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Toxicity, Mercury: Follow-up

Author: 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
Coauthor(s): Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Contributor Information and Disclosures

Updated: Sep 18, 2009

Follow-up

Prognosis

  • Outcome depends on the form of the mercury compound and severity of exposure. Mild exposure to inorganic (ie, elemental, mercuric salt) and organic compounds can result in a complete recovery. Fatality is usually the result of severe exposure to mercuric salt. Most organic mercury exposures leave a neurological sequela. Minimal dermal exposure to dimethylmercury has resulted in progressive neurologic deterioration and death, with initial symptoms delayed for several months.
  • Individuals who need to be admitted to the hospital include the following:
    • Individuals who ingested (or are thought to have ingested) mercury salts
    • Individuals thought to have elemental mercury inhalation and have pulmonary injury
    • Individuals who require intensive chelating therapy

Patient Education

  • For excellent patient education resources, visit eMedicine's Poisoning Center. Also, see eMedicine's patient education article Poisoning.

Miscellaneous

Medicolegal Pitfalls

  • Failure to obtain a history of exposure to mercury compounds in patients with significant historical features of the signs and symptoms of mercury exposure
  • Failure to initiate treatment in a patient with significant exposure and symptoms before obtaining the confirmatory laboratory analysis, which may be delayed for a week.
  • Failure to consult a medical toxicologist or regional poison control center for updated information on this rare type of poisoning.

Special Concerns

  • 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.
  • Mercury is being found more often in our household items such as fluorescent bulbs and the risk of potential exposure has increased. The need to understand proper procedure for disposing of potential exposure is critical. The Environmental Protection Agency (EPA) has outlined a clear process to dispose of accidental spill. For complete details on mercury spills with specifics related to a broken thermometer or fluorescent bulb, visit the EPA Web site.18
 


More on Toxicity, Mercury

Overview: Toxicity, Mercury
Differential Diagnoses & Workup: Toxicity, Mercury
Treatment & Medication: Toxicity, Mercury
Follow-up: Toxicity, Mercury
Multimedia: Toxicity, Mercury
References
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References

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

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Further Reading

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Keywords

Hg, heavy metal, mercury poisoning, mercury salts, methyl mercury, methylmercury, acrodynia, pink disease, acrodynic erythema, dermatopolyneuritis, erythredema, Swift disease, Swift's disease, hydrargyria, hydrargyrism, mercurialism, acute mercury poisoning, chronic mercury poisoning, inorganic mercury exposure, organic mercury exposure, elemental mercury exposure, inorganic mercury salt exposure, mercury toxicity, mercury ingestion, thimerosal

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Contributor Information and Disclosures

Author

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 Academy of Emergency Medicine, American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

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 Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michelle Ervin, MD, Chair, Department of Emergency Medicine, Howard University Hospital
Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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.

Managing Editor

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.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

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.

 
 
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