RESUMEN
RATIONALE: Metallic mercury poisoning through intravenous injection is rare, especially for a homicide attempt. Diagnosis and treatment of the disease are challenging. PATIENT CONCERNS: A 34-year-old male presented with pyrexia, chill, fatigue, body aches, and pain of the dorsal aspect of right foot. Another case is that of a 29-year-old male who committed suicide by injecting himself metallic mercury 15âg intravenously and presented with dizzy, dyspnea, fatigue, sweatiness, and waist soreness. DIAGNOSIS: The patient's condition in case 1 was deteriorated after initial treatment. Imaging studies revealed multiple high-density spots throughout the body especially in the lungs. On further questioning, the patient's girlfriend acknowledged that she injected him about 40âg mercury intravenously 11 days ago. The diagnosis was then confirmed with a urinary mercury concentration of 4828âmg/L. INTERVENTIONS: Surgical excision, continuous blood purification, plasma exchange, alveolar lavage, and chelation were performed successively in case 1. Blood irrigation and chelation therapy were performed in case 2. OUTCOMES: The laboratory test results and organ function of the patient in case 1 gradually returned to normal. However, in case 2, the patient's dyspnea was getting worse and he finally died due to toxic encephalopathy and respiratory failure. LESSONS: Early diagnosis and appropriate treatment are critical for intravenous mercury poisoning. It should be concerned about the combined use of chelation agents and other treatments, such as surgical excision, hemodialysis and plasma exchange in clinical settings.
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Intoxicación por Mercurio/diagnóstico , Intoxicación por Mercurio/terapia , Mercurio/administración & dosificación , Adulto , Resultado Fatal , Homicidio , Humanos , Inyecciones Intravenosas , Masculino , SuicidioRESUMEN
CONTEXT: Mercury exposure has been described among small-scale gold mining communities in developing countries, but reports of inhalational mercury toxicity among home gold extractors in the US remain uncommon. OBJECTIVE: We sought to identify inhalational mercury exposures and toxicity among artisanal gold extractors. METHODS: This is an observational case series of a single Poison Center database from 2002-2015. We review all cases of "mercury" or "mercury inhalation" exposures, with detailed description of a recent representative case. RESULTS: Nine cases were reported, with patients' ages ranging 32-81 years. Eight (89%) patients were male. Seven of eight (88%) patients with acute exposures reported pulmonary symptoms consistent with mercury vapor inhalation such as dyspnea and cough; two (29%) patients had severe toxicity requiring intubation. Four of six (67%) patients had markedly elevated whole blood mercury concentrations up to 346 mcg/L; each received a different chelation regimen. Four (44%) patients used methamphetamines at the time of their exposure. The case report describes a patient with elevated mercury concentrations who required intubation for hypoxic respiratory failure. He received chelation therapy based on chelator availability, with decreasing 24-hour urine mercury concentrations. The house where he was exposed remains uninhabitable from elevated ambient mercury vapor concentrations. CONCLUSION: Artisanal gold extraction may be associated with inhalational mercury toxicity, including elevated blood mercury concentrations and acute hypoxic lung injury requiring intubation.
