An unusual cause of high density radiological opacities.

INTRODUCTION: Metallic mercury poisoning through intravenous injection is rare, especially as part of a suicide attempt. Diagnosis and treatment of the disease are challenging as clinical features are not specific. MATERIAL AND METODS: A 41-year-old male presented with dyspnea, fatigue, loss of weight, and loss of appetite over two months. Routine radiological examination by chest X-ray and CT showed randomly distributed high density opacities with Hounsfield units (HU) around 500 HU all over the body. The diagnosis was then confirmed with a urinary mercury concentration of > 1000 mcg/24 h. RESULTS: The patient's clinical condition was getting worse in spite of chelation therapy and hemodialysis. The patient eventually died because of respiratory failure. CONCLUSION: Early diagnosis and appropriate treatment are critical for intravenous mercury poisoning especially because there are no specific signs or symptoms. There should be a high level of suspicion in drug abusers. Treatment should involve the combined use of chelating agents and other treatments such as hemodialysis and plasma exchange in advanced clinical settings.

Intoxicación por mercurio elemental por inyección intramuscular: presentación de caso y revisión de literatura / Poisoning with elemental mercury by intramuscular injection. Case report and review of literature

Se han reportado en la literatura pocos casos de intoxicación por mercurio por administración en tejidos blandos. No se cuenta con suficiente evidencia acerca del manejo con terapia quelante en este tipo de intoxicación. Se reporta el caso de una mujer de 34 años con antecedente psiquiátrico la cual se administró mercurio intramuscular en fosa cubital izquierda con fines autolíticos. Acudió al servicio de urgencias 24 horas posteriores a su administración, el motivo principal fue el dolor intenso en la zona y la presencia de edema, sin efectos sistémicos. La radiografía mostró depósitos metálicos en 1/3 de brazo, localizados en músculo, y que migraron a través de la fascia hacia 2/3 del antebrazo. La placa de tórax no mostró alteraciones. Fue intervenida quirúrgicamente en 3 ocasiones extrayendo mínimas cantidades de mercurio. La paciente fue manejada con antibióticos por presencia de celulitis. Un mes después presentó temblor mercurial, razón por la cual se tomaron muestras de sangre y orina para la determinación de mercurio, el cual resulto elevado en ambas muestras, por lo que se le administró terapia quelante con D-penicilamina.

There are just a few cases of mercury toxicity after administration in soft tissue, reported in the literature. There is insufficient evidence about the management with chelation therapy in this type of poisoning. We report the case of a 34 year-old woman with a psychiatric history who administered herself a mercury injection into de muscle in the left cubital fossa, referred as a suicide attempt. She came to the emergency department 24 hours after administration; the main reason was the intense pain in the area and the presence of edema, with no systemic effects. Radiography showed metallic deposits in 1/3 arm, located in muscle, which moved through the fascia to 2/3 of the forearm. Chest radiography was normal. She underwent surgery trhee times extracting trace amounts of mercury. The patient was managed with antibiotics by the presence of cellulite. One month later she had tremor mercuralis, so a blood and urine samples were sent to the laboratory in order to determinate mercury levels, which resulted high in both fluids, therefore chelation therapy with D-penicillamine was administered.

Neither DMPS nor DMSA is effective in quantitative elimination of elemental mercury after intentional IV injection.

BACKGROUND: Intravenous injection of elemental mercury (Hg) is rare and considered relatively harmless. Treatment recommendations vary and the effectiveness of chelation therapy is controversial. CASE REPORT: A 27-year-old man intravenously injected 1.5 mL of elemental Hg. Within 12 hours he became febrile, tachycardic and dyspneic. Physical examination was unremarkable. X-rays showed scattered radiodense deposits in the lung, heart, intestinal wall, liver and kidney. The serum Hg level on admission was 172 microg/L and peaked on day 6 at 274 microg/L. Cumulative renal elimination during a five day oral treatment period with 2,3-dimercaptopropane-1-sulfonate (DMPS) and meso-2,3-dimercaptosuccinic acid (DMSA) was 8 mg and 3 mg, respectively. CONCLUSION: Although urinary excretion could be enhanced during chelation therapy, Hg deposits in organs resulted in negligible elimination of mercury compared to the exposed dose.

Mercury vapor inhalation from Chinese red (Cinnabar).

INTRODUCTION: Acute inhalation of mercury fumes or vapors is a rare but frequently fatal cause of acute lung injury. This report describes a rare cause of mercury inhalation from Chinese red. CASE REPORT: An 87-year-old male inhaled the vapors from heating Chinese red (Cinnabar, mercury sulphide) intended to treat his foot ulceration. He subsequently developed acute lung injury (progressive dyspnea and acute respiratory failure) that was treated with mechanical ventilation. DMPS (2,3-Dimercapto-1-propanesulfonic acid) and penicillamine were used as chelating agents, and methylprednisolone pulse therapy was used to treat his pulmonary disease. Despite being extubated once, the patient eventually died from profound hypoxemia. CONCLUSION: A rare case of mercury intoxication was due to inappropriate use of an alternative medicine, Chinese red. This case serves as a reminder of the toxicity of the noxious gas from this substance and the importance of being familiar with alternative medicines.

Intravenous mercury injection and ingestion: clinical manifestations and management.

