Respiratory failure and death following acute inhalation of mercury vapor. A clinical and histologic perspective.

A family of four was exposed to toxic levels of mercury vapor while attempting to extract silver from mercury amalgam. All four suffered respiratory failure and subsequent death despite chelation therapy with dimercaprol. Histologic findings at autopsy were similar in all four cases demonstrating a progression of acute lung injury that appeared related to postexposure day survival. There were no clinical signs of extrapulmonary manifestations despite toxic serum mercury levels. Although serum mercury levels decreased in response to the mercury chelating agent dimercaprol, serum levels remained in the toxic range and no clinical response was observed. Acute inhalational exposure to high concentrations of mercury vapor causes pneumonitis that can lead to respiratory failure and death. This continues to be a health hazard in both the workplace and the home environment.

Nasogastric and nasoenteric intubation.

Among the most commonly performed nonvascular procedures in hospitalized patients are the placement of nasogastric tubes and nasoenteric feeding tubes. Large-bore nasogastric tubes are commonly used for both diagnostic and therapeutic purposes; small-bore nasoenteric tubes are used primarily for intestinal feeding. The techniques of insertion, methods of ensuring proper positioning, and the potential complications of these devices are similar, and thus they are reviewed together in this article.