Mercury Toxicity in Emergency Medicine Follow-up

  • Author: Barry M Diner, MD, MPH, FACEP; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Sep 18, 2009
 

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
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Patient Education

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

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.

Specialty Editor Board

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.

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.

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.

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.

References

  1. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline].

  2. 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].

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

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

  5. 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. Mar 21 2001;285(11):1436-7. [Medline].

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

  7. Canadian Food Inspection Agency. Food safety facts on mercury and fish consumption. Canadian Food Inspection Agency. Available at http://www.inspection.gc.ca/english/fssa/concen/specif/mercurye.shtml. Accessed May 2002.

  8. Health Canada. Advisory: Information on mercury levels in fish. May 29, 2002. Health Canada Online. Available at http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2002/2002_41_e.html.

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

  10. 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.

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

  12. Food and Drug Administration. Consumer Update on dental amalgams. United States Food and Drug Administration (FDA). Available at http://www.fda.gov/. Accessed March 30, 2009.

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

  14. Belson MG, Schier JG, Patel MM; CDC. Case definitions for chemical poisoning. MMWR Recomm Rep. Jan 14 2005;54(RR-1):1-24. [Medline].

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

  16. Young-Jin S. Mercury. In: 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.

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

  18. 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.

  19. Abramson, JS. Thimerosal in vaccines--An interim report to clinicians. American Academy of Pediatrics. Committee on Infectious Diseases and Committee on Environmental Health. Pediatrics. Sep 1999;104(3 Pt 1):570-4. [Medline].

  20. Bates B. Heavy metals and inorganic agents. In: Clinical Management of Poisoning and Drug Overdose. Vol 55. WB Saunders; 1998:750-6.

  21. Clifton JC 2nd. Mercury exposure and public health. Pediatr Clin North Am. Apr 2007;54(2):237-69, viii. [Medline].

  22. Ford M. Heavy metals. In: Tintinalli JE, ed. Emergency Medicine: A Comprehensive Study Guide. Vol 158. 4th ed. McGraw-Hill; 1996:839-41.

  23. Goyer RA. Toxic effects of metals. In: Casarett LJ, ed. Casarett and Doull's Toxicology: The Basic Science of Poisons. 5th ed. New York: McGraw-Hill; 1996:709-713.

  24. Graeme KA, Pollack CV Jr. Heavy metal toxicity, Part I: arsenic and mercury. J Emerg Med. Jan-Feb 1998;16(1):45-56. [Medline].

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

  26. Kershaw TG, Clarkson TW, Dhahir PH. The relationship between blood levels and dose of methylmercury in man. Arch Environ Health. Jan-Feb 1980;35(1):28-36. [Medline].

  27. Klaassen C. Heavy metals and heavy metal antagonists. In: Hardman JG, Limbird LE, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 9th ed. New York: McGraw-Hill; 1996:1654-1659.

  28. Norseth T, Clarkson TW. Studies on the biotransformation of 203Hg-labeled methyl mercury chloride in rats. Arch Environ Health. Dec 1970;21(6):717-27. [Medline].

  29. Parker SK, Schwartz B, Todd J, Pickering LK. Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics. Sep 2004;114(3):793-804. [Medline].

  30. Poddar AS, Kim JG, Gill KP, et al. Generation and characterization of a polyclonal antipeptide antibody to human glycodelin. Fertil Steril. Mar 1998;69(3):543-8. [Medline].

  31. Taueg C, Sanfilippo DJ, Rowens B, et al. Acute and chronic poisoning from residential exposures to elemental mercury--Michigan, 1989-1990. J Toxicol Clin Toxicol. 1992;30(1):63-7. [Medline].

  32. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2004;22(5):335-404. [Medline].

  33. Young J. Mercury. In: Goldfrank LR, ed. Goldfrank's Toxicology Emergencies. Vol 74. New York: McGraw-Hill; 1994:1051-62.

 
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This is a one 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.
Palm of a patient showing discrete erythematous papules and papulovesicles. Note lack of oozing, crusts, or excoriations. Although there is some increased palmar erythema, it differs from pink disease of inorganic mercury poisoning of children by presence of papules and lack of pain. Image Courtesy of American Academy of Dermatology.
Arm of a patient showing discrete scattered (shotgun) 1- to 2-mm papules. Note lack of oozing, crusts, excoriations, or other signs of acute eczema. Image Courtesy of American Academy of Dermatology.
 
 
 
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