Pediatric Mercury Intoxication Mimicking Pheochromocytoma

Bjeloševič, Marko; Fabianová, Martina; Olejník, Peter; Kunovský, Pavol

doi:10.4274/balkanmedj.2018.1025

Cited by 3 publications

(10 citation statements)

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“…In all four cases the second, third and fourth unithiol treatments resulted in urine mercury concentrations less than 10% of the first unithiol course [51,[74][75][76]. Additionally, the majority (>75%) of urine mercury excretion occurred in the first 48 h of the first treatment, supporting the animal data that the primary effect of the thiol chelators is reduction of renal stores of mercury [51,74,75,77].…”

Section: Chelationlimitations Blood and Urine Mercury Changes May Nosupporting

confidence: 56%

“…Likely because of the noted decrease in urine mercury output with continuous dosing, a number of clinicians have employed repeated "pulse" dosing with chelation free periods [51,[74][75][76]. Four reports describe the use of a repeated "pulse" dosing of unithiol:…”

Section: Chelationlimitations Blood and Urine Mercury Changes May Nomentioning

confidence: 99%

“…1. chronic mercury vapor exposure treated with 30 mg/kg/day (3000 mg/day) for five days repeated three times over 9 weeks [51] 2. chronic mercury vapor treated with 600 mg/day for 14 days with a 38 days break and then 800 mg/day for 20 days [74], 3. chronic occupational mercurous chloride exposure treated with 400 mg/day for 8 days followed by 5 days free of unithiol, then unithiol 400 mg/ day orally for 7 days, followed by 5 days free of unithiol, then 6 days of unithiol 400 mg/day orally [75], 4. chronic mercury exposure in a 10 month old treated with unithiol 20mg/kg/day IV for 4 days followed by 4 cycles of 20 mg/kg/day unithiol IV for 4 "cycles" of 2 days each [76].…”

Section: Chelationlimitations Blood and Urine Mercury Changes May Nomentioning

confidence: 99%

“…Acute asymptomatic cases show increased urinary mercury and reduced blood levels and remain asymptomatic [70,73]. However, chronic exposure after onset of neurotoxicity is generally manifested by prolonged recovery with or without permanent neurologic injury despite increased urine Hg and decreased blood Hg [46,51,56,60,61,76,89]. Additionally, in acute high-concentration mercury vapor cases unithiol or succimer appear to have limited effect on pulmonary injury [60,88].…”

Section: Choice Of a Chelator With Elemental Mercury And Mercury Vapormentioning

confidence: 99%

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Rethinking treatment of mercury poisoning: the roles of selenium, acetylcysteine, and thiol chelators in the treatment of mercury poisoning: a narrative review

Spiller

Hays

Casavant

2021

Toxicology Communications

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We reevaluate the treatment of mercury poisoning, incorporating recent advances in understanding of mercury toxicity and the mercury:selenium interaction. This review focuses on: 1) the role, limitations and benefits of chelation (Unithiol, succimer and N-Acetylcysteine); 2) the role of selenium supplementation; and 3) how the different forms of mercury are impacted by use of chelation and selenium. Unithiol and succimer produce increases in urinary excretion of mercury and to a lesser degree blood and total body mercury. The primary role of N-acetylcysteine is increasing renal mercury excretion, similar to the thiol-chelators. Additional unique features of acetylcysteine include increased efflux of methylmercury from the brain, and reduced oxidative stress via increased glutathione production. The role of selenium includes: 1) restoration of selenoprotein activity, 2) protection against mitochondrial injury and DNA damage, 3) demethylation of methylmercury, 4) sequestering of mercury via Hg:Se complexes, and 5) redistribution of Hg inside organisms. Selenium may increase blood Hg, via a "sink" effect, causing a redistribution of mercury away from the brain. A combined approach for mercury poisoning treatment was developed focusing on restoration of selenoprotein function, reduction of oxidative stress and increased mercury elimination.

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Section: Chelationlimitations Blood and Urine Mercury Changes May Nosupporting

confidence: 56%

Section: Chelationlimitations Blood and Urine Mercury Changes May Nomentioning

confidence: 99%

Section: Chelationlimitations Blood and Urine Mercury Changes May Nomentioning

confidence: 99%

Section: Choice Of a Chelator With Elemental Mercury And Mercury Vapormentioning

confidence: 99%

See 2 more Smart Citations

Rethinking treatment of mercury poisoning: the roles of selenium, acetylcysteine, and thiol chelators in the treatment of mercury poisoning: a narrative review

Spiller

Hays

Casavant

2021

Toxicology Communications

View full text Add to dashboard Cite

show abstract

“…The absence of SAM leads to the accumulation of norepinephrine, dopamine, and epinephrine in the urine, causing hypertension and tachycardia 5 . In mercury poisoning, catecholamine levels are typically mildly elevated (typically high normal to twice normal) as compared with at least fourfold elevations in pheochromocytoma 6,7 …”

Section: Figurementioning

confidence: 99%