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Exposición por Inhalación/efectos adversos , Intoxicación por Mercurio/terapia , Mercurio/toxicidad , Minería , Exposición Profesional/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Femenino , Oro , Humanos , Masculino , Intoxicación por Mercurio/etiología , Persona de Mediana Edad , Oregon , Centros de Control de Intoxicaciones , Estudios RetrospectivosAsunto(s)
Compuestos de Mercurio/efectos adversos , Intoxicación por Mercurio/complicaciones , Intoxicación por Mercurio/diagnóstico , Mercurio/sangre , Mercurio/orina , Preparaciones de Plantas/efectos adversos , Adulto , Antídotos/uso terapéutico , Quelantes/uso terapéutico , China , Delirio/inducido químicamente , Diagnóstico Diferencial , Fluidoterapia , Marcha , Humanos , Masculino , Espectrometría de Masas , Compuestos de Mercurio/administración & dosificación , Intoxicación por Mercurio/sangre , Intoxicación por Mercurio/psicología , Intoxicación por Mercurio/terapia , Intoxicación por Mercurio/orina , Debilidad Muscular/inducido químicamente , Narcolepsia/inducido químicamente , Dolor/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Preparaciones de Plantas/administración & dosificación , Postura , Psoriasis/tratamiento farmacológico , Trastornos del Sueño-Vigilia/inducido químicamente , Resultado del Tratamiento , Temblor/inducido químicamente , Unitiol/uso terapéuticoRESUMEN
INTRODUCTION: Mercuric chloride poisoning is rare yet potentially life-threatening. We report a case of poisoning with a potentially significant amount of mercuric chloride which responded to aggressive management. CASE REPORT: A 19-year-old female presented to the Emergency Department with nausea, abdominal discomfort, vomiting of blood-stained fluid, and diarrhea following suicidal ingestion of 2-4 g of mercuric chloride powder. An abdominal radiograph showed radio-opaque material within the gastric antrum and the patient's initial blood mercury concentration was 17.9 µmol/L (or 3.58 mg/L) at 3 h post-ingestion. Given the potential toxicity of inorganic mercury, the patient was admitted to the intensive care unit and chelation with dimercaprol was undertaken. Further clinical effects included mild hemodynamic instability, acidosis, hypokalemia, leukocytosis, and fever. The patient's symptoms began to improve 48 h after admission and resolved fully within a week. DISCUSSION: Mercuric chloride has an estimated human fatal dose of between 1 and 4 g. Despite a reported ingestion of a potentially lethal dose and a high blood concentration, this patient experienced mild to moderate poisoning only and she responded to early and appropriate intervention. Mercuric chloride can produce a range of toxic effects including corrosive injury, severe gastrointestinal disturbances, acute renal failure, circulatory collapse, and eventual death. Treatment includes close observation and aggressive supportive care along with chelation, preferably with 2,3-dimercapto-1-propane sulfonate or 2,3-meso-dimercaptosuccinic acid.
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Indicadores y Reactivos/toxicidad , Cloruro de Mercurio/toxicidad , Intoxicación por Mercurio/tratamiento farmacológico , Intento de Suicidio , Adulto , Quelantes/administración & dosificación , Quelantes/uso terapéutico , Terapia por Quelación , Dimercaprol/administración & dosificación , Dimercaprol/uso terapéutico , Femenino , Humanos , Indicadores y Reactivos/química , Indicadores y Reactivos/farmacocinética , Inyecciones Intramusculares , Cloruro de Mercurio/antagonistas & inhibidores , Cloruro de Mercurio/farmacocinética , Mercurio/sangre , Mercurio/química , Intoxicación por Mercurio/sangre , Intoxicación por Mercurio/terapia , Resultado del Tratamiento , Adulto JovenRESUMEN
This review aims to explore the toxicological aspects of mercury-based herbo-metallic preparations like cinnabar and "Rasasindura" that are primarily composed of mercuric sulfide (HgS). Cinnabar-containing preparations have been used extensively in Indian and Chinese systems of medicine for treatment of chronic ailments like syphilis, high fever, pneumonia, insomnia, nervous disorders, deafness, and paralysis of the tongue. Contrary to Western medicine, which does not promote the use of mercury due to its toxic effects, Indian and Chinese traditional practitioners believe that mercury-based formulations have potent therapeutic efficacy, while there is no toxicity due to the unique and repeated purification processes employed during preparation. However, lack of proper pharmacovigilance and widespread self-medication has resulted in undesirable effects to certain sections of the consumers of these preparations, which have contributed to the negative publicity for these forms of medicine. Variations in the quality of the preparations coupled with the lack of understanding of the differences in the recommended dosages and treatment strategies adopted by traditional medicine practitioners, further fuels concerns in the Western world on the safety and efficacy of traditional medicine. But in spite of these concerns, concerted efforts to understand the biological interactions and transformations of these preparations are yet to gain momentum. Although scattered reports on the toxicity of these preparations are available in literature, their mechanism of action has not been conclusively established. Long-term pharmacotherapeutic and in-depth toxicity studies are needed to address the apprehensions raised by these herbo-metallic preparations. This review highlights the lacunae in the studies conducted thus far, and assesses the need for further studies to provide significant data to establish the safety and efficacy of such preparations, as well as develop gold standards for stringent quality control of these preparations.
