroradiol. 1997 Jun-Jul. 18(6):1127-30. [Medline].

  83. White RF, Feldman RG, Moss MB, Proctor SP. Magnetic resonance imaging (MRI), neurobehavioral testing, and toxic encephalopathy: two cases. Environ Res. 1993 Apr. 61(1):117-23. [Medline].

  84. Benz MR, Lee SH, Kellner L, Döhlemann C, Berweck S. Hyperintense lesions in brain MRI after exposure to a mercuric chloride-containing skin whitening cream. Eur J Pediatr. 2011 Jun. 170(6):747-50. [Medline].

  85. O'Carroll RE, Masterton G, Dougall N, Ebmeier KP, Goodwin GM. The neuropsychiatric sequelae of mercury poisoning. The Mad Hatter's disease revisited. Br J Psychiatry. 1995 Jul. 167(1):95-8. [Medline].

  86. Andersen A, Ellingsen DG, Mørland T, Kjuus H. A neurological and neurophysiological study of chloralkali workers previously exposed to mercury vapour. Acta Neurol Scand. 1993 Dec. 88(6):427-33. [Medline].

  87. Murata K, Weihe P, Budtz-Jorgensen E, Jorgensen PJ, Grandjean P. Delayed brainstem auditory evoked potential latencies in 14-year-old children exposed to methylmercury. J Pediatr. 2004 Feb. 144(2):177-83. [Medline].

  88. Cantor MO. Mercury lost in the gastrointestinal tract; report of an unusual case. J Am Med Assoc. 1951 Jun 9. 146(6):560-1. [Medline].

  89. Ragothaman M, Kulkarni G, Ashraf VV, Pal PK, Chickabasavaiah Y, Shankar SK. Elemental mercury poisoning probably causes cortical myoclonus. Mov Disord. 2007 Oct 15. 22(13):1964-8. [Medline].

  90. Rustam H, Von Burg R, Amin-Zaki L, El Hassani S. Evidence for a neuromuscular disorder in methylmercury poisoning. Arch Environ Health. 1975 Apr. 30(4):190-5. [Medline].

  91. Forman J, Moline J, Cernichiari E, et al. A cluster of pediatric metallic mercury exposure cases treated with meso-2,3-dimercaptosuccinic acid (DMSA). Environ Health Perspect. 2000 Jun. 108(6):575-7. [Medline].

  92. Alhamad T, Rooney J, Nwosu A, Maccombs J, Kim YS, Shukla V. Lessons learned from a fatal case of mercury intoxication. Int Urol Nephrol. 2011 Jan 14. [Medline].

  93. Grandjean P, Guldager B, Larsen IB, Jorgensen PJ, Holmstrup P. Placebo response in environmental disease. Chelation therapy of patients with symptoms attributed to amalgam fillings. J Occup Environ Med. 1997 Aug. 39(8):707-14. [Medline].

  94. Zajac A. Mercury in dental fillings. www.losangelestimes.com. Available at http://articles.latimes.com/2010/dec/20/nation/la-na-mercury-dental-qa-20101220. Accessed: August 7, 2011.

 
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This is a 1-view, abdominal, upright radiograph in a male patient who intentionally ingested 8 ounces of elemental mercury. Notice how the mercury outlines the large intestine from ascending to descending. Image courtesy of Fred P. Harchelroad, MD, and Ferdinando L. Mirarchi, DO.
Patient with intentional ingestion of mercury from blood pressure instrument. Note how mercury beads can be seen deposited in lung fields. Image courtesy of Shuchi Vyas, MD.
 
 
 
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