Subcutaneous Injection of Mercury: “Warding Off Evil”

Abstract

Deliberate injection of mercury, especially subcutaneous injection, is rare but is seen in psychiatric patients, individuals who attempt suicide, those who are accidentally injected, and boxers who wish to build muscle bulk. Metallic mercury plays a major role in ethnic folk medicine. Neurologic and renal complications can result from high systemic levels of mercury, and subcutaneous injection usually results in sterile abscesses. Urgent surgical evacuation and close monitoring for neurologic and renal functions as well as chelation (if toxicity is indicated) are key aspects of treatment. Education of the adverse effects and dangers of mercury is important, especially in pregnant women and children. As increased immigration changes demographic patterns, proper disposal of mercury and preventing its sale and use should become urgent societal priorities. Psychiatric consultation should be obtained whenever appropriate.

Subcutaneous Injection of Metallic Mercury Mimicking Bacterial Cellulites: A Case Report

“…In case of acute inhalation, vaporized mercury may cause pneumonitis and noncardiogenic pulmonary edema, which can progress to respiratory failure and death (Vano-Galvan et al, 2009;Brodkin et al, 2007). While ingestion of organic or inorganic mercury leads to gastroenteritis, renal, cardiovascular and neurological involvement, orally ingested metallic mercury usually does not induce poisoning symptoms owing to the minimal absorption through the gut (Prasad, 2004;Brodkin et al, 2007). In subcutaneously injected forms, as in our case, the underlying tissue reacts to the mercury through acute inflammation, development of foreignbody giant cells and granuloma formation (Oh et al, 2007;Prasad, 2004).…”

“…While ingestion of organic or inorganic mercury leads to gastroenteritis, renal, cardiovascular and neurological involvement, orally ingested metallic mercury usually does not induce poisoning symptoms owing to the minimal absorption through the gut (Prasad, 2004;Brodkin et al, 2007). In subcutaneously injected forms, as in our case, the underlying tissue reacts to the mercury through acute inflammation, development of foreignbody giant cells and granuloma formation (Oh et al, 2007;Prasad, 2004). Besides, there is a debate on whether systemic toxicity may be induced following subcutaneous injection of metallic mercury (Ruha et al, 2001;Vano-Galvan et al, 2009).…”

“…Among these, mercury not only may be poisonous to the general population via food and fish, but also it might affect the individuals. The latter might be as a result of suicidal attempt, (Isik et al, 1997;Winker et al, 2002;Ruha et al, 2001;Kayias et al, 2003) occupational accident, (Ellabban et al, 2003;Vano-Galvan et al, 2009) penile augmentation, (Oh et al, 2007) and superstitious beliefs (Prasad, 2004). Injection of metallic mercury in the forms of subcutaneous or intravenous has been hitherto reported in less than a hundred cases since 1923 (Brodkin et al, 2007).…”

Termómetros de mercurio, aún tóxicos aún presentes

“…La exposición a través del tracto digestivo del Hg elemental está frecuentemente relacionada con la ingestión de pilas de botón o del mercurio del termómetro, pero el Hg elemental se absorbe muy poco desde el tubo digestivo (menos del 0,01%) por lo que no produce prácticamente toxicidad a nivel sistémico 5 . Sin embargo, otras vías de exposición pueden producir daño tanto a nivel local como sistémico.…”

“…La mayoría de los casos encontrados en la literatura se deben a autoinoculaciones en pacientes psiquiátricos, por ritos culturales, o en adictos a drogas por vía parenteral y en menor medida por inoculación accidental 5,7 . Los casos publicados en edades pediátricas son escasos, debiéndose principalmente a inoculación accidental de mercurio en región subcutánea por rotura de termómetro 2,8 .…”