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Medicina Tradicional/efectos adversos , Compuestos de Mercurio/toxicidad , Intoxicación por Mercurio/etiología , Extractos Vegetales/toxicidad , Antídotos/uso terapéutico , Humanos , Intoxicación por Mercurio/terapia , FarmacovigilanciaRESUMEN
Mercury poisoning is much more prevalent in the general population than possibly many physicians realize. We present data on 26 pediatric cases with mercury intoxication from exposure to mercury by inhalation or skin contact as a result of a broken thermometer in a school laboratory. This is the largest pediatric series in Turkey. During a 3-month period, the study team observed the children for clinical symptoms, physical findings, and blood and mercury levels. Of all patients, 21 inhaled, 3 inhaled and touched the element, and 2 took the mercury home. Sixteen children were symptomatic at admission, although blood mercury levels in the symptomatic children were higher than those in asymptomatic children (P = 0.003). The urine mercury levels were not statistically different between the groups at the admission (P > 0.05). The exposure times were 3.5 and 2 hours for symptomatic and asymptomatic children, respectively (P = 0.003). The 2 children who took the mercury home had the highest blood mercury levels and the most prolonged exposure time. N-acetylcysteine and chelation treatments were started in 21 children who had symptoms of mercury intoxication and high mercury levels in their blood or urine. No adverse effects were observed during chelation therapy. Prompt removal of children from contaminated environments and proper decontamination or elimination of devices containing large amounts of mercury from schools are necessary to prevent serious complications caused by exposure to mercury.
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Quelantes/uso terapéutico , Exposición a Riesgos Ambientales/efectos adversos , Depuradores de Radicales Libres/uso terapéutico , Intoxicación por Mercurio/diagnóstico , Intoxicación por Mercurio/terapia , Accidentes , Acetilcisteína/uso terapéutico , Adolescente , Niño , Descontaminación , Ambiente , Femenino , Calor , Humanos , Masculino , Mercurio/sangre , Mercurio/orina , Intoxicación por Mercurio/etiología , Penicilamina/uso terapéutico , Instituciones Académicas , Termómetros/efectos adversos , TurquíaRESUMEN
OBJECTIVES: To review the characteristics of the consultation about the management of mercury exposure and identify the controversial issues on the clinical management of individuals with a history of mercury exposure. DESIGN: Descriptive case series. SETTING: Hong Kong Poison Information Centre, Hong Kong. PARTICIPANTS: Persons consulting the Hong Kong Poison Information Centre about individuals with possible or definitive mercury exposure. MAIN OUTCOME MEASURES: Characteristics of the consultations, including: the demographics of affected individuals, source and reason for the consultation, tissue mercury levels, the source of mercury exposure, specific intervention if any, and clinical outcomes. RESULTS: Forty-one consultations were analysed. Most consultations were from the public sector. Reasons of the consultation were very variable. Individuals with abnormal tissue mercury levels were uncommon. There was only one case of acute mercury poisoning. The majority of identified individuals were not subjected to specific interventions. Chelation therapy was given to three patients, but in one of them it was considered to be contra-indicated. CONCLUSION: The management of mercury exposure is highly variable. Recommendations were made on the approach to an individual with potential mercury exposure or poisoning.
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Intoxicación por Mercurio/terapia , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Hong Kong , Humanos , Masculino , Intoxicación por Mercurio/diagnóstico , Persona de Mediana Edad , Centros de Control de Intoxicaciones , Derivación y ConsultaRESUMEN
Mercury is a widespread heavy metal with potential severe impacts on human health. Exposure conditions to mercury and profile of toxicity among humans depend on the chemical forms of the mercury: elemental or metallic mercury, inorganic or organic mercury compounds. This article aims to reviewing and synthesizing the main knowledge of the mercury toxicity and its organic compounds that clinicians should know. Acute inhalation of metallic or inorganic mercury vapours mainly induces pulmonary diseases, whereas chronic inhalation rather induces neurological or renal disorders (encephalopathy and interstitial or glomerular nephritis). Methylmercury poisonings from intoxicated food occurred among some populations resulting in neurological disorders and developmental troubles for children exposed in utero. Treatment using chelating agents is recommended in case of symptomatic acute mercury intoxication; sometimes it improves the clinical effects of chronic mercury poisoning. Although it is currently rare to encounter situations of severe intoxication, efforts remain necessary to decrease the mercury concentration in the environment and to reduce risk on human health due to low level exposure (dental amalgam, fish contamination by organic mercury compounds ). In case of occupational exposure to mercury and its compounds, some disorders could be compensated in France. Clinicians should work with toxicologists for the diagnosis and treatment of mercury intoxication.
