Acrodynia Workup

Updated: Jun 21, 2018
  • Author: Kamila K Padlewska, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Workup

Laboratory Studies

Evidence of excess mercury in the urine of affected persons has been noted. A 24-hour urine collection is recommended because urinary elimination of mercury is unpredictable and may vary from day to day or from hour to hour. Mercury values in persons with acrodynia can vary from 0-401 mcg/L. A value of less than 10 mcg/L is generally considered within reference range. Concentrations greater than 300 mcg/L are considered the threshold of toxicity, and symptoms rarely occur until mercury excretion rises to this level.

Blood evaluation is recommended, particularly for acute intoxication. Normal levels rarely exceed 15 mcg/L. Mercury levels in the plasma may be elevated for prolonged periods because of slow release from erythrocytes after oxidation.

Mercury blocks the action of catechol methyl transferase, leading to increased amounts of vanillylmandelic and homovanillic acid in urine.

Excretion of 17-ketosteroid has also been shown to be increased in these patients.

Analysis of hair strands by means of x-ray fluorescence for mercury contamination also may be considered, but the results may be falsely elevated in persons residing in environments with increased ambient atmospheric concentrations or in populations consuming methylmercury-contaminated seafood.

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Histologic Findings

Hyperplastic sweat glands and nonspecific inflammation have been observed in skin biopsy specimens. Degenerative changes have been found in peripheral nerves and chromatolytic changes at the anterior horn cells of the spinal cord.

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