Repeated Suicide Attempts by the Intravenous Injection of Elemental Mercury

Abstract

The case of a patient who repeatedly injected himself intravenously with elementary mercury in suicide attempts is presented and the toxicological effects of this chemical form and route of exposure of mercury are examined. A review of the literature reveals that elemental mercury, when injected as opposed to inhaled, causes few of the effects typical of mercurialism; pleuritic chest pain was frequently reported, whereas renal and central nervous system involvement were less common. Evidence of premorbid psychiatric disturbances was found in ten of fourteen non-cardiac catheterization exposures to intravenous elemental mercury. Findings in our patient were consistent with these observations. One additional and noteworthy finding in our case was that documented deposits of elemental mercury in the right parietal lobe of the brain did not correlate with any specific deficits on neuropsychological testing. Consultation-liaison psychiatry plays an important role in the treatment and care of these complex patients.

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).…”

Tentative de suicide par injection intraveineuse de mercure. À propos d’un cas

“…Les effets à long terme du mercure tissulaire, qui semble chimiquement stable, sont mal connus ; les radiographies en série sur plusieurs années ont montré la disparition graduelle du mercure, sans doute à cause de son oxydation biologique lente en un ion mercurique plus soluble éliminé secondairement par excrétions urinaire et gastro-intestinale [9,10]. Les micro-embols de mercure semblent avoir peu ou pas d'effet sur la fonction respiratoire même si les scanners thoraciques objectivent des images évocatrices de petits infarctus pulmonaires et d'épanchement pleural [3,[11][12][13]. Quand il est embolisé, le mercure élémentaire traverse les poumons via les shunts précapillaires ou les capillaires pulmonaires ; il passe dans la circulation systémique et on peut le retrouver dans le foie, la rate, les reins [9,14].…”

Health consequences of an intravenous injection of metallic mercury

“…After injection, mercury is very slowly cleared from the body, mostly by urinary and gastrointestinal excretion [15]. The long-term effects of deposited mercury are unknown, however, elemental mercury appears to be chemically stable and remains in the body for a long period [13,16]. Thus, even a massive injection of metallic mercury can be considered relatively harmless in contrast to inhalation of mercury vapor.…”