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Intoxicación por Mercurio/diagnóstico , Intoxicación por Mercurio/terapia , Mercurio/toxicidad , Terapia por Quelación , Exposición a Riesgos Ambientales , Lavado Gástrico , Humanos , Mercurio/química , Mercurio/farmacocinéticaRESUMEN
BACKGROUND: Mercury poisoning can occur as a result of occupational hazard or suicide attempt. This article presents a 36-year-old case admitted to emergency department (ED) due to exposure to metallic mercury. CASE PRESENTATION: A 36-year-old woman presented to the ED with a three-day history of abdominal pain, diarrhea and fever. One week ago her daughter had brought mercury in the liquid form from the school. She had put it on the heating stove. One day later, her 14-month old sister baby got fever and died before admission to the hospital. Her blood pressure was 134/87 mmHg; temperature, 40.2 degrees C; heart rate 105 bpm and regular; respiration, 18 bpm; O2 saturation, 96%. Nothing was remarkable on examination and routine laboratory tests. As serine or urinary mercury levels could not be tested in the city, symptomatic chelation treatment with N-acetyl cysteine (NAC) was instituted with regard to presumptive diagnosis and history. At the 7th day of admission she was discharged without any sequelae or complaint. At the discharge day blood was drawn and sent for mercury levels which turned out to be 30 microg/dL (normal range: 0-10 microg/dL). CONCLUSION: Public education on poisoning and the potential hazards of mercury are of vital importance for community health.
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Exposición a Riesgos Ambientales/efectos adversos , Enfermedades Gastrointestinales/inducido químicamente , Exposición por Inhalación/efectos adversos , Intoxicación por Mercurio , Mercurio/efectos adversos , Adulto , Lactancia Materna/efectos adversos , Terapia por Quelación/métodos , Resultado Fatal , Femenino , Humanos , Lactante , Intoxicación por Mercurio/sangre , Intoxicación por Mercurio/terapia , Resultado del TratamientoAsunto(s)
Inactivación Metabólica , Intoxicación por Mercurio/terapia , Mercurio/farmacocinética , Selenio/farmacocinética , Selenito de Sodio/toxicidad , Carga Corporal (Radioterapia) , Amalgama Dental/efectos adversos , Amalgama Dental/farmacocinética , Restauración Dental Permanente/efectos adversos , Humanos , Selenito de Sodio/uso terapéutico , Oligoelementos/farmacocinética , Oligoelementos/uso terapéutico , Oligoelementos/toxicidadRESUMEN
Pure inorganic heavy metal ingestions for suicidal intent are a rare occurrence. Most case reports on this subject focus on the serious neurological, hepatic, or renal side effects. We describe two cases of significant heavy metal poisonings (arsenic trioxide and mercuric chloride) that were successfully managed with aggressive decontamination and combined chelation therapy. Both chemicals were obtained in pure powder form through the Internet.
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Intoxicación por Arsénico/terapia , Terapia por Quelación , Cloruro de Mercurio/envenenamiento , Intoxicación por Mercurio/terapia , Óxidos/envenenamiento , Adulto , Trióxido de Arsénico , Arsenicales , Descontaminación , Dimercaprol/uso terapéutico , Quimioterapia Combinada , Humanos , Masculino , Polietilenglicoles/uso terapéutico , Solventes/uso terapéutico , Succímero/uso terapéutico , Intento de Suicidio , Irrigación TerapéuticaRESUMEN
BACKGROUND: Mercury is a well-known neurotoxin. There are three kinds of mercury exposure: elemental mercury poisoning, inorganic mercury poisoning and organomercury poisoning. Organomercury is the most toxic. Twenty-four hour urine for mercury and blood mercury are the gold standards for diagnosis of mercury poisoning, including low-level chronic mercury exposure. Other tests for mercury level are discussed. The purpose of the present paper was to review recent data on the nature, pathophysiology, pharmacokinetics, diagnostic methods, treatment and the linkage to neurodevelopmental disabilities of mercury exposure in children. METHODS: A literature search was undertaken of MEDLINE (1980-2003), and American Academy of Pediatrics, American Medical Association, American Dental Association, World Health Organization and Center for Disease Control websites. The search string 'mercury' was used in MEDLINE and articles were selected as appropriate by two independent reviewers. All relevant information was reviewed and data were extracted by two independent reviewers. RESULTS: Based on the meta-analysis of the accuracy of hair mercury, hair mercury levels correlated with mercury level in blood (sample size weighted correlation coefficient, r w = 0.61), with 24 h urine ( r w = 0.46) and with cord blood ( r w = 0.64). However, the correlation for hair mercury level with 24 h urine level and blood level was not high enough to replace them in clinical decision-making of individual patient. Epidemiological evidence has shown that low-level mercury poisoning is not a cause of autism (relative risk = 0.49, 95%CI = 0.36-0.66). The risk of neurodevelopmental disabilities from low-level exposure to methylmercury from the regular consumption of fish is still controversial even after combining results from different epidemiological studies worldwide. There is a lack of data in the literature about the effect of chelation therapy in children with neurodevelopmental disabilities. CONCLUSION: Mercury poisoning should be diagnosed only with validated methods. There is no evidence to support the association between mercury poisoning and autism.
