Intravenous Mercury Injection and Ingestion: Clinical Manifestations and Management

Abstract

Significant pulmonary dysfunction accompanied by radiographically demonstrated mercury emboli and temporary abnormalities in several organs improved shortly after initiation of chelation. The impact of chelation on long-term outcome of parenteral mercury exposure remains uncharacterized.

Toxicokinetics and toxicodynamics of elemental mercury following self-administration

“…The overall Hg 0 intake assumed by our patient (about 500 g) is one of the largest reported in similar cases (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Fatal outcomes are rather uncommon after i.v.…”

“…Hg was determined also in plasma (HgP, days 1-3 and 8-19) and in the bronchoalveolar fluid drained from the endotracheal tube (HgBF) (days [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. On the 14th day, we performed a chelation challenge test with 300 mg of meso-2,3-dimercaptosuccinic acid (succimer, DMSA), in three equal doses every 8 h, and strictly monitored HgB, HgP, and HgU, after each dose.…”

“…Deliberate i.v. injection occurred in suicidal (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) as well as homicidal attempts 29), in drug and alcohol addicts (30)(31)(32)(33)(34)(35)(36), and in athletes wishing to improve their performances (37)(38)(39). Injected Hg 0 causes few signs of mercurialism and infrequent renal involvement (40).…”

Liposuction Technique Used as a Treatment Modality for Suicide Attempt by Injection of Mercury

“…Mercury can be removed from the body by oral treatment with 2,3-dimercaptopropane-1-sulphonate and meso-2,3-dimercaptosuccinic acid [1]. As chelation therapy removes 1 mg of mercury per day only, it is best to physically remove as much of mercury as possible from all the accessible areas and use chelation therapy for the remaining mercury.…”

“…Mercury toxicity is not often included in differential diagnosis. Inhalation of elemental mercury vapours is more hazardous than its ingestion or intravenous injection [1]. The use of elemental mercury as a suicidal agent is extremely rare [2], but it can be fatal if entered into systemic circulation.…”