Neither DMPS nor DMSA is Effective in Quantitative Elimination of Elemental Mercury After Intentional IV Injection

Abstract

Although urinary excretion could be enhanced during chelation therapy, Hg deposits in organs resulted in negligible elimination of mercury compared to the exposed dose.

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.…”

“…A man survived the acute phase (15) after i.v. injection of about 40 mL of Hg 0 , whereas death occurred in a woman who injected as little as 1-2 mL (16), usually not a life-threatening amount (10,30). Apart from ethanol (3), no other acquired or genetic interfering factor is currently known.…”

“…Different chelating agents, including penicillamine, dimercaprol, 2,3-dimercaptopropane-1-sulphonate (DMPS), and DMSA, have been administered in cases of i.v. Hg injection (10). The beneficial role of these molecules relies on covalent binding and removal of Hg cations from sensitive tissues in critical organs (60,61).…”

“…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).…”