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Intoxicación por Mercurio/diagnóstico , Adolescente , Pruebas Respiratorias , Terapia por Quelación , Niño , Enfermedad Crónica , Exposición a Riesgos Ambientales , Heces/química , Cabello/química , Humanos , Mercurio/análisis , Intoxicación por Mercurio/terapiaRESUMEN
This article made a brief analysis of clinical adverse effects of cinnabar. Except for allergic reaction, almost all the adverse events of cinnabar were caused by unreasonable application. The majority of the poisoning cases were associated with excessive and/or long-term dosage, and improper preparation methods, such as decocting, heating or fumigating. Children showed to be prone to poisoning. The poisoning caused by unreasonable use of cinnabar should be considered to be drug alert, but not advert effect. And the toxicity of cinnabar could be avoided by normalizing the preparation method, controlling the dosage and duration.
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Composición de Medicamentos/efectos adversos , Compuestos de Mercurio/efectos adversos , Intoxicación por Mercurio/prevención & control , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Coma/inducido químicamente , Incompatibilidad de Medicamentos , Sobredosis de Droga , Enfermedades Gastrointestinales/inducido químicamente , Humanos , Hipersensibilidad/etiología , Compuestos de Mercurio/envenenamiento , Intoxicación por Mercurio/terapiaAsunto(s)
Dieta/efectos adversos , Peces , Intoxicación por Mercurio , Bifenilos Policlorados/envenenamiento , Animales , Ácidos Grasos Omega-3/administración & dosificación , Contaminación de Alimentos/prevención & control , Enfermedades Transmitidas por los Alimentos/diagnóstico , Enfermedades Transmitidas por los Alimentos/terapia , Humanos , Intoxicación por Mercurio/complicaciones , Intoxicación por Mercurio/diagnóstico , Intoxicación por Mercurio/terapia , Factores de RiesgoRESUMEN
UNLABELLED: Three adolescents with severe hypertension due to mercury intoxication are presented. Two of them had skin rash, signs and symptoms of central nervous system involvement, peripheral neuropathy and mild-to-moderate proteinuria in addition to hypertension. All three patients had a history of exposure to mercury, the source being broken barometers taken from school laboratories 2-4 months previously. Urine and blood mercury levels were consistent with mercury intoxication. The patients were treated with chelation therapy. One of them died; the others recovered over a period of 1-4 months. CONCLUSION: mercury intoxication should be considered in any child with signs and symptoms of hypertension, skin rash, peripheral neuropathy and behavioural changes. The parents and school administrators, as well as paediatricians, should be aware of the potential risks of mercury and should be encouraged to avoid mercury-containing devices in schools and households.
