Scribd
Upload
20 views

Mercury Poisoning: T Sabitha Silpa Iii Mbbs 155

Uploaded by

Sabitha Tirukoti
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
20 views

Mercury Poisoning: T Sabitha Silpa Iii Mbbs 155

Uploaded by

Sabitha Tirukoti
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 21

MERCURY POISONING

T SABITHA SILPA
III MBBS
155
Introduction
Mercury has 3 forms

Elemental mercury :

- heavy, silvery liquid and volatile at room temperature


- Non poisonous due to poor absorption in GIT
- mercury vapour can cause acute toxicity

Organic compounds:

- Better absorbed from Git


- Cross blood brain barriers to accumulate in brain
- Salts include methyl mercury, dimethylmercury , ethyl mercury, phenyl mercury

Inorganic salts

- Kidney is main storage organ


- Mercuric chloride: colorless, odorless, white crystalline powder but has metallic taste. common
cause of acute poisoning
- Mercurous chloride: heavy amorphous, white and tasteless powder
- Mercuric sulfide: not absorbed through skin, non poisonous
- Mercuric cyanide, oxide and iodide,
Uses:

Medicine:
Disinfectant, dental amalgam, purgative and diuretic, and earlier used in the treatment
of syphilis.
Industry:
Manufacture of thermometer, barometer, calibration instruments, fluorescent and
mercury vapor lamp, electrical equipment, explosives and fireworks.
Miscellaneous:
Electroplating, photography, insecticide, germicide, fingerprint powder, paints and
embalming fluid.
Action:

● Mercury binds with sulfhydryl groups resulting in enzyme inhibition and


pathological alteration of cellular membranes.
● Elemental mercury and methyl mercury are toxic to the CNS. Inorganic
mercury salts are corrosive to the skin, eyes and GIT, and nephrotoxic.
Inorganic and organic forms may cause contact dermatitis.
Absorption and excretion

● It is absorbed through the GIT and respiratory tract.

● After absorption, mercury gets deposited in all tissues, particularly in the liver,
kidneys, spleen and bones.

● When inhaled, the maximum concentration occurs in the brain.

● Mainly excreted through the kidneys (urine), liver (bile) and colonic mucous
membrane (feces). It passes rapidly to the fetus through placental circulation.
Acute poisoning
Signs and symptoms

Elemental mercury:

Target organ for inhaled mercury vapour is mainly brain

Divided into 3 phases :


● Initial phase - metal fume fever
● Intermediate phase- severe multiorgan symptoms ; headache,nausea, cough, chest
pain, bronchitis, chemical pneumonitis, pulmonary edema, gingivostomatitis
● Late phase- CNS symptoms like insomnia, ataxia, restriction of visual field,
paresis, delirium, polyneuropathy

Subcutaneous nodules or ,granulomas are seen if injected.

Organic mercury:

CNS symptoms like visual field constriction, ataxia, paresthesias , hearing loss,
dysarthria, tremors, neurobehavioral impairment, paralysis, death.
Inorganic mercuric salts:
● Ingestion produces extensive precipitation of intestinal mucosa proteins
● mucosal necrosis causing hemorrhagic gastroenteritis
● Massive fluid loss - shock

GIT: - metallic taste, hoarse voice


- mouth, tongue and fauces corroded, swollen
- Mucous memb appears greyish white
- Hot burning pain
- Nausea, retching and vomiting (vomitus contains greyish, slimy, mucoid
material with blood & shreds of mucous membrane)
- Diarrhea, often bloody with tenesmus
Renal: Oliguria, albuminuria, hematuria- renal failure or nephrotic syndrome
CVS: hypertension, tachycardia, difficulty in breathing & circulatory collaps e
Fatal dose
● Mercury vapour: 10mg/m3
● Methyl mercury: 10-60 mg/kg
● Mercuric chloride : 1-4g (30-50 mg/kg)

Fatal period : 3-5 days


Laboratory diagnosis:

By measuring blood & urine levels by atomic absorption spectrophotometer


Hair analysis by neutron activation analysis

- Blood mercury level > 10 µg/dl


- 24 hours urinary excretion of mercury > 20 µg/l indicates toxicity.
- A hair mercury level > 5 ppm indicates chronic toxicity
Treatment

- the victim is immediately removed from source of exposure and supplemental


oxygen is given.

- Egg whites, milk or animal charcoal to precipitate mercury

- Gastric lavage with 250 ml of 5% sodium formaldehyde sulfoxylate.