BACKGROUND: Mercury is a complex toxin with clinical manifestations determined by the chemical form, route, dose, and acuity of the exposure. Parenteral injection of elemental mercury remains uncommon. CASE REPORT: A 40-year-old male injected 3 mL of elemental mercury intravenously and ingested 3 mL as a suicide attempt. Within 24 hours, he became dyspneic, febrile, tachycardic, and voiced mild gastrointestinal complaints. Chest X-ray revealed scattered pulmonary infiltrates and embolized mercury bilaterally. A ventilation/perfusion scan demonstrated ventilation/ perfusion deficits. Additionally, his renal function declined, as manifest by minor elevations in blood urea nitrogen and creatinine and decreased urine output. Pulmonary therapy, intravenous hydration, and chelation using 2,3-dimercaptoscuccinic acid (DMSA/Succimer) were started. Over the next 36 hours, the patient's pulmonary and renal functions improved. Temperature and heart rate subsequently normalized, and symptoms at discharge were mild exertional dyspnea. DISCUSSION: Liquid mercury injected intravenously embolizes to the pulmonary vasculature and perhaps vessels in other organs such as heart and kidney. In-situ oxidation to inorganic mercury, which is directly toxic to a variety of tissues, may help explain the multisystem involvement. CONCLUSION: Significant pulmonary dysfunction accompanied by radiographically demonstrated mercury emboli and temporary abnormalities in several organs improved shortly after initiation of chelation. The impact of chelation on long-term outcome of parenteral mercury exposure remains uncharacterized.

Significant mercury deposits in internal organs following the removal of dental amalgam, & development of pre-cancer on the gingiva and the sides of the tongue and their represented organs as a result of inadvertent exposure to strong curing light (used to solidify synthetic dental filling material) & effective treatment: a clinical case report, along with organ representation areas for each tooth.

Because of the reduced effectiveness of antibiotics against bacteria (e.g. Chlamydia trachomatis, alpha-Streptococcus, Borrelia burgdorferi, etc.) and viruses (e.g. Herpes Family Viruses) in the presence of mercury, as well as the fact that the 1st author has found that mercury exists in cancer and pre-cancer cell nuclei, the presence of dental amalgam (which contains about 50% mercury) in the human mouth is considered to be a potential hazard for the individual's health. In order to solve this problem, 3 amalgam fillings were removed from the teeth of the subject of this case study. In order to fill the newly created empty spaces in the teeth where the amalgams had formerly existed, a synthetic dental-filling substance was introduced and to solidify the synthetic substance, curing light (wavelength range reportedly between 400-520 nm) was radiated onto the substance in order to accelerate the solidifying process by photo-polymerization. In spite of considerable care not to inhale mercury vapor or swallow minute particles of dental amalgam during the process of removing it by drilling, mercury entered the body of the subject. Precautions such as the use of a rubber dam and strong air suction, as well as frequent water suctioning and washing of the mouth were insufficient. Significant deposits of mercury, previously non-existent, were found in the lungs, kidneys, endocrine organs, liver, and heart with abnormal low-voltage ECGs (similar to those recorded 1-3 weeks after i.v. injection of radioisotope Thallium-201 for Cardiac SPECT) in all the limb leads and V1 (but almost normal ECGs in the precordial leads V2-V6) the day after the procedures were performed. Enhanced mercury evaporation by increased temperature and microscopic amalgam particles created by drilling may have contributed to mercury entering the lungs and G.I. system and then the blood circulation, creating abnormal deposits of mercury in the organs named above. Such mercury contamination may then contribute to intractable infections or pre-cancer. However, these mercury deposits, which commonly occur in such cases, were successfully eliminated by the oral intake of 100 mg tablet of Chinese parsley (Cilantro) 4 times a day (for average weight adults) with a number of drug-uptake enhancement methods developed by the 1st author, including different stimulation methods on the accurate organ representation areas of the hands (which have been mapped using the Bi-Digital O-Ring Test), without injections of chelating agents. Ingestion of Chinese parsley, accompanied by drug-uptake enhancement methods, was initiated before the amalgam removal procedure and continued for about 2 to 3 weeks afterwards, and ECGs became almost normal. During the use of strong bluish curing light to create a photo-polymerization reaction to solidify the synthetic filling material, the adjacent gingiva and the side of the tongue were inadvertently exposed. This exposure to the strong bluish light was found to produce pre-cancerous conditions in the gingiva, the exposed areas of the tongue, as well as in the corresponding organs represented on those areas of the tongue, and abnormally increased enzyme levels in the liver. These abnormalities were also successfully reversed by the oral intake of a mixture of EPA with DHA and Chinese parsley, augmented by one of the non-invasive drug-uptake enhancement methods previously described by the 1st author, repeated 4 times each day for 2 weeks.

Acute mercury poisoning and mercurial pneumonitis from gold ore purification.

We describe four men who had symptoms of acute mercury poisoning following exposure to mercury vapor. They were attempting home gold ore purification using a gold-mercury amalgam and sulfuric acid. Three of the four patients required treatment with penicillamine. The clinical and laboratory data are presented along with pulmonary function test results. Long-term follow-up of one patient indicates residual morbidity, with continued reduction in pulmonary diffusing capacity. This suggests permanent impairment of pulmonary function despite prompt chelation therapy.