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Intoxicación por Mercurio , Adolescente , Terapia por Quelación , Niño , Seguridad de Equipos , Resultado Fatal , Femenino , Humanos , Hipertensión/etiología , Hipertensión/terapia , Masculino , Intoxicación por Mercurio/complicaciones , Intoxicación por Mercurio/diagnóstico , Intoxicación por Mercurio/terapia , EstudiantesRESUMEN
INTRODUCTION: Inorganic mercury poisoning is uncommon, but when it occurs it can result in severe, life-threatening features and acute renal failure. Previous reports on the use of extracorporeal procedures such as haemodialysis and haemoperfusion have shown no significant removal of mercury. We report here the successful use of the chelating agent 2,3-dimercaptopropane-1-sulphonate (DMPS), together with continuous veno-venous haemodiafiltration (CVVHDF), in a patient with severe inorganic mercury poisoning. CASE REPORT: A 40-year-old man presented with haematemesis after ingestion of 1 g mercuric sulphate and rapidly deteriorated in the emergency department, requiring intubation and ventilation. His initial blood mercury was 15 580 microg/l. At 4.5 hours after ingestion he was started on DMPS. He rapidly developed acute renal failure and so he was started on CVVHDF for renal support and in an attempt to improve mercury clearance; CVVHDF was continued for 14 days. METHODS: Regular ultradialysate and pre- and post-filtrate blood samples were taken and in addition all ultradialysate generated was collected to determine its mercury content. RESULTS: The total amount of mercury in the ultrafiltrate was 127 mg (12.7% of the ingested dose). The sieving coefficient ranged from 0.13 at 30-hours to 0.02 at 210-hours after ingestion. He developed no neurological features and was discharged from hospital on day 50. Five months after discharge from hospital he remained asymptomatic, with normal creatinine clearance. DISCUSSION: We describe a patient with severe inorganic mercury poisoning in whom full recovery occurred with the early use of the chelating agent DMPS and CVVHDF. There was removal of a significant amount of mercury by CVVHDF. CONCLUSION: We feel that CVVHDF should be considered in patients with inorganic mercury poisoning, particularly those who develop acute renal failure, together with meticulous supportive care and adequate doses of chelation therapy with DMPS.
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Hemodiafiltración/métodos , Compuestos de Mercurio/envenenamiento , Intoxicación por Mercurio/terapia , Sulfatos/envenenamiento , Unitiol/uso terapéutico , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/terapia , Adulto , Estudios de Seguimiento , Gastritis/inducido químicamente , Gastritis/terapia , Hematemesis/inducido químicamente , Hematemesis/terapia , Humanos , Masculino , Compuestos de Mercurio/farmacocinética , Tasa de Depuración Metabólica , Úlcera Gástrica/inducido químicamente , Úlcera Gástrica/terapia , Intento de Suicidio , Sulfatos/farmacocinética , Resultado del TratamientoRESUMEN
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.
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Exposición por Inhalación , Compuestos de Mercurio/envenenamiento , Intoxicación por Mercurio/terapia , Anciano , Anciano de 80 o más Años , Fibrosis/patología , Úlcera del Pie/tratamiento farmacológico , Humanos , Pulmón/diagnóstico por imagen , Masculino , Compuestos de Mercurio/uso terapéutico , Intoxicación por Mercurio/diagnóstico por imagen , Oxígeno/sangre , RadiografíaRESUMEN
Autism and allied autistic spectrum disorders (ASD) present myriad behavioral, clinical, and biochemical abnormalities. Parental participation, advanced testing protocols, and eclectic treatment strategies have driven progress toward cure. Behavioral modification and structured education are beneficial but insufficient. Dietary restrictions, including removal of milk and other casein dairy products, wheat and other gluten sources, sugar, chocolate, preservatives, and food coloring are beneficial and prerequisite to benefit from other interventions. Individualized IgG or IgE testing can identify other troublesome foods but not non-immune mediated food sensitivities. Gastrointestinal improvement rests on controlling Candida and other parasites, and using probiotic bacteria and nutrients to correct dysbiosis and decrease gut permeability. Detoxification of mercury and other heavy metals by DMSA/DMPS chelation can have marked benefit. Documented sulfoxidation-sulfation inadequacies call for sulfur-sulfhydryl repletion and other liver p450 support. Many nutrient supplements are beneficial and well tolerated, including dimethylglycine (DMG) and a combination of pyridoxine (vitamin B6) and magnesium, both of which benefit roughly half of ASD cases. Vitamins A, B3, C, and folic acid; the minerals calcium and zinc; cod liver oil; and digestive enzymes, all offer benefit. Secretin, a triggering factor for digestion, is presently under investigation. Immune therapies (pentoxifyllin, intravenous immunoglobulin, transfer factor, and colostrum) benefit selected cases. Long-chain omega-3 fatty acids offer great promise. Current pharmaceuticals fail to benefit the primary symptoms and can have marked adverse effects. Individualized, in-depth clinical and laboratory assessments and integrative parent-physician-scientist cooperation are the keys to successful ASD management.