- Polythiol resins helps in binding mercury in the GIT.

- High colonic lavage with 1:1000 solution of sulphoxylate twice daily. Whole
bowel irrigation may be done.
- BAL is the traditional chelator of choice (10% solution in oil, 3–5 mg/kg
IM every 4 h for 2 days, tapered to 6 hourly for 1 day and then 12 hourly
for 7 days),

- DMSA or succimer (10 mg/kg orally every 8 h for 5 days and then 12
hourly for 2 weeks)

- D-penicillamine is an alternative oral treatment.

- Maintain electrolyte and fluid balance.

- Symptomatic treatment.
Postmortem findings

- Body looks emaciated.

- GIT: Mucosa shows inflammation, congestion & grayish corrosion.


Ulceration or gangrene seen.

- Kidneys: Acute proximal tubular damage and glomerular degeneration or


glomerulonephritis

- Liver: Congested and shows cloudy swelling or fatty change.

- Heart: Fatty degeneration and subendocardial hemorrhage


Chronic poisoning:
(Hydrargyrism)

Chronic poisoning results from


- continuous accidental absorption by workers
- Excessive therapeutic use
- Recovery from large dose
- External ointment application for long time
Signs and symptoms

Mercury vapour;

chronic intoxication produces a triad of tremors, neuropsychiatric disturbances &


gingivostomatitis

Organic compounds:

Paresthesia of lips, hands & feet

Ataxia, tremors, dysarthria, constriction of visual fields,

deafness & impairment of motor speed, memory & coordination

Inorganic mercury compounds:

Anorexia, nausea, insomnia, abnormal sweating, headache, lassitude, increased


excitability, tremors, gingivitis, hypersalivation, loosening of teeth with blue lines in
the gum, jaundice, increased urination, personality changes, memory and intellectual
deterioration
Specific diseases

Intention Tremors ( Danbury tremors/ shaking palsy)


- occurs first in hands, then to lips & tongue , finally arms & legs
- Tremor is moderately coarse & is interspersed by jerky movements every
few minutes.
- In advanced stage, person is unable to dress himself, write legibly or walk
properly
- Also called hatter’s shakes or glass blower’s shakes
- More severe form of tremors is concussion mercurilis
Mercurial Erethism
- Due to chronic inorganic mercury toxicity
- Neuropsychiatric effects are seen
Mercurialentis
- seen in mercury vapour exposure
- It is peculiar eye change due to brownish deposit of mercury through cornea
to anterior lens capsule
- Slit lamp shows malt brown reflex
- Bilateral
- No effect on visual acuity

Acrodynia / Pink disease


- mostly seen in children due to repeated ingestion or contact with mercury
- Pinkish morbilliform/ acral rashes, desquamation of palms & soles, pain in
extremities, flushing, itching, swelling is seen

Minamata disease
- Due to chronic organic mercury intoxication by eating seafood
- Symptoms include disturbances in hand coordination, gait & speech
- Chewing & swallowing difficulties
- Visual blurring, tremors, rigidity, seizures & clouding of consciousness
Treatment:

● Remove the patient from the source of exposure.

● N-acetyl penicillamine is the chelator of choice.

● Oral hygiene.

● Demulcent drinks.

● Saline purgatives.
Postmortem findings:

EXTERNAL
- Emaciated body with pale skin.
- Erosions of oral mucosa, gum of lower jaw may show bluish gray lines of
pigment deposition, along with loosening of teeth.
INTERNAL
Brain:
- In organic mercury poisoning,the gyri of both hemispheres are usually
atrophic and the sulci widened.
- Inorganic mercury poisoning may cause cerebral infarctions, pneumonia, renal
cortical necrosis and disseminated intravascular coagulopathy.
Medicolegal aspects:

Accidental poisoning may occur from:


● ingestion of broken thermometers
● Antiseptics solutions ingestion
● Soluble salts employed as vaginal douches
● Absorption of mercurial preparations applied to skin
● Iv Diuretics
● In children, swallowing sulphocyanide of mercury tablet due to its bright
grey appearance
Suicidal & homicidal is rare
Reference:

Forensic medicine and toxicology- Gautam Biswas


Textbook of Forensic medicine and Toxicology -VV Pillay
Essentials of Forensic medicine and Toxicology - KS Narayana reddy
Thank you
Reference:
Forensic medicine and toxicology- Gautam Biswas

You might also like